The Wrong Lessons - The Monster at Our Door: The Global Threat of Avian Flu - page 17

produced several million doses of the wrong strain, and general industry output fell below government
expectations. 67
While the Ford administration was wrestling with these supply-side problems, there was eerie silence
on the demand side. The Fort Dix outbreak had died away and no new swine flu cases had emerged on the
East Coast or, according to the WHO, anywhere else in the world. One of the CDC's key advisors, polio
vaccine pioneer Albert Sabin, counseled Sencer that it would be best to actively stockpile the new vaccine
in the public-health network but delay the actual immunization campaign, except for high-risk groups,
until swine flu reemerged. Sencer felt that approach was too risky, because air travel now guaranteed that
any pandemic would be “jet-spread” within hours. Immunization began in October, with very uneven zeal
across the country: some localities, such as Delaware, organized impressive campaigns that resulted in 80
percent coverage, while others, like New York City (where the Times editorialized against the program),
made only risible gestures resulting in less than 10 percent of the population being immunized. By elec-
tion eve, with no sign of the dreaded swine flu, public misgivings about the immunization campaign were
widespread; two weeks after Jimmy Carter's defeat of Ford, the deaths of several elderly people from the
rare Guillain-Barré syndrome were circumstantially linked to the vaccine, and immunization was abruptly
halted. 68
From that point on, swine flu became synonymous with political fiasco. Carter's new HEW secretary,
Joseph Califano, asked two Harvard scholars, Richard Neustadt and Harvey Fineberg, to undertake a case-
study of the Ford administration's response to the Fort Dix outbreak. Although Neustadt and Fineberg
discovered a definite chain of error, including exaggerated estimates of swine flu's similarity to the 1918
virus and the CDC's failure to heed Sabin's advice about stockpiling, they found it impossible to dismiss
the CDC's original apprehensions as irrational or irresponsible. Indeed, Califano himself later conceded
that he would have probably made the same decision as Mathews, his ill-fated predecessor. As Neustadt
and Fineberg document, expert opinion inside the communicable disease community leaned toward the
position that overreaction had been preferable to no reaction. (Or, as Edwin Kilbourne put it, “better a
vaccine without an epidemic than an epidemic without a vaccine.”) 69 On Capitol Hill, however, there was
little sympathy for HEW or the CDC. 70
The most vicious backlash came not from opposition Democrats, but from the Reagan wing of the Re-
publican Party. When the Carter administration tried to fund a permanent federal flu vaccination program
in 1978 it ran into fierce opposition from Senator Richard Schweiker of Pennsylvania in the Senate Health
Subcommittee. “It is really sort of ironic,” the senator scolded Califano. “We just came through the worst
medical disaster in history in terms of modern technology, and you want to give them a prize for what has
been done.” Two years later, Reagan appointed Schweiker as secretary of Health and Human Services (the
cabinet successor to HEW) and the program was terminated. Under Reagan and Schweiker federal grants
for successful immunization programs for common diseases such as measles were also drastically cut, and
influenza vaccine development was handed back to a pharmaceutical industry that had less enthusiasm
than ever for the product. The trend—endorsed by Carter and Califano—toward more widespread, even
universal, annual flu immunization was stopped cold in its tracks.
Influenza, indeed, became something of a Washington pariah, “the top of no one's list,” according to
Neustadt and Fineberg. 71 Careers had been wrecked by implosion of the immunization campaign, and no
ambitious public-health official wanted to risk the ignominy that Congress had inflicted upon former CDC
Director Sencer and his immediate superior, Dr. Cooper. Over succeeding decades, moreover, the swine
flu episode has become even more of a black legend militating against proactive public-health initiatives.
Even in the late 1990s, with the emergence of the most deadly strain of influenza ever seen by science,
the nonepidemic of 1976 was still casting a larger shadow over federal policy-making than the infinitely
more serious 1918 pandemic.