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Swine flu — stockpile or vaccinate?
N 79
TIBS - April 1977
swine flu campaign. But some facts do seem clear. The decision to launch the campaign seems to have come from the bottom up, not from the White House. In fact the scientists involved had reached a near unanimous decision to proceed with a full campaign, rejecting even the option of stockpiling vaccine on the grounds that the flu, once it struck, spread too quickly to get the vaccine into people. President Ford had little choice but to endorse the proposal. It is easy to second-guess the decision in retrospect, and there is also the curious fact that the U.S.A. was the only country to launch a swine flu campaign. Asked at the time why other countries were not following suit if the peril were so grave, officials here replied that only the U.S.A. had the manufacturing capacity to make the vaccine in time. The basic rationale for the campaign, that it was gambling only money to save lives, is still hard to fault. It would have been impossible to foresee the association with guillain-barre paralysis which eventually forced the abandonment of the campaign. On the other hand no one thought to prepare the public or press for the fact that the better the surveillance system, the more side-effects are found with almost any medicament. But since the risks of dying from guillain-barre are far smaller than those of dying from flu, this factor would probably not have made a major difference in the decision to go ahead. Even if the decision to launch the swine flu campaign was fundamentally sound, what is going to happen next year? The public has been told so often that the campaign was a fiasco that acceptance of the shots would probably be even lower next year than it was this. Just as the easiest political course this time was to go ahead with the campaign, the easiest option next year may well be to do nothing, or te make and stockpile the vaccine without administering it. Yet since swine flu didn’t hit this year, it is more likely, not less, to strike next year. Logic dictates that there should be another swine flu vaccination campaign next year. Politics indicates a decision to stockpile or do nothing. No prizes offered for guessing which will prevail.
LETTERFROM WASHINGTON Swine flu - stockpile or vaccinate? The rights and wrongs of the mass vaccination campaign against swine flu will probably continue to be debated for some time. The campaign’s influence on such matters as insurance costs, the true incidence of vaccine side-effects, and public confidence in vaccines, is likely to be long lasting. But a more immediate issue is now being raised, that of whether the campaign should have been mounted at all. The most impressionable element of public opinion, which is to say the media, has persuaded itself that the campaign was a fraud and a fiasco. The charge first surfaced before flu of any kind had been reported in the U.S.A. Reporters and editors were almost too busy to record the start of flu season in early February - the strain is A-Victoria again - because by that time they had moved on to the question of how the ‘fiasco’ was perpetrated. Obviously it had to be a political decision, doubtless in some way connected with election politics. At least one major national newspaper directed a team of reporters to trace the political factors in the decision to mount the campaign. They found nothing, but that didn’t shake the fiasco theory. The theorists received tinal proof of their beliefs, if a faith can be said to need proof, when the Carter administration tired the architect of its predecessor’s flu campaign, Center- for Disease Control director David J. Sencer. Was Sencer really fired because of the swine flu campaign? Was CDC’s failure to solve the outbreak of ‘legionnaire’s dis-
ease’ another nail in Sencer’s coffin? Just a few days before Sencer’s tiring, morale at CDC was lifted by the belated discovery of a bacterium-like organism that seemed a strong suspect for being the causative agent of the Philadelphia outbreak. But that still left the possibility that Sencer was being fired for having guessed wrong about swine flu. Sencer himself is said to believe that swine flu had nothing to do with the decision. The explanation given by Joseph Califano, the new Secretary of Health, Education and Welfare, is simply that he wanted his own men at the head of all the major health bureaux. This has indeed been the general policy, but with exceptions. For a time in early February all health agency heads had been given notice except for Sencer and Donald Fredrickson, Director of NIH, both of whom were left in limbo. In a much publicised visit to the Bethesda campus, Califano announced that Fredrickson, a republican appointed by Ford, was being retained to symbolize the ‘depoliticization’ of NIH. Shortly after, the axe fell on Sencer. Why then was he temporarily reprieved? One explanation is that since CDC is based in Atlanta, Georgia, Califano’s hatchetmen figured Sencer might have some .White House friends and it took them several days to ascertain that he hadn’t. Whatever the reason for Sencer’s dismissal, and Califano’s public explanation seems the most probable, it is too early to pronounce the post-mortem on the
Erratum In R. H. Holm’s book review ‘Bio-inorganit chemistry’ (TIBS 2 (Jan.) 24) the name of the editor should read David R. Williams.
