Homeland Insecurity - The Monster at Our Door: The Global Threat of Avian Flu - page 55

al from sectors judged to be insufficiently profitable; moreover, revolutionary breakthroughs in vaccine
design and manufacturing technology have languished due to lack of sponsorship by either the govern-
ment or the drug industry.
As discussed in an earlier chapter, the so-called “fiasco” of the swine flu vaccine in 1977 was used
as an excuse by the Reagan administration to discard the Carter-Califano policy of gradually widen-
ing the scope of annual influenza vaccinations. Reagan-era medical priorities were cancer and heart
disease—“middle-class” health issues with broad electoral resonance—rather than infectious disease or
community-based medicine; as a consequence, savage federal cutbacks in the early 1980s led the Insti-
tute of Medicine to warn in 1987 that the United States was ill-prepared to face the threat of emergent
diseases. The Institute declared: “The decline in preparedness and effectiveness of the nation's first-line
medical defense systems can be traced to these ill advised budget cuts which forced the termination of es-
sential and research and training programs.” 238 A year later, with AIDS raging in big American cities and
infectious disease mortality increasing by nearly 5 percent annually, Institute authors added, “We have let
down our public health guard as a nation and the health of the public is unnecessarily threatened as a res-
ult.” Yet another Institute of Medicine report in 1992, authored by Joshua Lederberg and Robert Shope,
contrasted the breakdown of the public-health infrastructure with the radical changes in disease ecology
being wrought by globalization. 239
There was great hope that the Clinton administration with its strategic focus on health-care reform
would finally re-arm the country to adequately face the new viral perils, but as writer Greg Behrman re-
counts in his bitter history of how Washington “slept through the global AIDS pandemic,” Clinton public-
health policy was undermined by the administration's own fetishism of deficit reduction, followed by
the Republican capture of Congress in 1994. 240 To her credit, Donna Shalala, Clinton's HHS secretary,
did establish a pandemic influenza planning process in 1993, with the National Vaccine Program Office
(NVPO) as the lead agency. After the 1997 Hong Kong outbreak, to which the CDC was a major respon-
der, Shalala ordered NVPO to prepare technical content for a federal response plan; HHS also established
a liaison committee on pandemic influenza with the Department of Defense, the Federal Emergency Man-
agement Agency (FEMA), and the Red Cross. Much of this, however, was simply bureaucratic rewiring
that provided little incentive for vaccine development or re-investment in local public-health agencies.
In October 2000, the GAO scolded HHS for making so little progress in the development of an avian
flu vaccine. It warned that the United States might only have a month (or less) of warning before a pan-
demic became widespread, and it accused HHS of failing to develop contingency plans to ensure expan-
ded vaccine manufacturing capacity. It also pointed to a major contradiction in business-as-usual reliance
on the private sector: “Because no market exists for vaccine after [flu season], manufacturers switch their
capacity to other uses between about mid-August and December.” At minimum, HHS needed to find some
way to keep production lines running full-time, all year long, as well as to diversify the number of com-
panies committed to vaccine production. In addition, the GAO slammed HHS for dithering over whether
or not to stockpile antivirals, even as top influenza experts were begging the government to procure as
much oseltamivir (Tamiflu)—the “miracle” neuraminidase inhibitor—as possible. Finally, the audit faul-
ted Shalala's department for poor coordination of the respective roles of the federal government, state
agencies, and private manufacturers. Almost eight years of “process,” the GAO report implied, had failed
to achieve a “plan” in any substantive or meaningful sense. 241
Meanwhile, the Republican leadership in Congress, after driving a silver stake through Clinton's
health insurance reform, slashed at programs that even faintly smacked of social entitlement. Federal
funding for state immunization programs (which Clinton had dramatically increased) was a principal tar-
get, with aid cut in some cases by more than 50 percent. As a 2000 study by the National Institutes of
Health (NIH) emphasized, influenza vaccination already lagged far behind its potential to prevent disease