Criticized, Fired, Sued, or Prosecuted: Hindsight and Public Health Accountability

In 1976, public health officials in the United States faced a tough decision. The detection of a novel virulent strain of influenza on a military base in New Jersey led some experts to predict a pandemic. Although seasonal influenza occurs annually, predicting pandemics is notoriously difficult. A novel influenza virus might herald a pandemic or signal a false alarm. With media reports of early cases of so-called swine flu fueling fear of a large outbreak and with the extra pressure of a looming presidential election, Dr David Sencer, then director of the Center for Disease Control (now the Centers for Disease Control and Prevention), reviewed the scientific evidence, consulted experts, and, with congressional approval, launched the national swine flu vaccination program. The rapidly implemented program was expensive, expansive, and controversial. The pandemic never materialized; swine flu did not spread widely; and the new vaccine was associated with an increased risk of Guillain-Barré syndrome—a rare but potentially life-threatening neurologic condition. In early 1977, Joseph Califano, the secretary of the US Department of Health, Education, and Welfare, announced the suspension of the swine flu vaccination program and dismissed Sencer. Sencer’s firing was a dramatic instance of accountability for an unsuccessful public health decision, but public health officials are always accountable to their agency supervisors, political leaders, the media, and the public. Even decisions that were, like Sencer’s, made with the best intentions and were reasonable given the information available at the time can be judged in hindsight to be bad, and the consequences can range from harsh public criticism to dismissal.