Air Date: Week of March 3, 2006

President Gerald Ford receives a swine flu shot. (Photo: Courtesy Gerald R. Ford Library)

In 1976, a young military recruit died of what was thought to be swine flu, setting off a massive government vaccination campaign. The response: forty million Americans vaccinated, national paranoia, and 14 deaths. Dr. Harvey Fineberg is the author of "The Epidemic That Never Was: Policy Making in the Swine Flu Scare." He shares a history lesson and a cautionary tale with host Bruce Gellerman.

Transcript

GELLERMAN: From the Jennifer and Ted Stanley Studios in Somerville, Massachusetts, this is Living on Earth. I’m Bruce Gellerman, sitting in for Steve Curwood.

Health officials around the world are hoping for the best, but planning for the worst, as they devise ways to deal with a possible bird flu pandemic. The avian flu virus, H5N1, has been found in more than a dozen nations, and millions of birds have been killed in an attempt to contain the deadly disease.

Bird flu isn’t easily transmitted from animals to people. So far, 90 people have died from the virus. But if the virus mutates and makes the jump from human to human, it could spread like wildfire with catastrophic consequences.

That’s precisely what happened in the flu pandemic of 1918. In just 25 weeks, as many as 100 million people died from influenza. That’s more than AIDS has killed in 25 years. In fact, more people died from the 1918 flu than have died from AIDS and all the wars of the 20th century combined.

The circumstances confronting us today are similar in many ways to the situation back in 1976 when there were fears a swine flu would plague the world. It touched off what’s been called the largest public health fiasco in history and serves as a cautionary tale, which Dr. Harvey Fineberg tells in his book, “The Epidemic That Never was: Policy Making in the Swine Flu Scare.”

Dr. Fineberg is president of the Institute of Medicine at the National Academy of Sciences in Washington D.C. Dr. Fineberg, hello.

FINEBERG: I’m very happy to be with you.

GELLERMAN: Take me back to 1976, Ft. Dix, New Jersey.

FINEBERG: Yes, 1976. Remember, it was the American Bicentennial Year. It was also a year when early on, in Fort Dix, New Jersey, there was an outbreak in late January of respiratory illness. That illness, it turned out, was largely due to influenza. Some of the influenza was identified as a type that was familiar, so-called AVictoria. But a number of the cases – initially four, and ultimately 13 clinical cases – were identified as a virus related to that believed to have caused that huge pandemic in 1918-19, so-called “swine flu.”

GELLERMAN: Now, one recruit dies .

FINEBERG: That’s correct. One of the 13 recruits who came down with this illness went on a march overnight and did die the next day.

GELLERMAN: In the next few weeks then, in 1976, the CDC gets involved and things start escalating very quickly.

FINEBERG: The Centers for Disease Control jumped on the problem immediately and drew together experts to consult as to what to do. Out of that came a recommendation that the nation should undertake a major private-public campaign, initiated by the government to vaccinate the population and protect them against influenza.

GELLERMAN: President Ford has an interesting meeting with these experts, and twice he asks them, “Are you sure, are you absolutely sure, we need to, you know, go with this?” And in fact, he says at one point, “Listen, I’m going to leave the room, and I’m going to leave my door open for ten minutes, and if you want to come in, anybody, you come into my office.” And nobody does.

FINEBERG: At the moment the president made the decision there was no dissent.

[ARCHIVE TAPE]

FORD: We’re going to find a way, either with or without the help of Congress, to carry out this program that is absolutely essential. A program that was recommended to me unanimously by 25 or 30 of the top medical people in this particular field.

FINEBERG: What he was calling for was for the Congress to enact a special appropriation, 137 million additional dollars, to provide for this vaccination program.

GELLERMAN: The government tries to get the word out that it wants people to volunteer and get their shots. We have a piece of tape from a public service announcement. Do you remember Jimmy the Greek?

FINEBERG: (Laughs) I do.

[ARCHIVE TAPE]

MAN: Hi, I’m Jimmy the Greek. Some people are waiting for a flu epidemic to hit before making up their minds on the flu shots. No coach ever took his team to the Super Bowl by waiting until game time to build his defense. You see, it takes up to three weeks to build immunity.

FINEBERG: At the time, public health officials were remarkably successful, in historical terms, in getting people out to get immunized. More than 40 million Americans were vaccinated in the space of ten weeks. That was actually an unprecedented number.

GELLERMAN: Creating and administering the swine flu vaccine was a real full-blown case of Murphy’s Law – everything went wrong, it seemed.

FINEBERG: Not everything, but quite a few things. For one, the strategic error at the outset, in my judgment, was this failure to separate the decision to produce the vaccine from the decision to proceed with vaccinating or attempting to vaccinate every person.

Another fundamental problem was that the leadership did not establish any checkpoints along the way, any basis on which they could re-examine their assumptions and see what was really happening in the field, and reconsider whether the decision to proceed was, indeed, the correct one.

There were a few cases of what’s called an ascending paralysis, which is usually reversible. It’s a condition Guillain-Barré Syndrome. A little understood condition which, it turned out, appeared to have an excess of association with immunization. And because of that problem, in the absence of any outbreak or any evidence of disease, by December the program was suspended. In effect, it was ended.

GELLERMAN: What are the lessons from 1976? I mean, was this a fire drill or a false alarm?

FINEBERG: It was a little bit of both. It was certainly a false alarm from the point of view of the epidemiology, but it was a fire drill from the point of view of the capacity of our nation to respond in the face of a threat like influenza. One of the big lessons of that time, which is still true today, is the highly variable capacity from community to community, from state to state, in mounting, carrying out and completing an immunization campaign.

This is still a concern, even as we speak, about our preparedness against avian flu today. We do have a first national plan about avian flu, but until we have 3,000 county plans and hundreds of municipal plans and everyone in place and ready to go, we really do not yet have a national preparedness for avian flu.

The critics who simply say it won’t happen are actually more likely to be right in any given month, or week or year, than those who are preparing. But just because your house didn’t burn down this year doesn’t mean you were foolish to have fire insurance. And just because a major flu pandemic has not occurred this year as yet, and may not occur perhaps for many years, it doesn’t mean that we are making a mistake to prepare actively and fully. In fact, I believe strongly that we should be prepared.

GELLERMAN: Harvey Fineberg is president of the Institute of Medicine at the National Academy of Sciences in Washington, DC. Dr. Fineberg, thank you very much.

FINEBERG: Thank you. I appreciate the opportunity.

GELLERMAN: To help prepare for a possible avian flu outbreak, you could go to the federal government's website: pandemicflu.gov. It tells you to store water, teach your children to cover coughs, and stock-up on dried fruit and peanut butter.

But for a more advanced discussion, check out AvianFluTalk.com. At that website you can learn about the antiviral properties of honey and whether the prescription drug Tamiflu really can fight the avian flu virus. You can also read about the benefits of owning the model N95 gas mask.

 

Links

Harvey Fineberg, Institute of Medicine

Federal Government website on pandemic flu

World Health Organization on Epidemics and Pandemics