Washington
Post
Staff
Writer
Monday,
May 27,
2002;
Page A09
Twenty-six years ago, the United States government got word that a deadly virus nobody had seen for years -- and which experts thought was gone forever -- was possibly circulating again.
There wasn't any proof it was back, just a few worrisome hints. However, the microbe had killed millions of people earlier in the century, so even a small amount of evidence had to be taken seriously. So, at great effort and expense, the government launched a plan to vaccinate the American population against the virus.
It
seemed
like
a
good
idea
at
the
time.
But
it
turned
into
one
of
the
biggest
public
health
debacles
in
memory.
The
disease
was
swine
flu,
whose
appearance
in
1976
was
believed
to
be a
reincarnation
of
the
infection
that
killed
tens
of
millions
of
people
in
1918
and
1919.
Today,
the
U.S.
government
is
engaged
in
similar
deliberations
about
smallpox,
a
disease
officially
eradicated
in
1980
but
whose
virus
some
experts
believe
may
be
possessed
by
terrorists.
Over
the
next
month,
a
panel
of
scientific
experts
convened
by
the
Centers
for
Disease
Control
and
Prevention
(CDC)
will
debate
the
value
--
and
hazards
--
of
making
the
smallpox
vaccine
available
in
the
United
States
for
the
first
time
in
30
years.
Universal
vaccination
is
out
of
the
question,
but
widespread
distribution
is
possible.
By
the
end
of
June,
the
experts
will
recommend
a
course
of
action
to
the
Bush
administration.
Influenza
and
smallpox
--
and
their
vaccines
--
differ
in
innumerable
ways,
making
comparisons
tricky.
Influenza
occurs
naturally
and
spreads
quickly.
Smallpox
hasn't
existed
outside
of
laboratory
freezers
since
1978,
but
might
be
in
terrorist
arsenals.
The
flu
vaccine
has
few
serious
side
effects,
while
the
smallpox
vaccine
has
many.
Nevertheless,
the
swine
flu
campaign
is
the
one
recent
example
of a
large,
government-sponsored
emergency
immunization
program,
and
as
such
may
offer
lessons
for
today.
Events
began
with
the
death,
on
Feb.
4,
1976,
of
an
Army
recruit
at
Fort
Dix,
N.J.,
during
an
outbreak
of
respiratory
infections
following
the
holidays.
Throat
washings
were
taken
from
19
ill
soldiers,
and
a
majority
tested
positive
for
that
winter's
dominant
strain
of
the
influenza
virus,
which
was
called
A/Victoria.
But
four
samples
were
different,
and
New
Jersey
public
health
officials
sent
them
to
the
CDC
to
be
identified.
On
Feb.
12,
the
CDC
delivered
a
chilling
report.
The
four
samples
--
which
included
one
from
the
dead
soldier
--
were
swine
flu.
As
the
name
suggests,
swine
flu
was
endemic
to
pigs.
However,
the
devastating
pandemic
of
the
Spanish
flu
in
1918
and
1919
is
believed
to
have
been
caused
by a
strain
of
swine
flu
that,
through
mutation,
gained
the
ability
to
infect
people.
In
1927,
a
scholar
put
the
Spanish
flu's
global
mortality
at
21.5
million.
In
1991,
a
systematic
recalculation
raised
it
to
30
million.
The
latest
estimate,
published
in
the
current
Bulletin
of
the
History
of
Medicine,
sets
the
minimum
mortality
at
50
million,
with
an
upper
limit
of
100
million.
The
possibility
that
the
Spanish
flu
had
reemerged
was
a
matter
whose
importance
is
hard
to
overstate
--
and
wasn't
missed
by
anyone
in
1976.
Within
days
of
identifying
the
strain,
federal
health
officials
were
meeting
at
the
CDC
to
discuss
what
to
do.
According
to
various
accounts,
the
idea
that
a
swine
flu
epidemic
was
quite
unlikely
never
received
a
full
airing
or a
fair
hearing,
although
numerous
experts
apparently
held
that
view.
Instead,
the
notion
that
an
epidemic
was
likely
enough
to
warrant
population-wide
vaccination
grew
from
dominant
opinion
to
unquestioned
gospel.
At
the
same
time,
the
rhetoric
of
risk
suffered
steady
inflation
as
the
topic
moved
from
the
mouths
of
scientists
to
the
mouths
of
government
officials.
