Patrick Di Justo: The last great swine flu epidemic





[Patrick Di Justo is a science writer based in New York.]

In January 1976, 19-year old U.S. Army Private David Lewis, stationed at Fort Dix, joined his platoon on a 50-mile hike through the New Jersey snow. Lewis didn't have to go; he was suffering from flu and had been confined to his quarters by his unit's medical officer. Thirteen miles into the hike, Lewis collapsed and died a short time later of pneumonia caused by influenza. Because Lewis was young, generally healthy and should not have succumbed to the common flu, his death set off a cascade of uncertainty that confused the scientists, panicked the government and eventually embittered a public made distrustful of authority by Vietnam and Watergate.

This past Sunday, Homeland Security Secretary Janet Napolitano left open the possibility of a mass immunization program for the current outbreak of swine flu. If that happens, the Obama administration has a lot to learn from the debacle set in motion by Private Lewis' ill-fated hike.

Lewis was a victim of swine flu, a form of influenza endemic to pig populations. Influenza is caused by a virus, a microorganism that is mostly dead and partially alive. The virus' genetic code, held inside a protein sheath, consists of several helices of RNA. The virus injects its RNA into a healthy cell, which causes the cell to stop its usual work and make more copies of the virus. RNA genes mutate easily; for this reason, each new flu season brings a slightly different form of the disease into the population. Most year-to-year mutations bring little change to the virus, but for some still unknown reason, influenza seems to undergo a significant genetic change every ten years or so.

This major mutation results in a radically new strain of flu, one that races through a population because few people are immune to it. The dangerous influenza epidemics of 1938, 1947, 1957 (60,000 dead in the U.S.) and 1968 (the dreaded Hong Kong flu) fit this pattern. It was believed that swine flu, a particularly deadly form of the virus, had a 60-year mutation cycle that brought on worldwide pandemics, killing millions of people. Both the 10- and 60-year cycles were due to converge in the mid 1970s; Lewis' death in 1976 was thought to be the first instance of a new, incredibly lethal type of flu.

Doctors from the Centers for Disease Control tested Private Lewis' blood, and determined that his immune system had developed antibodies to a strain of flu similar to the Spanish influenza of 1918. That particular strain of swine flu produced the worst human pandemic of the 20th century: 1 billion sick in every country of the world, at least 22 million dead in the space of a few months. If Lewis had been exposed to something like the 1918 flu virus, the world could be in for an extensive and lethal outbreak. CDC doctors, charged with protecting the U.S. from epidemics, began to worry.

By the end of January, 155 soldiers at Fort Dix reported positive for swine flu antibodies. None of the soldiers' families or co-workers, however, had been exposed to the virus; all of the reported swine flu cases had been limited to the soldiers in Private Lewis' camp. The virus wasn't spreading. For some reason this information did not mollify the doctors, and on Feb. 14, 1976, the CDC issued a notice to all U.S. hospitals to be on the lookout for any cases of swine flu.

By March, the normal end of flu season, worldwide cases of all types of flu had diminished, and not one case of swine flu had been reported outside of Fort Dix. For some reason this news did not placate the doctors either, and on March 13, 1976, the director of the CDC asked Congress for money to develop and test enough swine flu vaccine to immunize at least 80 percent of the population of the United States, believed to be the minimum needed to avoid an epidemic.

1976 was the year of the U.S. Bicentennial. 1976 was a presidential election year. 1976 was two years after Watergate caused Nixon's resignation, and one year after the fall of Saigon. The U.S. government, both Republicans and Democrats, had never been held in such low esteem. Practically every elected official felt an overwhelming itch that patriotic year to do something to get the public thinking of them as good guys again. A swine flu pandemic was an opportunity on a plate. What better way to get into the good graces of the voters than to save them from a plague?...

On Oct. 1, 1976, the immunization program began. By Oct. 11, approximately 40 million people had received swine flu immunizations, mostly through the new compressed air vaccination guns. That evening, in Pittsburgh, came the first blow to the immunization program: Three senior citizens died soon after receiving their swine flu shots. The media outcry, linking the deaths to the immunizations without any proof, was so loud it drew an on-air rebuke from CBS news anchor Walter Cronkite, who warned his colleagues of the dangers of post hoc ergo propter hoc ("after this, therefore, because of this") thinking. But it was too late. The government had long feared mass panic about swine flu -- now they feared mass panic about the swine flu vaccinations.

The deaths in Pittsburgh, though proved not to be related to the vaccine, were a strong setback to the program. The death blow came a few weeks later when reports appeared of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, among some people who had received swine flu immunizations. The public refused to trust a government-operated health program that killed old people and crippled young people; as a result, less than 33 percent of the population had been immunized by the end of 1976. The National Influenza Immunization Program was effectively halted on Dec. 16....

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