July 17, 2009

Lessons of the 1976 Swine Flu Threat

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Swine Flu ‘Debacle’ of 1976 is Recalled (Excerpt)

By Shari Roan, Los Angeles Times
April 27, 2009

The swine flu brush of 1976 — some call it a debacle — holds crucial lessons for the government and health officials who must decide how to react to the new swine flu threat in the days and weeks ahead.

The panic in 1976 was due in part to the belief — now known to be erroneous — that the 1918-19 flu pandemic, which killed half a million Americans and an estimated 20 million people worldwide, was caused by a virus with swine components. Recent research suggests instead that it was avian flu — but that seems unlikely to assuage the anxiety over the current outbreak.

The episode began in February 1976, when an Army recruit at Ft. Dix, N.J., fell ill and died from a swine flu virus thought to be similar to the 1918 strain. Several other soldiers at the base also became ill. Shortly thereafter, Wenzel and his colleagues reported two cases of the flu strain in Virginia. “That raised the concern that the original cluster at Ft. Dix had spread beyond New Jersey,” said Wenzel, former president of the International Society for Infectious Diseases.

The Centers for Disease Control (CDC) solicited the opinions of infectious disease specialists nationwide and, in March, called on President Ford and Congress to begin a mass inoculation. The $137-million program began in early October. Waiting in long lines at schools and clinics, more than 40 million Americans — almost 25% of the population — received the swine flu vaccine. But within days reports emerged that the vaccine appeared to increase the risk for Guillain-Barre syndrome, a rare paralyzing neuromuscular disorder that can be fatal.

More than 500 people are thought to have developed Guillain-Barre syndrome after receiving the vaccine, resulting in death from severe pulmonary complications for 25 people (probably caused by an immunopathological reaction to the vaccine). No one completely understands what causes Guillain-Barre in certain people, but the condition can develop after a bout with infection or following surgery or vaccination. The federal government paid millions in damages to people who developed the condition or to their families.

The 1976 vaccine program was halted in December after 10 weeks, and the pandemic, which some experts estimated at the time could infect 50 million to 60 million Americans, never unfolded. Only about 200 cases of swine flu and one death were ultimately reported in the U.S., the CDC said.

1976: Fear of a Great Plague

By Paul Mickle, The Trentonian
April 26, 2009

On the cold afternoon of February 5, 1976, an Army recruit told his drill instructor at Fort Dix, N.J., that he felt tired and weak but not sick enough to see military medics or skip a big training hike. Within 24 hours, 19-year-old Pvt. David Lewis of Ashley Falls, Mass., was dead, killed by an influenza not seen since the plague of 1918-19, which took 500,000 American lives and 20 million worldwide.

Two weeks after the recruit's death, health officials disclosed to America that something called "swine flu" had killed Lewis and hospitalized four of his fellow soldiers at the Army base in Burlington County.

The ominous name of the flu alone was enough to touch off civilian fear of an epidemic. And government doctors knew from tests hastily conducted at Dix after Lewis' death that 500 soldiers had caught swine flu without falling ill.

Any flu able to reach that many people so fast was capable of becoming another worldwide plague, the doctors warned, raising these questions: Does America mobilize for mass inoculations in time to have everybody ready for the next flu season? Or should the country wait to see if the new virus would, as they often do, get stronger to hit harder in the second year?

Thus was born what would become known to some medical historians as a fiasco and to others as perhaps the finest hour of America's public health bureaucracy.

Only young Lewis died from the swine flu itself in 1976. But as the critics are quick to point out, hundreds of Americans were killed or seriously injured by the inoculation that the government gave them to stave off the virus.

According to his sister-in-law, John Kent of President Avenue in Lawrence went to his grave in 1997 believing the shot from the government had killed his first wife, Mary, long before her time.

Among other critics are Arthur M. Silverstein, whose book, "Pure Politics and Impure Science," suggests President Gerald Ford's desire to win the office on his own, as well as the influence of America's big drug manufacturers, figured into the decision to immunize all 220 million Americans.

Still, even the partisan who first branded Ford's program a fiasco, says now that it happened because America's public health establishment identified what easily could have been a new plague and mobilized to beat it amazingly well.

To understand the fear of the time you have to know something about the plague American soldiers seemed to bring home with them after fighting in Europe during World War I. The Great Plague, as it came to be called, rivaled the horrid Black Death of medieval times in its ability to strike suddenly and take lives swiftly. In addition to the half million in America, it killed 20 million people around the world. It got its name because it was a brand of flu usually found in domestic pigs and wild swine. It was long thought to have come, like so many flus, out of the Chinese farm country, where people and domestic pigs live closely together.

