Swine flu Case Analysis 1
Running head:SWINE FLU CASE ANALYSIS
Swine Flu
Case Analysis
Lily Walstad
PA - 521
Professor Rivera
November 13, 2008
Abstract
This paper will give a summary of the swine flu case of 1976, along with a case analysis in relation to strategic management and organizational behavior in the government. The first part of the paper will give a detailed description of the actions and key players involved in the swine flu NationalInfluenza ImmunizationProgram, along with its outcome. The analysis will explore the skills and tactics used by Dr. Sencer in the pursuit of thisprogram. The swine flu case illustrates a persuasive style of leadership, process of implementing organizational change, and the importance of ethics in creating public policy for a national immunizationprogram.
Case Summary
In January 1976 a small flu epidemic broke out in Fort Dix, New Jersey. Most were infected with the Victoria flu, but four were infected with the swine flu virus. The swine flu infections sparked potential concerns since it was closely related to the Spanish flu virus which caused the pandemic of 1918. The Center for Disease Control (CDC) was alerted to the outbreak, which now had led to one death. The CDC was headed by Dr. David Sencer and under the Department of Health, Education, and Welfare (HEW). The CDC was responsible for protecting the country against outbreaks. In order for them to accomplish this mission they relied on three outside constituents: (1) local health officials, (2) private physicians, and (3) pharmaceutical companies. The local health officials and private physicians served as CDC’s surveillance and control for prominent viruses in the community.From this surveillance the pharmaceutical companies are then advised of which vaccinations to produce. The decision of how to respond to the swine flu virus at FortDix rested in the hands of CDC and Dr. David Sencer.
The swine flu virus at FortDix caused great concerns because lab results indicated it was closely related to the flu pandemic of 1918. The pandemic of 1918 killed over 500,000 in the United States and over 20 million world-wide. It is cited as the most devastating epidemic in recorded history (Billings, 1997). It infected 28% of all Americans and more people died of the influenza in a single year than in the four years of the Black Death Bubonic Plague of 1347 to 1351 (Billings, 1997). The influenza epidemic of 1918 was so severe that the average life span in the United States was depressed by 10 years and had a mortality rate at 2.5% (Billings, 1997). With this urgency in mind, Dr. David Sencer decided to bring forth the case to the CDC’s Advisory Council on Immunization Programs to consider the severity of the threat. This council consisted of distinguished epidemiologists and flu experts from around the country. The council concluded that a prompt and decisive action needed to take place. This recommendation was based on four main concerns: (1) it was closely related to the virus of 1918, (2) since the virus had been dormant for 58 years the public had no natural immunity, (3) a serious flu epidemic occurs every 20 years so the United States was due, and (4) there was limited time to produce and distribute an adequate vaccine before the flu season.
Dr. Sencer advised Cooper, his superior and the Assistant Secretary for HEW, of the council’s conclusion on the severity and threat of the swine flu along with his recommendations. Cooper found the matter quite urgent and requested Dr. Sencer to draft a memo for Washington immediately, even though Cooper would be out of town for the next 10 days. Dr. Sencer spent the next two days drafting a memo for Washington, titled “How Should the Federal Government Respond to the Influenza Problem Caused by a New Virus?” The memorandum was crafted for Cooper’s signature and was to be forwarded to David Mathews, Secretary for HEW. Dr. Sencer included some facts along with some assumptions regarding the severity and potential threat of a swine flu epidemic. He concluded the memorandum with four courses of action: (1) No Action, (2) Minimum Response, (3) Government Program, and (4) Combined Approach. Dr. Sencer concluded the memorandum with the recommendation thataction 4 (Combined Approach) be implemented immediately.
The memorandum was reviewed by President Ford and his staff. Upon this review the President felt the Advisory Council on Immunization Programs was a far too narrow audience. Therefore he requested another examinationfrom outside experts which included Jonas Salk and Albert Sabin, two scientists honored for their successful fight against polio. This group concurred with the initial findings from the Advisory Council on Immunization Programs. With the second examination completed President Ford approved Dr. Sencer’s recommendation to use a Combined Approach and for implementation to begin immediately. On March 22, 1976 President Ford asked Congress to “appropriate $135 million prior to the April recess to inoculate every man, woman and child in the United States… Finally, I am asking each and every American to make certain he or she receives an inoculation this fall” (Moore, 1995, p.144).
