"There are no villains that we can find" in the now infamous 1976 swine flue immunization program, said Harvard Prof. Richard E. Neustadt, commenting on the newly released report he coauthored - "The Swine Flu Affair: Decision Making on a Slippery Slope."
But if there are no villains in the 170-page report he and Dr. Harvey Feinberg prepared for Health, Education and Welfare Secretary Joseph A. Califano Jr., there are no heros either.
Rather, the $85,000 study of the 1976 federal program that protected against an epidemic that never materialized reads like Hans Christian Andersen's classic fairy tale "The Emperor's New Clothes."
The major difference between the Neustadt-Feinberg study and the Anderson story is that in the fairy tale there was one voice of reason, a little boy who pointed out that the new clothes existed only in the emperor's imagination, and he was, in reality, parading naked through the streets.
Neustadt and Feinberg were unable to find within the federal health bureaucracy a character similar to the little boy saying, 'Look! There is no swine flue!'
Instead, they picture a health bureaucracy that in a period of less than a month had decided that, based on the facts that one person had died of swine flu, four others had definitely had it and 500 probably had - all at Fort Dix. N.J. - the president should ask for the expenditure of $135 million to protect the nation from a disease that might strike an unprotected population.
"Decision making for the swine flu program had seven leading features," they wrote in their study. "To over-simplify matters, somewhat, they:
'Overconfidence by specialists in theories spun from meager evidence.
'Convition 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."
As the authors point out, while the threat of swine flu - a strain of influenzea similar to that which caused 20 million deaths during the worldwide pandemic of 1918-19 - was being discussed within the federal Center for Disease Control, the experts placed the odds at 49 to 1 against another pandemic.
Little is known about influenza, a disease about which there are many theories and little hard evidence. While many specilists believe that there are sufficiently major changes in the viruses about once a decade to cause widespread infection, scientists have not been gathering good data for a long enough time to prove or disprove the theory. It was on this theory that most of the federal decision making was based.
But who, the authors point out, would take the responsibility of saying "don't worry about it," and with that the responsibility for deaths that might result if the flu struck nationwide?
By March 13 - the one death had occurred on Feb. 4 - CDC director Dr. David J. Sencer had written an "action memorandum" calling for a national immunization program, pointing out that 450.000 Americans died in the earlier pandemic and warning of "a strong possibility that this country will experience widespread (swine) influenza in 1976-1977 . . ."
By March 15, then HEW Secretary David Mathews had written then budget director James T. Lynn that "ther is evidence there will be a major flue epidemic this fall. The indication is that we will see a return of the 1918 flu virus that is the most virulent form of flu. In 1918 a half million people died. The projections are that this virus will kill 1 million Americans in 1976 . . ."
Eleven days later President Ford told the nation he was asking for $135 million to launch the swine flu program.
Everyone involved was acting in good faith, according to Neustadt and Fineberg, but no insufficient and incorrect information. Once the ball was rolling, the authors say, no one was willing to step in front of it.