An adult female receiving a vaccination that was administered by a public health clinician, by way of a jet injector during the nationwide swine flu vaccination campaign, which began October 1, 1976.
( Public domain
Centers for Disease Control and Prevention
AMANDA ARONCZYK: This is On the Media, I'm Amanda Aronczyk.
BOB GARFIELD: And I'm Bob Garfield. If it has somehow vanished in the collective memory, 1918 is never far from the thoughts and nightmares of the stewards of public health. And when danger emerges, they feel an obvious urgency to get their response right. They're not always successful. Toward the end of the Gerald Ford administration came one such moment. Again it arrived in the immediate aftermath of a cruel war–Vietnam. Not a war in which the infection spread but one which left the public wary of government claims, motives and intervention.
MALE CORRESPONDENT: Today there is news of a new and potentially very dangerous influenza strain. Health officials say it may be related to the strain that killed so many people in 1918. [END CLIP]
BOB GARFIELD: This was early in 1976. Dr. Harvey Fineberg, former dean of the Harvard School of Public Health, recalls that it was a winter of bitter cold.
HARVEY FINEBERG: A number of soldiers at Fort Dix in January and February of 1976 came down with an illness.
MALE CORRESPONDENT: Four soldiers out of several hundred who infected were infected by a particular flu virus. [END CLIP]
HARVEY FINEBERG: One of them got out of his sick bed, went on a forced march and then collapsed and died. This turned out, on further examination at the Centers for Disease Control, to be the swine flu virus. The same type that had caused the great pandemic of 1918-19.
BOB GARFIELD: Fineberg knows every detail. As co-author of the government's report The Swine Flu Affair: Decision-Making on a Slippery Disease, it fell to him to document the 1976 lethal pandemic that wasn't. It turned out to be an unprecedented national public health mobilization for an infection that never spread. Within weeks of the Fort Dix death, the government commissioned mass production of a flu vaccine. While public health officials embarked on an equally massive campaign to inform folks that, 'yeah it's the swine flu, it's bad and it is truly contagious.’
FEMALE CORRESPONDENT: Jim brought it home from the office. He give it to Betty and one of his kids and to Betty's mother. But Betty's mother went back to California the next day. On her way to the airport, she give it to a cab driver. [END CLIP]
BOB GARFIELD: Look, here's President Ford himself rolling up his sleeves for the White House physician.
GERALD FORD: It's all done?
PHYSICIAN: All set.
BOB GARFIELD: What a trooper. In 10 weeks time, 45 million more Americans got flu shots. The good news is that the Fort Dix flu never left Fort Dix. The bad news was that a wary post Vietnam public was left once again to doubt the government in a matter of life and death. Harvey Feinberg says it came down to the complexities of both risk assessment and intervention.
HARVEY FINEBERG: You could think of it as a kind of insurance scheme, but the decision at that time didn't separate that insurance of producing the vaccine from the decision to go ahead and try to immunize all of the American public.
BOB GARFIELD: There's the difference between the odds and the level of risk, right? If the chances of an event are relatively small but the risk is unthinkable, governments are obliged to be on the safe side. You personally are never going to be in a hijacked airplane that's flown into a building but you still have to remove your belt and shoes when you fly and so to hundreds of millions of other people who are also not going to be in a hijacked airplane. It's a cost benefit ratio, no?
HARVEY FINEBERG: There is a difference, an important difference, between the likelihood that something will occur and the severity of the event if it does occur. Interestingly, at that time there was no effort to be explicit about these assumptions. And part of what made it difficult over months was that they never asked themselves the question, if it changed, what would lead us to do something other than what we are now on a course to do?
BOB GARFIELD: The officials at the CDC and in the White House certainly understood the Chicken Little effect. Which is to say when the government does take drastic measures just in case, if the sky doesn't fall, a pandemic doesn't materialize, they're perceived to have overreacted. So if they fail, they fail. If they succeed, they fail.