TIBS - April 1977
swine flu campaign. But some facts do seem clear. The decision to launch the campaign seems to have come from the bottom up, not from the White House. In fact the scientists involved had reached a near unanimous decision to proceed with a full campaign, rejecting even the option of stockpiling vaccine on the grounds that the flu, once it struck, spread too quickly to get the vaccine into people. President Ford had little choice but to endorse the proposal. It is easy to second-guess the decision in retrospect, and there is also the curious fact that the U.S.A. was the only country to launch a swine flu campaign. Asked at the time why other countries were not following suit if the peril were so grave, officials here replied that only the U.S.A. had the manufacturing capacity to make the vaccine in time. The basic rationale for the campaign, that it was gambling only money to save lives, is still hard to fault. It would have been impossible to foresee the association with guillain-barre paralysis which eventually forced the abandonment of the campaign. On the other hand no one thought to prepare the public or press for the fact that the better the surveillance system, the more side-effects are found with almost any medicament. But since the risks of dying from guillain-barre are far smaller than those of dying from flu, this factor would probably not have made a major difference in the decision to go ahead. Even if the decision to launch the swine flu campaign was fundamentally sound, what is going to happen next year? The public has been told so often that the campaign was a fiasco that acceptance of the shots would probably be even lower next year than it was this. Just as the easiest political course this time was to go ahead with the campaign, the easiest option next year may well be to do nothing, or te make and stockpile the vaccine without administering it. Yet since swine flu didn’t hit this year, it is more likely, not less, to strike next year. Logic dictates that there should be another swine flu vaccination campaign next year. Politics indicates a decision to stockpile or do nothing. No prizes offered for guessing which will prevail.
LETTERFROM WASHINGTON Swine flu - stockpile or vaccinate? The rights and wrongs of the mass vaccination campaign against swine flu will probably continue to be debated for some time. The campaign’s influence on such matters as insurance costs, the true incidence of vaccine side-effects, and public confidence in vaccines, is likely to be long lasting. But a more immediate issue is now being raised, that of whether the campaign should have been mounted at all. The most impressionable element of public opinion, which is to say the media, has persuaded itself that the campaign was a fraud and a fiasco. The charge first surfaced before flu of any kind had been reported in the U.S.A. Reporters and editors were almost too busy to record the start of flu season in early February - the strain is A-Victoria again - because by that time they had moved on to the question of how the ‘fiasco’ was perpetrated. Obviously it had to be a political decision, doubtless in some way connected with election politics. At least one major national newspaper directed a team of reporters to trace the political factors in the decision to mount the campaign. They found nothing, but that didn’t shake the fiasco theory. The theorists received tinal proof of their beliefs, if a faith can be said to need proof, when the Carter administration tired the architect of its predecessor’s flu campaign, Center- for Disease Control director David J. Sencer. Was Sencer really fired because of the swine flu campaign? Was CDC’s failure to solve the outbreak of ‘legionnaire’s dis-
ease’ another nail in Sencer’s coffin? Just a few days before Sencer’s tiring, morale at CDC was lifted by the belated discovery of a bacterium-like organism that seemed a strong suspect for being the causative agent of the Philadelphia outbreak. But that still left the possibility that Sencer was being fired for having guessed wrong about swine flu. Sencer himself is said to believe that swine flu had nothing to do with the decision. The explanation given by Joseph Califano, the new Secretary of Health, Education and Welfare, is simply that he wanted his own men at the head of all the major health bureaux. This has indeed been the general policy, but with exceptions. For a time in early February all health agency heads had been given notice except for Sencer and Donald Fredrickson, Director of NIH, both of whom were left in limbo. In a much publicised visit to the Bethesda campus, Califano announced that Fredrickson, a republican appointed by Ford, was being retained to symbolize the ‘depoliticization’ of NIH. Shortly after, the axe fell on Sencer. Why then was he temporarily reprieved? One explanation is that since CDC is based in Atlanta, Georgia, Califano’s hatchetmen figured Sencer might have some .White House friends and it took them several days to ascertain that he hadn’t. Whatever the reason for Sencer’s dismissal, and Califano’s public explanation seems the most probable, it is too early to pronounce the post-mortem on the
Erratum In R. H. Holm’s book review ‘Bio-inorganit chemistry’ (TIBS 2 (Jan.) 24) the name of the editor should read David R. Williams.