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Posts Tagged ‘H1N1’

Why didn’t we learn from the last swine flu debacle?

Posted by David Kassel on October 28, 2009

The Obama administration may be facing a credibility problem due to its apparent inability to anticipate the current shortage of vaccine to inoculate millions of Americans against the swine flu. 

As the Washington Post noted,  the Obama administration officials had projected in July that companies would make 80 million to 120 million doses of the vaccine by this month. They outlined an aggressive response to the current flu pandemic and promised to inoculate every American.

But only about 16.5 million doses have become available so far, putting the administration in the uncomfortable political position of appearing unprepared for what President Obama declared last week was a national emergency.

The Associated Press reported that federal Health and Human Services Secretary Kathleen Sebelius was blaming the manufacturers, who provided “overly rosy” numbers on the amount of vaccine that would be available.  It seems the Centers for Disease Control, however, did not anticipate the slower-than-expected growth of the virus in eggs in the manufacturing process for the vaccine.

Why are these things such a surprise?  Why didn’t the administration assume that the production might be slower than initially projected?

In Thinking in Time, their book on presidential decision making, historians Richard Neustadt and Ernest May analyzed the Ford administration’s mistakes in the previous swine flu fiasco of 1976.   It makes for interesting reading today.  After I re-read their account of the fiasco, which is one of several case studies sprinkled throughout the book, it seemed to me at least some of the Ford administration mistakes  may have been repeated this time around.

There were, to be sure, many differences between the situations then and today — the main difference being that in 1976, the flu refused to appear outside of 13 cases in a crowded Army camp.  Today, the flu is spreading rapidly, of course.  Compounding  the credibility problem resulting from the lack of the flu in 1976 was a severe neurological side effect that was statistically associated with the vaccine.  The mass immunization program was stopped.  So far, no side effects have shown up associated with the new vaccine.

But Neustadt and May contend that had a flu pandemic actually occurred in 1976, the supplies of the vaccine would have been inadequate to cover anywhere near all Americans, as Ford had promised.  Had that been the case, the Ford administration’s credibility problem could have been far worse than it was.  Sound familiar?  

In March 1976, David Sencer, the head of the then Center for Disease Control, had recommended that a new vaccine for the swine flu be developed, produced, tested, and distributed in the next three months, according to Neustadt and May.  His projection was that innoculation efforts would begin after Independence Day and that everyone would be reached by Thanksgiving.   President Ford agreed to the program after he received an endorsement from an ad hoc panel of experts.

Sencer and other Ford administration officials failed to ask many hard questions, Neustadt and May contended, including questions about tradeoffs between side effects and flu, distinguishing severity from spread, and stockpiling.

Neustadt and May maintained that a key reason why the Ford administration’s loss of credibility may have been far worse had swine flu erupted in this country or abroad had to do with the limitations at the time on the supply of the vaccine.  The Ford administration had managed to inoculate 40 million Americans — an amount apparently far higher than what has so far been accomplished today.  Yet, in what now sounds prescient, Neustadt and May wrote:

For down at the low level where shots actually were given, everything depended on the ingenuity and skill with which state plans had been prepared and local services enlisted…all those would have intersected wth supplies of vaccine insufficent to inoculate adults once and children twice if the demand ran high…

Unfortunately, that appears to be exactly the situation we are finding ourselves in today.


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