By January 1977 the inoculation effort had turned into a disaster. The primary reason was that the insurance companies would not cover the vaccine. This in turn caused manufactures to slow production which pushed the testing and manufacturing schedules further behind. This problem was solved when Congress agreed to indemnify the insurance companies. The first inoculation occurred on October 1, 1976 and over the next 10 to 12 weeks 40 million Americans were inoculated. Although this was an astonishing accomplishment,ultimately the swine flu National Influenza immunization Program proved to be disastrous. Of the 40 million Americans who received the vaccine some died shortly after, while others suffered damaging side-effects such as the Guillain-Barre syndrome which caused paralysis. Ultimately, 54 Guillain-Barre cases appeared in people vaccinated, with 30 casesoccurring within thirty days after their vaccination (Moore, 1995, p.145). In the end no additional cases of swine flu occurred in humans. That winter season it was the Victoria flu that threatened the lives of many, especially since “…no vaccine was available because the swine flu effort had preempted all the vaccine-making capacity” (Moore, 1995, p.145). “The program was halted on December 16, and the program's two primary administrators were fired early the following year by President Carter's HEW Secretary, Joseph Califano (it was Califano who commissioned the Neustadt-Feinberg report)” (Spitzer, 1984, p313). As a final point the swine flu National Influenza Immunization program totaled more than $130 million in direct cost, exposed the government to future claims, and severely damaged preventative medicine and the reliability of the CDC.
Case Analysis
The swine flu case provided the opportunity to dissect the style and techniques used by Dr. Sencer in terms of leadership, creating organizational change and managing ethics when initiating public policy. His leadership style facilitated his task of initiating theswine flu NationalInfluenza ImmunizationProgram. Dr. Sencer faced the difficult moral question of how much risk a manager should impose on society when pursuing public policy. For a public managerthe most important role is the ability to put the public first which should be at the forefront of ethics in government. This case “…shows how circumstances, individual interests, ignorance and politics combined to produce what is now regarded either as a fiasco, a disaster or a tragedy for what had been a highly regarded U.S. government institution, the Center for Disease Control in Atlanta” (Allen, 1981, p.350).
Although, Dr. Sencer is considered an ineffective leader due to the absence of ethics in his leadership it is still important to dissect his leadership style to further understand his persuasive techniques. There are two key abilities to Dr. Sencer’s leadership style: (1) is the ability to understand the need to invoke followers and (2) is the ability to know how to obtain their support. Chemers (p92) defined leadership as a process of social influence in which one person is able to enlist the aid and support of others in the accomplishment of a common task. While Schein (p74) found that leadership is comprised of the attitude and motivation to examine and manage culture. Dr. Sencer had a combination of both the definitions and he used his leadership style to first enlist external actors and then obtain their support to accomplish his task of establishing the swine flu National Influenza ImmunizationProgram. Dr. Sencer not only wanted to accomplish his task but also had a strong desire to bring about a cultural change by bringing preventative medicine to the forefront of the health field industry. Dr. Sencerbelieved this type of change could be accomplished by getting approval for the swine flu National Influenza Immunization Program. He understood that in order for this change to occur the CDC must recognize the need to pursue preventative medicine instead of relying solely on the treatment of medical illness. In order to change the CDC’sview on preventative medicine Dr. Sencer used a unique leadership style that can be correlated to what Schein (p75) defined as leadership for an organization at midlife. Schein (p75) defines an organization at midlife as having already developed a substantial history and a culture that is more cause than effect. Schein (p74) found that different leadership styles are required depending on which development stage an organization is in. For an organization at midlife, “leaders at this stage need diagnostic skills to figure out not only what the cultural influences are, but also what their impact is on the organization’s ability to change and learn” (Ott, p75).
Diagnostic skills are defined as indentifying who can, or must, or might play a role in making decisions(Moore, 1995, p151). Dr. Sencer recognized the importance of diagnostic skills in convincing millions of Americans, the CDC, and President Ford to take a risky flu shot for an epidemic that had yet not occurred.As a leader Dr. Sencer “…must enlist the aid and support of followers, guide and encourage the efforts of the team toward task accomplishment” (Ott, p93) He neededthese followers for permission to use public resources, operational assistance to help produce results, and for their direct authority to command compliance (Moore, 1995, p113). Dr. Sencer understood that President Ford’s approval gave him direct authority to command compliance and in turn permission to use public resource and operational assistance to produce results. Also, by obtaining approvals from the Advisory Council on Immunization Programs, Assistant Secretary of Health, and anoutside group of experts (assigned by the President) he obtained validity and credibility for theswine flu National Influenza Immunization Program.
