The swine flu affair decisionmaking on a slippery disease. 1 The New Flu 2019-02-13

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Officials Are Urged to Heed Lessons of 1976 Flu Outbreak

the swine flu affair decisionmaking on a slippery disease

So did young 4 men in uniform. A relative hand- ful were hospitalized. In the waning days of the flu season, the incoming Secretary of what was then the Department of Health, Education and Welfare, Joseph Califano, asked Richard Neustadt and Harvey Fineberg to examine what happened and to extract lessons to help cope with similar situations in the future. One death, thirteen sick men and up to 500 recruits who evidently had caught and resisted the disease, all in one Army camp, were the only established instances of human-to-human swine flu found around the world as February turned into March, the last month of flu season in the Northern Hemisphere. The duties of Meyer and Seal overlapped, but they were accustomed collabora- tors. The absence of surprise reflected expert views at that time about epidemic cycles and about the reappearance of particular types of viruses in people. Publicity had no effect upon the effort to establish what the Fort Dix outbreak meant.

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1 The New Flu

the swine flu affair decisionmaking on a slippery disease

They need to let people make an informed decision. This matter was much on Seal’s mind and espe- cially on Meyer’s. In the waning days of the flu season, the incoming Secretary of what was then the Department of Health, Education and Welfare, Joseph Califano, asked Richard Neustadt and Harvey Fineberg to examine what happened and to extract lessons to help cope with similar situations in the future. Kilbourne, one of the country’s most respected influenza specialists, extolling cycles and affirming that pandemics occur every eleven years—another one of which, he warned, was surely coming soon: Worldwide epidemics, or pandemics, of influenza have marked the end of every decade since the 1940’s—at intervals of exactly eleven years—1946, 1957, 1968. Regardless of one’s view as to the origin of recycling of human strains of influenza, the matter of being prepared to pro- duce swine virus vaccine rapidly should receive consideration by epidemiologists. The book is actually the text of a report from Harvard staff commissioned by the incoming health Secretary, Joe Califano, as a 'lessons-learned enquiry lite'.

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Book: The Swine Flu Affair: Decision

the swine flu affair decisionmaking on a slippery disease

Cikins, a former county supervisor, said he thinks that his ailments are related to the flu vaccine, although he was never able to prove that. Since then it had confined itself to pigs. Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. A decision had to be made within two weeks to give time for the preparation, testing, and administration of the vaccine before the next flu season. The potential risks were disclosed in the fine print of a two-page consent form at the time, he said. Even if the production were not accelerated, Wenzel and others said that decisions about vaccine production, distribution and risks need to be clearly spelled out to the public. The rest of the story is well known—the problems of manufacture, the refusal of the insurance companies to issue liability policies, the public's only moderate response to the vaccination programme, the occurrence of Guillain-Barré syndrome and, most noticeable of all, the non-occurrence of an outbreak of swine flu.

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Book: The Swine Flu Affair: Decision

the swine flu affair decisionmaking on a slippery disease

. The program was marked by controversy, delay, administrative troubles, legal complications, unforeseen side effects and a progressive loss of credibility for public health authorities. This difference, in expert terms an “antigenic shift,” would negate any resistance carried over from exposure to the other current viruses. While a qualified success in terms of numbers reached-more than 40 million Americans received the vaccine-the disease never reappeared. Three weeks after receiving his shot 33 years ago, Cikins suffered his first in a series of autoimmune disorders, temporary blindness in his right eye, which lasted a year.

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The Swine Flu Affair: Decision

the swine flu affair decisionmaking on a slippery disease

On the other hand, that virus was isolated from a fifth soldier who had been sick in early February, and blood tests confirmed eight more old cases of swine flu, none of them fatal. On April 26, the Obama administration declared the spread of swine flu a public health emergency. On the East Coast of the United States, January 1976 was very cold. What sense to a conference that did not bring it up? Administration officials said they are keenly aware of the history. Four things combined to create the concern.

