Volume 12, Number 1—January 2006
Reflections on the 1976 Swine Flu Vaccination Program
|1.Expect the unexpected: it will always happen. Some examples:|
|•Children did not respond to the initial formulation of vaccine. •Liability for untoward events after immunization became a major issue. •Deaths occurred in Pittsburgh that were coincidental with but unrelated to the vaccines (8). •Cases of a new and unrelated disease, Legionnaires disease, appeared (9). •"Excess" cases of Guillain-Barré syndrome appeared among recipients of vaccines (10). •Erroneous laboratory reports of viral isolates or serologic conversions occurred in Washington, DC, Boston, Virginia, and Taiwan. •The pandemic failed to appear.|
|2.Surveillance for influenza disease worked well. This was plain, "old-fashioned" surveillance without computers. A new strain of influenza was identified within weeks of the first recognized outbreak of illness.|
|3.Interagency cooperation works without formal agreements. The state health departments, military, National Institutes of Health, US Food and Drug Administration, and Center for Disease Control all worked together in a cooperative and mutually beneficial manner.|
|4.Surveillance for untoward events demonstrated that only when large numbers of people are exposed to a vaccine or drug are adverse reactions identified (Guillain-Barré syndrome with influenza vaccines; paralysis with the Cutter poliovirus vaccine in 1955).|
|5.Health legislation can and should be developed on the basis of the epidemiologic picture.|
|6.Media and public awareness can be a major obstacle to implementing a large, innovative program responding to risks that are difficult, if not impossible, to quantitate.|
|•Creating a program as a presidential initiative makes modifying or stopping the program more difficult. •Explanations should be communicated by those who can give authoritative scientific information. •Periodic press briefings work better than responding to press queries.|
|7.The advisability of the decision to begin immunization on the strength of the Fort Dix episode is worthy of serious question and debate (see text).|
|8.The risk of potentially unnecessary costs in a mass vaccination campaign is minimal. (The direct cost of the 1976 program was $137 million. In today's dollars, this is <$500 million.) The potential cost of a pandemic is inestimable but astronomical.|
- Kilbourne ED. Flu to the starboard! Man the harpoons! Fill with vaccine! Get the captain! Hurry! New York Times. 1976 Feb 13. p. 32, col. 4.
- Obama B, Lugar R. Grounding a pandemic. Op-ed section. New York Times. 2005 Jun 6. [cited 1 Nov 2005]. Available from http://www.nytimes.com/2005/06/06/opinion/06obama.html? ex=1130994000&en=1b199f715505a19c&ei=5070
- Unprepared for a flu pandemic [editorial]. New York Times. 2005 Jul 17; Sect. 4:11 (col. 1).
- Hodder RA, Gaydos JC, Allen RG, Top FH Jr, Nowosiwsky T, Russell PK. Swine influenza A at Fort Dix, New Jersey (January–February 1976). III. Extent of spread and duration of the outbreak. J Infect Dis. 1977;136:S369–75.
- Dowdle WR, Hattwick MAW. Swine influenza virus infections in humans. J Infect Dis. 1977;136:S386–9.
- Denny FW, Glezen WP, Karzon DT, Katz SL, Krugman S, McIntosh K, Swine-like influenza vaccine: a commentary. J Pediatr. 1976;88:1057.
- Schwartz H. Swine flu fiasco. New York Times. 1976 Dec. 21. p. 33, col. 1–2.
- Schmeck HM Jr. More deaths reported after shots but no link to flu vaccine is found. New York Times. 1976 Oct 14; Sect. A:1+.
- Fraser DW, Tsai TR, Orenstein W, Parkin WE, Beecham HJ, Sharrar RG, Legionnaires' disease: description of an epidemic of pneumonia. N Engl J Med. 1977;297:1189–97.
- Schonberger LB, Hurwitz ES, Katona P, Holman RC, Bregman DJ. Guillain-Barré syndrome: its epidemiology and associations with influenza vaccination. Ann Neurol. 1981;9(Suppl):31–8.
- Department of Health and Human services. Annex 11: Pandemic influenza response and preparedness plan. Washington: The Department; 2003 Aug 26.
- Dowdle WR. Influenza pandemic periodicity, virus recycling, and the art of risk assessment. Emerg Infect Dis. 2006;12.
- Schoenbaum SC, McNeil BJ, Kavat J. The swine-influenza decision. N Engl J Med. 1976;295:759–65.
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