Dr. Sencer understood who he needed to enlist to accomplish his task, but he still needed to convince these external actors to aid him in establishing the swine flu National Influenza Immunization Program. He was able to convince the Advisory Council on Immunization Programs and the Assistant Secretary of HEW since they viewed him as having the same core values as the group, especially since he was the Director of the CDC. “…When a leader is seen as competent in task-related domains and committed to the group’s care values, followers are willing to give the leader greater latitude of action and authority” (Ott, p93). Chemers (p93) found that this type of loyalty to the group’s core values gives assurance to the group that the leader will pursue the collective interests of the group. The Advisory Council on Immunization Programs and Cooper believed that any recommendation from Dr. Sencer would serve the interest of the CDC, which was to protect the country against outbreaks and treat medical illness. It was this assumption that convinced them to aid Dr. Sencer in his task. The endorsement from these external actors had a strong impact on the President’s decision, but this alone was not the only factor. Chemers (p93) found that the decision to act as a follower represents a social cost that must be balanced by some benefit. For President Ford to act as a follower and endorse a policy that had great risks associated with it there would need to be some benefit for him. Dr. Sencer recognized that President Ford needed an opportunity to exercise bravery and competent leadership because he was being portrayed as a bumbling inept leader. The benefit to President Ford would be to enhance his reputation as a leader of the nation.
His leadership style aided his pursuit of organizational change within the CDC and Americans to move towards preventative medicine. For this type of change to occur Dr. Sencer would not only need to minimize the resistance from various groups but also convince various groups of the need for this type of social change. Coch and French (p423) found that the best way to overcome the resistance to change is to allow participation of people in the change process. “…Change can be accomplished by the use of group meetings in which management effectively communicates the need for change and stimulates group participation in planning the changes” (Ott, p428). In each step of the swine flu National Influenza Immunization ProgramDr. Sencer involved various groups of people, primarily those he needed to approve his plan which are the external actors previously discussed. Lewin (p431) found that it is typically easier to change individuals formed into a group than to change any one of them separately. Instead of attempting to change each scientist at CDC one at a time Dr. Sencer decided to use the meeting with the Advisory Council on Immunization Programs to promote his program. Dr. Sencer used this group technique at every pivotal stage of the swine flu National Influenza Immunization Program.
Lewin (p429) also found that before this type of social change can occur it is important to analyze the state of quasi-stationary equilibrium in an organization or more simply put the state of “no social change” in the organization. Before the outbreak at FortDix there was no urgency to change the priority of the CDC from their primary objective of the treatment of medical illness to preventative medicine. It is with this knowledge that Dr. Sencer knew he would need to create urgency in order for this change to occur. Lewin found “… levels of quasi-stationary equilibria can be changed in either two ways: by adding forces in the desired direction or by diminishing opposing forces” (Ott, p429). Dr. Sencer changed the level of quasi-stationary equilibria in the CDC and America by means of diminishing the opposing forces. By correlating the swine flu to the epidemic of 1918 he lessened the resistance from opposing forces. “To overcome this inner resistance, an additional force seems to be required, a force sufficient to “break the habit” to “unfreeze” the custom” (Ott, p430). The thought of an epidemic like the one of 1918 was exactly the force Dr. Sencer needed to create urgency around preventative medicine and promote the swine flu National Influenza Immunization Program, which he believed would provide the need step to the advancement of preventative medicine.
Dr. Sencer had a persuasive leadership style that allowed him to enlist the aid and support of followers to approve the swine flu National Influenza Immunization Program. However, he achieved this through means of manipulation and lack of full disclosure regarding the situation. The pitfalls of his leadership came at the strategic level in his inability “… to see and acknowledge the full complexity of problems” and “… the willingness and emotional strength to admit uncertainty…”(Ott, p78). Dr. Sencer was so consumed by his desire to bring preventative medicine to the forefront of the health field industry that he was unwilling to acknowledge the full complexity of the situation and address the uncertainties and risks associated with a national immunization program. In his memo to Washington he eliminated any information regarding concerns about money, potential damaging side-effects of the swine flu vaccine, and the risks associated with the reputations of the external actors involved. Dr. Sencer lost sight of his main objective as a public manager which is to put the public first. By not gathering enough information to reduce the threat of uncertainties and using an “all or nothing” approach he threatened the lives of many and the reputation of the CDC. He had the opportunity to put the public first by using a hedged response which would have allowed the government time to monitor the situation over the summer and fall to understand if an epidemic was likely to occur. During this time they could have started production on the vaccine, allowing ample time for testing, but wait until later to administer the vaccine. His arrogance in claiming to know the public good ultimately led to the devastating outcome of the swine flu National Influenza Immunization Program. “…It is dangerous for managers to become so arrogant that they no longer trouble to check their ideas about what is publicly valuable with citizens and those who represent the public” (Moore,1995, p148) As a public manager, Dr. Sencer faced a moral choice and instead of choosing the public’s safety he choose to ignore the risk and uncertainties and push forth his plan of a national influenza program. Hopefully in the future these types of programs and decisions will be “…assessed in terms of a “probability exercise” examining the alternative action available and then the likelihood of the outcomes” (Allen, 1981, p352).