There was nothing in this for CDC except trouble. Here we were at the end of one flu season with time to try to do something before the next flu season. The obvious thing to do was immunize everybody. But if we tried to do that, guide it, help it along, we might have to interrupt a hell of a lot of work on other diseases … work here, and in the states, a lot of places.
Then if a pandemic came, lots of people—maybe millions—would be angry … because they couldn’t get shots when they wanted…. Or they got sick of something else that they mistook for flu and thought our shots weren’t working. Most people in this country (including half the doctors) call all kinds of things flu that aren’t. As for "another 1918," I didn’t expect that, but who could be sure? … It would wreck us.
Yet, on the other hand, if there weren’t a pandemic we’d be charged with wasting public money … crying wolf … causing all that inconvenience for nothing … and not only the people who got shots … the people who administered the shots … our friends out in the states …what would they think of us? It was a no-win situation … we saw that … talked about it ….
But institutional protection could not override the ethic of preventive medicine. Disease prevention was the professional commitment of them all, including those who cared for CDC the most. They felt themselves trapped. With a pandemic possible and time to do something about it, and lacking the time to disprove it, then something would have to be done. So ran the logic of what Sencer heard from his staff.
The next day, at the March 10 ACIP meeting, staff spelled out the situation (couched of course in Dowdle’s terms, not those of institutional protection). It was an open meeting, though with minimal press attendance. After hours of discussion a consensus emerged:
First, the possibility of pandemic existed. None thought it negligible. Kilbourne thought it very likely. Most seem to have thought privately of likelihoods within a range from two to twenty percent; each was prepared to bet, however, with nobody but himself. These probabilities, after all, were based on personal judgment, not scientific fact. They voice them to us now, they did not argue them then.4
Second, while severity could not be estimated, one death in a dozen was worrisome. Besides, somewhere in everybody’s mind lurked 1918. No one thought there literally could be a repetition; antibiotics would hold down the death rate. Deaths aside, few thought the virus would be so severe. When last seen in the ’20’s it was mild. But nobody could bring himself to argue that such mildness was assured. It wasn’t.
Third, traditional definition of high-risk groups did not apply. People under 50 had no natural protection, and young adults had suffered unusually high mortality in the 1918 pandemic. This argued for producing enough vaccine to inoculate them all before the next flu season. All meant all, or as many as possible, because one could not count on “herd” immunity to stifle epidemic spread. In influenza nothing on this scale had ever been attempted. But not since 1957 had the timing of discovery allowed for it. And then we did not have vaccines as safe or as effective as the ones developed since. Nor did we have the guns for swift injection. With a decision now the manufacturers could buy their eggs and make the vaccine fast enough so that inoculations could begin in summer, when