The Swine Flu Dilemma

Fearing a repetition of the worldwide 1918-19 influenza pandemic that cost 548,000 lives in the U.S. alone, President Ford last March called for the inoculation of virtually all Americans against swine flu. His announcement had all the fervor of a declaration of "war, and Congress promptly authorized funds for the largest public health measure in U.S. history. But the flu campaign has run into one roadblock after another. Last week it appeared close to total collapse.

The threat was an impasse over who would protect the vaccine manufacturers against a possible onslaught of lawsuits. Few medical authorities believe the vaccine itself is dangerous, but they point out that with so many shots being given, some reactions are inevitable. That would be true, as one drug spokesman put it, "even if we vaccinated the whole population with tap water." Worried about defending against many frivolous suits, insurance companies have refused to provide coverage for the manufacturers. So has Congress, although at week's end some compromise was being sought--perhaps legislation that would limit damages anyone could collect from drug companies.

The legal hassle was not the only problem. From the start, manufacturers have found meeting Ford's original goal of providing 200 million shots for the winter's flu season a staggering task; the quantities required are up to ten times the usual production run. In addition, local officials have complained that the cost of inoculations will greatly exceed the money available in the $135 million package appropriated by Congress.

Seed Viruses. The doubts have been magnified by the fact that not a single new case of swine flu has been found since the strain (ominously similar to the 1918-19 virus) was identified in several hundred G.I.s at Fort Dix, N.J., earlier this year. Even Dr. Edwin D. Kilbourne of New York's Mount Sinai School of Medicine, a leading proponent of the Ford program, concedes that the Fort Dix outbreak could have been a "freak occurrence." Complicating matters further, the vaccine, grown in fertilized eggs from "seed" viruses developed in Kilbourne's lab, has been only partially successful in clinical trials.

Injected into some 5,000 volunteers, the vaccine appeared to offer good protection with minimum side effects to people over the age of 23. But it caused high fever in a significant number of youngsters. Concerned by these results, Dr. Albert Sabin, developer of oral polio vaccine and originally a supporter of Ford's program, reversed himself and said that unless there is an actual outbreak, the vaccinations should be limited to "high-risk" people, notably the aged and chronically ill. A rival polio-vaccine pioneer, Dr. Jonas Salk, disagrees. Describing the vaccine as safe, he pointed out that even a partial immunization program reduces the spread of the virus by closing what he calls the immunity gap. Said he: "Vaccine is the most useful tool we have for preventing viral disease."

Government health officials clearly agree. They note that the last major new flu strain--Hong Kong A--caused some 30,000 deaths when it appeared in the U.S. in 1968-69, and they hope to start giving swine-flu shots Sept. 1.

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