Recent research has shown, however, that the post-WWI flu was brought to Europe by American troops who had been based in the South before they went to war. Medical detectives, still working on the case in the 1990s, determined that a small group of our soldiers took swine flu to Europe and that it spread to the world from there.

How the swine flu got to Fort Dix in 1976 still hasn't been tracked down. At the time, Dix military doctors knew only that a killer flu had made it to the base and that they were lucky more men hadn't died or been sickened seriously.

Weeks after Lewis died, doctors from the Centers for Disease Control and other federal public health officials were meeting in Washington, trying to decide if they should recommend the government start a costly program of mass inoculations.

One doc later told the authors of "The Epidemic that Never Was" that he and others in on the meetings realized there was "nothing in this for the CDC except trouble," especially because a decision had to be made fast to get the immunizations manufactured by the fall.
"...The obvious thing to do was immunize everybody," the doctor said. "But if we tried to do that ... we might have to interrupt a hell of a lot of work on other diseases."
The doctors knew they faced complaints if the epidemic broke out and vaccines weren't ready, as well as criticism if they spent millions inoculating people for a plague that didn't happen.
"As for 'another 1918,' I didn't expect that," the doctor continued in the book. "But who could be sure? It would wreck us. Yet, if there weren't a pandemic, we'd be charged with wasting public money, crying wolf and causing all the inconvenience for nothing ... It was a no-win situation."
By mid-March, CDC Director Dr. David J. Sencer had lined up most of the medical establishment behind his plan to call on Ford to support a $135 million program of mass inoculation. On March 24, one day after a surprise loss to Ronald Reagan in the North Carolina Republican presidential primary, Ford decided to make the announcement to the American public.

Congress still had to appropriate the money, of course, and that wasn't going to be easy. Even before official congressional consideration of the plan was taken up, there were forces arguing against it. Another big hurdle was the drug makers, who were insisting the government take liability for any harmful side effects from the vaccine.

During congressional hearings in the spring and early summer, lawmakers heard some naysayers who noted that the swine flu of last winter never got beyond Dix and that only one death had been reported. The president and his experts prevailed, however, and on Aug. 12 Congress put up the money to get the job done.

The mighty task was put into the hands of a charismatic 33-year-old physician for the Department of Health, Education and Welfare, Dr. W. Delano Meriwether, a world-class sprinter who still competed in track meets. Now he was in a race for life, or so he thought. Meriwether was given until the end of the year to get all 220 million Americans inoculated against swine flu.

By Oct. 1, the makers had the serums ready and America's public health bureaucracy had lined up thousands of doctors, nurses and paramedics to give out the shots at medical centers, schools and firehouses across the nation.

Within days, however, several people who had taken the shot fell seriously ill. On Oct. 12, three elderly people in the Pittsburgh area suffered heart attacks and died within hours of getting the shot, which led to suspension of the program in Pennsylvania.

Jersey pressed on with inoculations, however. Through the fall, even as more bad reports about the side effects of the vaccine came out, thousands of mostly older people in Greater Trenton lined up outside health centers, schools and firehouses to get the shot, sometimes waiting for an hour.

One of them was Lawrence's Mary Kent, a 45-year-old mother of two teenage boys who couldn't tie the ribbons on Christmas presents only days after she got her shot at the Trenton War Memorial in early December.

On Dec. 16, increasingly concerned about reports of the vaccine touching off neurological problems, especially rare Guillain-Barre syndrome, the government suspended the program, having inoculated 40 million people for a flu that never came.

By year's end, Jack Kent knew his wife was seriously ill and started reading all about the side effects of the president's flu inoculation, especially nerve problems like those his wife was experiencing. Even before Mary Kent died an invalid at age 51 in January 1982, Kent had joined the hundreds of Americans who filed suit against the government on behalf of children left without a parent due to fatal side effects from the swine flu vaccine. Kent's sister-in-law, also named Mary Kent, recalled the other day that Jack Kent died in 1997 still angrily blaming the government for giving his wife Guillian-Barre, leading to her death.

The swine flu case of 1976 forever reduced confidence in public health pronouncements from the government and helped foster cynicism about federal policy makers that continues to this day. Citing the swine flu fiasco, for instance, one scholar recently authored a report suggesting the threat of AIDS has been similarly overblown.

Yet Joseph Califano, one of the earliest to use the word "fiasco" in describing the swine flu affair, came to the conclusion that it all couldn't have been avoided. Califano, whom President Carter appointed Secretary of Health, Education and Welfare after beating Ford in the November election, said the doctors had no choice but to err on the side of the caution. In "The Epidemic That Never Was," Califano said that faced with the threat of another killer plague with the potential to end millions of lives, the doctors were right to seek an inoculation program.

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Updated 6/1/10 (Newest Additions at End of List)

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