Flap over Swine Flu

When Administration health officials begin lining up Americans for their flu shots next fall, joked Democratic Senator Warren Magnuson of Washington, "they might have 'em vote at the same time." Magnuson's wisecrack, made during hearings on President Ford's emergency request for $135 million to inoculate all Americans against a possible outbreak of swine influenza (TIME, April 5), was tacit recognition of the emerging controversy surrounding the proposal. Despite final congressional approval and the signing of the measure into law last week, some legislators and doctors are wondering out loud whether the flu program is merely another symptom of election-year fever.

Ford's request had the backing of a blue-ribbon medical advisory committee--including Jonas Salk and Albert Sabin, of polio vaccine fame--but critics of the program charge that the Administration left unanswered some nagging questions. Among them:

> Is there really a serious threat of a major outbreak of swine flu?

The President's medical advisers say the newly detected swine flu strain is similar to the lethal virus that caused some 20 million deaths worldwide during the 1918-19 global flu pandemic. The new strain showed up at Fort Dix, N.J., where a 19-year-old Army recruit died of flu-related pneumonia in February. Investigators also found direct evidence of swine flu in eleven other men and signs of exposure to the virus--determined by the presence in the blood of antibodies to the new strain--in 273 others. Yet a subsequent check of 50 men hospitalized for flu at Fort Dix turned up only the prevailing A/Victoria virus, which caused last winter's relatively mild flu epidemic in the U.S.

Critics of the inoculation program add that, despite a careful search, no cases have been found beyond the base. Nonetheless, says Virologist Edwin D. Kilbourne of Manhattan's Mt. Sinai Medical School--and one of Ford's advisers--there is the distinct possibility that the swine virus has only gone into hibernation and may emerge again as next winter approaches.

> Can a program of mass inoculation avert an epidemic?

HEW's Deputy Assistant Secretary for Health, Dr. Theodore Cooper, says vaccines are effective against flu about 80% of the time, but other scientists argue that vaccination offers only haphazard protection. Because flu viruses mutate so frequently, vaccines produced to combat one strain may be less effective against a genetic variant that appears later in the same season. If appropriate inoculations could always be prepared in advance, doctors would have been able to prevent the outbreak of A/Victoria flu this winter among Fort Dix recruits--who were vaccinated against three other viral strains. Admits Virologist Gary Noble of the U.S. Public Health Service's Center for Disease Control: "Ford made the vaccine sound a little rosier than it is."

> Could the vaccine itself be dangerous to the recipients?

President Ford insisted that the reaction to swine flu vaccine would be mostly limited to sore arms. But Dr. Francis Ennis, of the Department of Health, Education and Welfare's vaccine-regulating agency, estimates that some 15% of the recipients could run fevers and have headaches, too. As a precaution, the National Institutes of Health plans tests of the new vaccine on about 1,000 adults between the ages of 18 and 45 at several military bases and medical centers. In addition, at a high-level meeting of the Government's flu advisers in Bethesda, Md., last week, Dr. R. Gordon Douglas of the University of Rochester School of Medicine urged additional tests on possible higher-risk groups, including pregnant women and people with such ailments as chronic lung, heart and kidney disorders, as well as diabetics and those with disorders of the nervous system. Also, public health officials said they would not recommend vaccination of preschool youngsters because of the possible danger of fever and convulsions. The drug companies themselves are aware of the risks; they have served notice that they do not want to be held liable for any adverse reactions among people who are inoculated.

> Can enough vaccine be made to inoculate most Americans before the next flu season?

Ford's program asks for at least 200 million shots, which would be distributed by state and local health authorities and administered by private doctors (who would be allowed to charge for the service). But even spokesmen for the four major manufacturers, who will receive $100 million for the vaccine--the other $35 million will go for research and other costs--admit that they are not sure they can produce the entire amount by next winter. In fact, the manufacturers have already asked HEW to lower some quality-control standards. It has obliged them by dropping one of its new mandatory measurements for impurities in vaccines.

Some medical authorities who are concerned about mass inoculations, like Dr. E. Russell Alexander of the University of Washington, think that there is a reasonable alternative to Ford's program: continue full speed ahead in producing and stockpiling the vaccine--but hold off on inoculations if there is no major swine flu outbreak by August. That strategy, though, might itself pose dangers. Other public health authorities point out that if they wait until swine flu reappears, they will not be able to administer the shots quickly enough for them to be effective.

Administration officials acknowledge the difficulties that the largest public vaccination effort ever attempted in the U.S. will entail. Still, they insist that the risks are small compared to what might happen if there is a major outbreak of a new type of influenza against which most people have no natural resistance. Says one White House aide: "Consider the outcry if with all that evidence the President had said no."

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