HARVEY FINEBERG: You're right. In fact some people have even said if there had been a pandemic that year, public health authorities would have been faulted for not having done enough, to actually get the vaccine soon enough. There is a kind of damned if you do, damned if you don't character to these decisions. In the end, in public health, you weigh very heavily the protection of the public against this risk of reputation or future credibility. But one of the lessons of the Swine Flu Affair was that long term credibility also matters.
BOB GARFIELD: The New York Times wrote a story. Two of the three major networks reported on something that happened early on, a government announcement about a potential health crisis related to swine flu. Based on what the government told them were they responsible in the reporting? Were they hysterical? How would you characterize the immediate reaction from the press?
HARVEY FINEBERG: What was especially fascinating at the time, was the different ways in which the several news networks went about investigating the background for this story. John Cochran at NBC News was the lead in looking into the question of what's behind this announcement that there's going to be a serious pandemic and the government has to do something. He used his White House connections to talk to many of the officials at the White House and he found none of them enthusiastic about this. And he concluded that the politicians were forced to do the bidding of the scientific and health experts. The other approach was Robert Pierpoint at CBS who received a call from his Atlanta bureau that there was dissent within the Centers for Disease Control. And he talked to experts within the CDC, a number of whom told him that the decision to go ahead and announce a mass vaccination program was premature and unwise. So he concluded that there must have been a political motive. This was after all an election year and that there was something other than the science that was driving this choice. And it's fascinating when you review the actual coverage through the year, that the difference in perspective framed at the outset persisted throughout the entire coverage of this story. NBC, much more sympathetic to government. CBS. Much more critical of the policy choice.
BOB GARFIELD: You know, we talk about another fabled Chicken Little. This one's the blind men and the elephant. The reporting was skewed based on which beat the reporters were on and who were accustomed to talking to.
HARVEY FINEBERG: It's a cautionary tale for journalists not to leap to their own conclusions based on talking only to one side of the argument. And here, in a way both were legitimate. It is true, most government officials were very reluctant. Many experts within the CDC felt it was, as yet, unjustified. But the leadership of the public health establishment, the head of CDC, the secretaries, assistant secretaries in what was then health education welfare, they felt compelled to protect the public. It was not a political decision. Dick Neustadt and I, who did a review for then, the new secretary Joe Califano, looking at this episode and the immediate aftermath, could find no basis for a political motive in these decisions. And in, fact it's not clear what the right choice is from a political point of view.
BOB GARFIELD: You've mentioned that there were false assumptions made at the time based on insufficient data and they went for an all in strategy to address what turned out to be a minor outbreak. But the question is, did public health and government officials act correctly based on their lousy data? Did they act incorrectly? I guess what I'm asking is, did they blow it?
HARVEY FINEBERG: I do think that things could have been done better. And they could have been done better in five ways. First, they could have done better at laying the base for program review, being more explicit about what assumptions they were making and when they could revisit those choices. Secondly, they could have been more realistic about the implementation. They never, for example, got the US military involved in thinking about logistics of immunizing that number of people in that short a time. Third, they didn't manage the media with great skill. Most of the leaders at that time were people who had grown up in the print media era and they were not as well equipped to deal with television. Fourth, they didn't weigh enough, the credibility in the long term for public health to have continuing effect on the public. And finally, they did make assumptions about the virus and about the epidemiology of the virus that were not adequately scrutinized. So yes, things could have been done better but at the heat of the moment, certain actions had to be taken. The key was discriminating between the things you had to do to prepare, to get the insurance laid, to be ready to immunize and making the decisions, separating the decision to actually begin that process based on what more you could learn.
BOB GARFIELD: Harvey, thank you very much.
HARVEY FINEBERG: My pleasure Bob. Thank you.
BOB GARFIELD: Harvey Fineberg is a physician, the president of the Gordon and Betty Moore Foundation and the author of The Swine Flu Affair: Decision-Making on a Slippery Disease.