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Harvey Fineberg, who now runs the Institute of Medicine, was commissioned to analyze the 1976 Swine Flu Fiasco. This article summarizes his warnings regarding mistakes that ought not to be repeated.
The "swine flu affair" was an unprecedented effort in1976 to immunize the entire US population against a possible swine influenza epidemic. The program eventually resulted in the immunization of approximately one-fifth of the US population-many more Americans than had ever been inoculated against influenza in 1 year. However, no epidemic appeared, and the reported adverse effects of vaccination led to the program's suspension. The press characterized the program as a failure and a fiasco. For public health leaders, it was a searing experience.
In 1978, at the invitation of Joseph Califano, secretary of the Department of Health, Education, and Welfare at that time, my senior colleague Richard E. Neustadt and I prepared a report on the swine influenza immunization program, which was republished with additional case material in 1983 [1, 2]. We intended this analysis to reveal lessons that could be applied to subsequent threats from influenza. We were particularly concerned with the danger that "the lessons of the crash program are learned too well-too literally-producing stalemate in the face of the next out-of-routine threat
from influenza. Someday there will be one" [2, p. xxvi]. This article summarizes some of the key lessons that we gleaned from the swine flu affair and suggests ways that these lessons may be applied to preparations for avian influenza.
