Expert opiinion and unanimous opinion are weak reeds

From Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata.  Page 148.  So much for expert opinion and unanimity of expert opinion.  It was never a real thing, neither in 1976 or in 2020.  

Ford’s next step was to call a meeting with leading scientists, giving his decision the imprimatur of the most impressive medical researchers. It was held on March 24, at 2:30 in the afternoon, in the Cabinet Room of the White House. Those attending included Kilbourne, Stallones, and Jonas Salk and Albert Sabin, two feuding doctors who were American heroes for their roles in wiping out polio with a vaccine.

Some of the specialists in influenza saw the new flu strain and its ties to the 1918 flu as an excuse to try an immunization campaign that might vastly improve upon what happened in the last flu pandemic, the Hong Kong flu of 1968. That time, too few were immunized, and too late, to staunch the virus’s spread. But most others had a different response to the 1918 metaphor.

It “came as a bolt from the blue,” to many who had to make a decision, Neustadt and May wrote, “capturing imaginations and dominating impressions. Though the 1918 influenza holds but a small place in most histories, biographies, and memoirs, it seems that almost everyone at higher levels in the federal government in 1976 had a parent, uncle, aunt, cousin, or at least a family friend who had told lurid tales of personal experience with the 1918 flu. The killer had been known then as ‘Spanish flu’: the term ‘swine flu’ meant nothing much to laymen off the farm. But the year 1918—more precisely 1918–1919—cited in conjunction with the flu called up vivid images in Washington almost sixty years later. Those images were rooted in folk history and were more powerful because of it.”

When Sencer and the leading scientists of the day met with President Ford, their discussions were overlaid with the metaphor of the 1918 flu. And that metaphor drove the decision.

Sencer opened the meeting by reviewing the facts of the potential swine flu epidemic, as he saw them. Ford then asked Salk and Sabin for their opinion. Both were enthusiastically in favor of a swine flu campaign. Finally, Ford asked those who wanted the nation to proceed with a swine flu immunization effort to raise their hands. All did.

With the scientists’ explicit recommendation that the swine flu vaccine program proceed, Ford dismissed the meeting and said he would adjourn to the Oval Office. Anyone who wanted to speak to him privately there was urged to do so. “Just get up, come over, knock, and walk in,” Ford told them. No one did.

Ford felt confident that the medical community was behind the decision to start a swine flu campaign. But, Neustadt and May argue, that consensus was less than firm. Look at the medical experts who were invited to the meeting. Salk and Sabin agreed with each other for once and supported Sencer and Cooper, who were sponsoring the program. Sencer himself had suggested the others at the meeting, and most of them had already made up their minds to support the program. Alexander was there but, Neustadt and May observed, he “rarely spoke up anyway.” The others “were already committed to Sencer’s plan.” As a result, the group’s “unanimity meant less than Ford assumed. It neither kept Sabin and Salk together (Sabin turned against the program three months later) nor reflected firm views in the medical community where opposition (and indifference) mounted as months passed without swine flu,” they write.

Ford was unaware of these complications. When no one crept into his office to express reservations about the program, he concluded that there were no doubters. So he decided to go ahead, reasoning, as he said, that “if you’ve got unanimity, you’d better go with it.”

Ford strolled into the Cabinet Room and asked Salk and Sabin to join him. Then he walked over to the press room to make his announcement, telling the nation about an unprecedented effort that was about to take place to stop a deadly flu.

Flanked by Sabin and Salk, Ford began: “I have been advised that there is a very real possibility that unless we take effective counteractions, there could be an epidemic of this disastrous disease next fall and winter here in the United States.” Ford said: “Let me state clearly at this time: no one knows exactly how serious this threat could be. Nevertheless, we cannot afford to take a chance with the health of our nation.”

With that preamble, Ford announced that he was asking Congress to appropriate $135 million “for the production of sufficient vaccine to inoculate every man, woman, and child in the United States,” for a disease that no one could even prove to exist.