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Swine Flu

One of the analyst groups I work with had produced an excellent paper on contingency planning for H1N1.

The report is not available for download but they did make an interesting observation:

On a cautionary note, the H1N1 virus has not been particularly severe so far for most of the infected population, although the virus is spreading rapidly. During the 1976 swine flu outbreak, an extensive vaccination program did not prove particularly successful, with more people reporting bad side effects from the vaccine than experienced the actual virus.

Richard E. Neustadt was commissioned by the U.S Government to produce a report on the 1976 swine flu outbreak. The report — The Swine Flu Affair, Decision-Making on a Slippery Disease — can be downloaded as a pdf file here.

An interesting excerpt from the report:

The National Influenza Immunization Program, the official title for this venture, was unprecedented in intended timing and in scope among American immunization efforts. It aimed at inoculating everyone before December 1976 against a new flu strain that might conceivably become as big a killer as the flu of 1918, the worst ever. The program was funded by Congress through a $135 million appropriation, and it was later buttressed by special legislation in the field of liability. It was conducted through state health departments, with technical assistance from health agencies in HEW. Inoculations started late, October 1, 1976. They had been slowed somewhat by difficulties in deciding children”™s dosages and seriously stalled by liability issues. On December 16, the program was suspended to assess statistical evidence of a serious side-effect. Mass immunization never started up again. As a full-scale operation, the program”™s life was thus not twelve months but two and a half.

The killer never came. The fact that it was feared is one of many things to show how little experts understand the flu, and thus how shaky are the health initiatives launched in its name. What influenza needs, above all, is research. Decision-making for the swine flu program had seven leading features. To simplify somewhat, they are:

  • Overconfidence by specialists in theories spun from meagre evidence.
  • Conviction fueled by a conjunction of some preexisting personal agendas.
  • Zeal by health professionals to make their lay superiors do right.
  • Premature commitment to deciding more than had to be decided.
  • Failure to address uncertainties in such a way as to prepare for reconsideration.
  • Insufficient questioning of scientific logic and of implementation prospects.
  • Insensitivity to media relations and the long-term credibility of institutions.

Hopefully we are not repeating the same seven features.