Echoes of 76
In the spring of 1976 at Fort Dix, a military base in New Jersey a particularly bad flu outbreak would capture the attention of health officials. The army estimated a few hundred soldiers fell ill and samples taken of the mystery flu strain would be sent to labs for analysis. They would identify it as an H1N1 influenza strain also known as the swine flu, thought to have killed over forty million in 1918. News would spread fast and the federal government's response would begin with a meeting of the Advisory Committee on Immunization Practices. A quote from one committee member at the time summed it up well.
“If we believe in prevention, we have no alternative but to offer and urge the immunization of the population”
H1N1 vaccines had been made before by the military so there was confidence that it could be done. Timing was also fortuitous; they had just finished production of the normal flu vaccine and the specialized flocks of hens and roosters used in vaccine production were still alive although scheduled for destruction. Fearing a repeat of 1918 and with the 1968 Hong Kong flu fresh in recent memory the president would create the National Influenza and Immunization Program (NIIP) with the goal to produce sufficient vaccines for the entire population. This was announced in a press conference with the president that included Jonas Salk and Albert Sabin, well respected public health professionals of the time. NIIP would also create a monitoring system for adverse events dubbed the Surveillance Assessment Center (NIIP-SAC). Congress and the Senate would both write and approve legislation to fund the program appropriating 137 million dollars.
The first big problem outside of making the vaccine was acquiescing to the demands of manufacturers that they be indemnified against any adverse event that may occur. They would quickly grant their request, but many would worry that even asking for such a thing would send a subtle message that something may be wrong with the product. In August, another mystery illness would kill some attendees of a Legionnaires convention in Philadelphia, within two days influenza was ruled out as the culprit but opponents of the plan and conspiracy theorists of the time would claim it as a false flag operation to stoke fear and promote NIIP. It would be the discovery of what we now know as Legionnaire's disease, a bacterial pneumonia like infection. There would also be a cluster of three deaths in elderly patients that were vaccinated at the same clinic, an investigation would not attribute the deaths to the vaccine, but public hysteria ensued anyway. Despite these issues NIIP managed to vaccinate over forty million people.
As the vaccination campaign proceeded on however the complete absence of any other H1N1 flu transmission became evident. Public concern was beginning to mount over a rare neurological condition known as Guillain Barre Syndrome. Opinion would quickly shift as the risks of exceedingly rare side effects began to outweigh any apparent benefit. A moratorium would be declared for the shots by December, the pendulum had fully swung as was made evident by a scathing New York Times article labeling the entire incident a “debacle.”
The swine flu fiasco as it became known would hold many important lessons for public health that we never seem to learn. About a dozen years ago during the most recent swine flu outbreak Dr. Harvey Fineberg was interviewed to discuss problems with the public health response back then and how that should guide us now and in the future.
The interview is surreal to read today and includes many great insights that were ignored including avoiding overconfidence about scientific insights. His synopsis of how policy was kickstarted is just as good an explanation for our current conundrum. Political leaders wanting to do the right thing but lacking the expertise to know what that was would rely on the opinion of health experts. At the heart of the problem then and now is the inability of our health experts to effectively communicate the risk/benefit with any real accuracy. Fortunately, he points out that the health care system has a much more sophisticated approach to mass media today.
Jacob Hyatt Pharm D.
Father of three, Husband, Pharmacist, Realtor, Landlord, Independent Health and Medicine Reporter
https://substack.com/discover/pharmacoconuts
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Further reading and references
https://www.ncbi.nlm.nih.gov/books/NBK219603/
https://www.history.com/news/the-discovery-of-legionnaires-disease
https://academic.oup.com/cid/article/52/suppl_1/S4/498175
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291400/
Sencer DJ, Millar JD. Reflections on the 1976 swine flu vaccination program. Emerg Infect Dis. 2006;12(1):29-33. doi:10.3201/eid1201.051007
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686218/
Fineberg HV. Swine flu of 1976: lessons from the past. An interview with Dr Harvey V Fineberg. Bull World Health Organ. 2009;87(6):414-415. doi:10.2471/blt.09.040609
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2946351/
McCullers JA, Van De Velde LA, Allison KJ, Branum KC, Webby RJ, Flynn PM. Recipients of vaccine against the 1976 "swine flu" have enhanced neutralization responses to the 2009 novel H1N1 influenza virus. Clin Infect Dis. 2010 Jun 1;50(11):1487-92. doi: 10.1086/652441. PMID: 20415539; PMCID: PMC2946351.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859467/
Kash JC, Qi L, Dugan VG, Jagger BW, Hrabal RJ, Memoli MJ, Morens DM, Taubenberger JK. Prior infection with classical swine H1N1 influenza viruses is associated with protective immunity to the 2009 pandemic H1N1 virus. Influenza Other Respir Viruses. 2010 May 1;4(3):121-7. doi: 10.1111/j.1750-2659.2010.00132.x. PMID: 20409208; PMCID: PMC2859467.