In a
memo
prepared
for
his
superiors
at
the
Department
of
Health,
Education
and
Welfare
(HEW),
David
Sencer,
head
of
the
CDC,
talked
about
the
"strong
possibility"
of a
swine
flu
epidemic.
Later,
HEW's
general
counsel
commented
that
"the
chances
seem
to
be 1
in
2."
A
memo
from
the
HEW
secretary
to
the
head
of
the
Office
of
Management
and
Budget
noted
that
"the
projections
are
that
this
virus
will
kill
one
million
Americans
in
1976."
A
few
experts
suggested
the
vaccine
be
made
and
stockpiled
but
used
only
if
there
was
more
evidence
of
an
epidemic.
This
was
considered
but
rejected
early
on.
The
argument
was
that
the
influenza
vaccine
had
few,
if
any,
serious
side
effects,
and
that
it
would
be
far
easier
(and
more
defensible)
to
get
it
into
people's
bodies
before
people
started
dying.
On
March
24,
President
Gerald
Ford
announced
on
television
that
he
was
asking
Congress
for
$135
million
"to
inoculate
every
man,
woman
and
child
in
the
United
States"
against
swine
flu.
Over
the
next
nine
months,
very
little
went
right
--
or
as
planned.
Pharmaceutical
companies
undertook
crash
programs
to
make
enough
of
the
vaccine
by
the
start
of
flu
season
in
October.
But
it
turned
out
the
Fort
Dix
bug
grew
poorly
in
chicken
eggs,
the
growth
medium
for
the
influenza
virus.
This
meant
that
yields
were
going
to
be
about
half
of
what
was
planned.
In
addition,
one
company
used
the
wrong
virus
and
had
to
start
over.
The
insurance
industry
announced
it
wouldn't
insure
manufacturers
against
liability
arising
from
the
vaccine.
An
act
of
Congress
shifted
most
of
the
liability
to
the
government.
Studies
of
Fort
Dix's
soldiers
showed
that
about
500
had
been
infected
with
swine
flu.
But
with
only
one
death,
this
called
into
question
the
deadliness
of
the
strain.
In
addition,
swine
flu
didn't
appear
that
summer
in
the
Southern
Hemisphere,
as
would
be
expected
if a
pandemic
were
starting.
Tests
showed
that
single
injections
of
some
vaccine
formulations
didn't
protect
children.
This
required
time-consuming
studies
of a
two-shot
regimen.
Albert
Sabin,
the
father
of
the
oral
polio
vaccine
and
a
high-profile
advocate,
broke
with
the
party
line
and
called
for
stockpiling,
but
not
immediate
use,
of
the
vaccine.
Three
elderly
people
in
Pittsburgh
died
on
the
same
day
within
hours
of
getting
swine
flu
shots.
It
was
a
chance
event,
but
just
the
sort
of
guilt
by
association
that
arises
whenever
a
public
health
intervention
is
done
on a
mass
scale.
What
killed
the
program,
though,
was
the
observation
in
early
December
that
people
given
the
swine
flu
vaccine
had
an
increased
risk
of
developing
Guillain-Barre
syndrome,
a
rare,
usually
reversible
but
occasionally
fatal
form
of
paralysis.
Research
showed
that
while
the
actual
risk
for
Guillain-Barre
was
only
about
1 in
1,000
among
people
who
had
received
the
vaccine,
that
was
about
seven
times
higher
than
for
people
who
didn't
get
the
shot.
On
Dec.
16,
the
swine
flu
vaccine
campaign
was
halted.
About
45
million
people
had
been
immunized.
The
federal
government
eventually
paid
out
$90
million
in
damages
to
people
who
developed
Guillain-Barre.
The
total
bill
for
the
program
was
more
than
$400
million.
There
are
a
lot
of
lessons
to
draw,
said
Harvey
Fineberg,
a
former
dean
of
Harvard's
School
of
Public
Health,
who
co-authored
an
analysis
of
the
"swine
flu
affair"
for
Joseph
A.
Califano,
HEW
secretary
under
President
Jimmy
Carter,
who
succeeded
Ford
in
January
1977.
Among
them:
Don't
over-promise;
think
carefully
about
what
needs
to
be
decided
when;
don't
expect
the
consensus
of
experts
to
hold
in
the
face
of
changing
events.
The
biggest,
he
said
recently,
was
perhaps
the
most
obvious:
Expect
the
unexpected
at
all
times.
2009
-
"Swine
Flu"
Lies?
http://www.wellwithin1.com/swineflu.htm