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the swine flu affair decisionmaking on a slippery disease

BoB deadlines now forced his pace. A perhaps simplistic reading of this immediate past tells us that 11 plus 1968 is 1979, and urgently suggests that those concerned with public health had best plan without further delay for an imminent natural disaster. Were it returning now to humans, none younger than 50 would have built up specific antibodies from previous infection. In a public statement last week, former health and human services secretary Mike Leavitt recommended that officials study the federal investigation of the 1976 program. Man has never been able to intervene effectively to prevent morbidity and mortality accom- panying the emergence of a major influenza variant, but the opportunity may come soon. In the medical community, however, there is disagreement about the rate of adverse reactions.

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The Swine Flu Affair

the swine flu affair decisionmaking on a slippery disease

The whole affair, so well described in this book, is a good example of the fallibility of expert opinion and the fallibility of government. Around Fort Dix, however, in the civilian population—which was Goldfield’s territory for investigation—analysis of every case of flu reported, by a medi- cal community on the alert, showed only Victoria. Surveillance was the task at hand. Then immunization trials would be needed if there were a new vaccine, also extensive testing. Given the state of knowledge of influenza at the time, I think we made the right decision. There had been shifts in 1957 and in 1968, both followed by pandemics—Asian flu and Hong Kong flu respectively—and public health officials were expecting another by, say, 1978 or 1979. This time around, 78-year-old Cikins said, the government should disclose the risks of getting vaccinated balanced against those of getting the flu.

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Officials Are Urged to Heed Lessons of 1976 Flu Outbreak

the swine flu affair decisionmaking on a slippery disease

The president then said he would suspend the meeting and go to the Oval Office, where anyone who had doubts could talk to him privately. This memorandum of action was deliberately designed to force a favourable response from a beset administration, which could not afford to turn it down and then have it leak. The Asian flu of 1957 was thought to have resembled flu in the pandemic year of 1889. On 22 March a meeting was held by President Ford, attended by Mathews and Cooper, and other members of the administration. To settle the wager the medical officer sent cultures to the state laboratory. In Fort Dix itself, where the Army conducted its own investigation shielded from civilians, the Victoria strain proved dominant, at least for the time being.

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1 The New Flu

the swine flu affair decisionmaking on a slippery disease

Indeed for a regulatory body like the BoB, responsible for setting standards and for quality control, March was already late. Since their uncertainty was real, they agreed also that there should be no publicity until there were more data: why raise public concern about what might turn out an isolated incident? By mid-January many men began reporting respiratory ailments. The president was not warned about six things: trouble with serious side effects, with children's dosages, with liability insurance, with expert opinion, with the public health service's public relations, and with his own credibility. Ford asked for any dissent, but there was none. Also, you can type in a page number and press Enter to go directly to that page in the book. Are we now in the position where the 'avian influenza industry' and the vested interests within is actually self-fulfilling? Walter Dowdle, reported the result to his superiors—in four cases including the fatality, the unknown was swine flu.

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Book: The Swine Flu Affair: Decision

the swine flu affair decisionmaking on a slippery disease

In the New York Times Harold Schmeck reported, February 20: The possibility was raised today that the virus that caused the greatest world epi- demic of influenza in modern history—the pandemic of 1918-19—may have returned. The annual questions were: vaccine against what viruses, aimed at which population groups? Third, the Fort Dix virus differed in both its surface proteins, termed “antigens,” from the influ- enza virus then circulating in the human population. In January 1976 an outbreak of upper respiratory disease occurred at Fort Dix, a military base in New Jersey. I was fascinated to see how the actions of a few people each with their own agenda managed to effectively 'put a gun to the President's head'. Fauci, director of the National Institute of Allergy and Infectious Diseases. Many were taken by bacterial pneumo- nia, a complication of influenza now treatable with antibiotics, but an unknown number succumbed to the flu itself. Among other problems, the single-shot doses that were produced did not work on children.

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