Forum Session

Managing Uncertainty: Swine Flu Then and Now
July 10, 2009


Michele J. Orza, ScD


An outbreak of H1N1 influenza (more colloquially known as Swine Flu) identified in March has recently been declared a pandemic by the World Health Organization. Everyone from local to international authorities is challenged by uncertainty about how the pandemic might evolve and busy determining how best to prepare for further developments. In the United States, interagency teams are tackling all aspects of the pandemic, from tracking cases to developing a vaccine, and Congress is considering requests from the President for billions of dollars to combat the virus.

But this is not the first time we have encountered such a virus. In 1976, cases of Swine Flu were detected at a U.S. military base, and the U.S. government launched a massive campaign against the virus, including efforts to vaccinate the entire population. The epidemic never spread from the military base, and the government’s campaign was widely considered an overreaction. This Forum session both looked back at what was learned from the Swine Flu program of the 1970s and looked forward to how the federal government might incorporate those lessons into its response to the current pandemic. It also examined more generally the challenge of dealing with uncertainty and the tools available and needed to confront that challenge successfully.


Harvey V. Fineberg, MD, PhD, President, Institute of Medicine, National Academy of Sciences; Margaret A. Hamburg, MD, Commissioner, U.S. Food and Drug Administration

Related Materials

For related NHPF materials see: "Influenza Vaccine Shortages: Dress Rehearsal for a Future Pandemic? Or Wake-Up Call?" (Forum Session, November 8, 2004); "Tick-Tock: Preparing for the Next Influenza Pandemic" (Background Paper, August 27, 2004); "Strong as the Weakest Link: Medical Response to a Catastrophic Event" (Background Paper No. 65, August 8, 2008); and "The Vaccine Industry: Does It Need a Shot in the Arm?" (Background Paper, January 25, 2006).

The book on which Dr. Fineberg's remarks were based is:Richard E. Neustadt and Harvey V. Fineberg, The Swine Flu Affair: Decision-Making on a Slippery Disease, Harvard University, report to Joseph Califano, Secretary of the U.S. Department of Health, Education, and Welfare, 1978, re-released by the Institute of Medicine, May 2009.

See also the comprehensive, regularly updated websites on the H1N1 Influenza (Swine Flu) Pandemic maintained by the U.S. Centers for Disease Control and Prevention and the World Health Organization.

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