The First Swine Flu Epidemic
The present swine flu pandemic has frightened and bewildered millions of people. The World Health Organization (WHO) has raised alerts to the highest levels, out of fear that this swine flu A (H1N1), to which no one has immunity, might cause untold suffering and death. In the United States, the Centers for Disease Control (CDC) has presented the same argument and pointed out that no specific vaccine exists against A (H1N1) influenza. Confused local health authorities have rapidly closed and reopened schools before cases can be confirmed. Yet the public now suspects that health authorities have overreacted: the WHO counts 52,160 confirmed cases and 231 deaths in the world. At least 90% of the deaths have been in Mexico (with 113 deaths), the United States (87 deaths), and Canada (13 deaths). Only 2 deaths have occurred outside of the Americas. Since influenza kills 30,000 or more yearly in the United States, 87 deaths seems mostly incidental. It is possible that the swine flu may reemerge again, of course. Are health authorities to be commended for their caution, or condemned for what looks like needless overreaction? Much will depend on whether health authorities have led the public to ignore their warnings to future threats.
This is not the first swine flu alarm to be presented to the American public. In March, 1976, President Ford asked Congress for $135 million to cover the cost of vaccine production against a swine flu thought to be related to the virus that killed 20 million people worldwide in 1918-1919. After consulting with dozens of governmental agencies and private health leaders, President Ford concluded a public health initiative of this magnitude was necessary. Ford announced his decision with Albert B. Sabin (1906-1993) and Jonas Salk (1914-1995) at his side. These two doctors had “conquered” polio, and their status as medical statesmen (or in Salk’s case, medical celebrity) lent authority and gravity to the situation. No one of comparable stature or fame was with President Obama when he urged the American people to take personal precautions, and gave assurances that federal health agencies were monitoring the unfolding epidemic.
In contrast to today, a vaccine did exist in 1976. Doctor Sabin, the developer of the superior oral polio vaccine, which had largely replaced Salk’s killed vaccine by the 1960s, quickly expressed reservations about the whole program. Older Americans did have immunity to the 1918 virus which circulated throughout the 1920s, but did no real harm in those years. Sabin became convinced the virus would not appear in 1976. The vaccine could not be ready by Labor Day for the necessary rapid mass immunization campaign if the virus did appear, as vaccine makers demanded protection from Congress in case of lawsuits against unpredictable reactions to the vaccine. “There is more chance of being killed by car or by the A-Victoria flu strain than by swine flu,” Sabin said. The United States was preparing to battle the wrong flu.
Sabin compared the vaccines of four pharmaceutical houses and found they varied significantly in potency and effectiveness for each age group. He thought the vaccines would render 20% of young children ill, with fevers of 102-104 degrees for a day or two. Only one manufacturer could prepare a vaccine acceptable for ages 6-17. The whole situation was “misleading” and “irresponsible.” Finally, using the vaccine in 1976 would provide little protection is the virus appeared the next year: people would think they were protected if vaccinated, when they were not. Certainly, this is a possible consequence for today.
Though Sabin was regarded as the most experienced authority on vaccines and immunization procedures, his warnings and criticisms were ignored. David Sencer of the CDC led the government’s alarmist claims about numbers of deaths approximating bubonic plague levels. Sencer, who was fired after the fiasco, could not command Sabin’s eminent authority, of course. The government program was supported by Jonas Salk, a genuine American hero. Salk felt that giving people the vaccine was better than having it sit on the shelf.
Frequently, Salk and Sabin are portrayed as rivals. Salk on numerous occasions suggested Sabin maliciously engineered a campaign to replace the “safe” Salk polio vaccine with the “dangerous” Sabin oral vaccine. By 1976, Salk was the master of his own institute at La Jolla, California, and was engaged in metaphysical writings about the meaning and direction of evolution. He gave little thought to how vaccines are administered. Sabin refrained from public criticism of Salk until 1990, when he referred to Salk’s work as “kitchen chemistry,” then said that Salk had “discovered nothing,” and he concurred with the eminent virologist Joseph Melnick that Salk’s polio vaccine research was like that of the director of product development at a pharmaceutical house.
Nothing came of the 1976 swine flu pandemic. Millions were vaccinated in the usual hit and miss manner. A tenuous link was established between Guillian-Barre syndrome and the vaccine. Sufferers of mild to severe paralysis filed 1,078 lawsuits, 67 for wrongful death, with 19 of those deaths for Guillian-Barre syndrome. No actual relationship has been verified clinically, but unpredictable consequences and unproven links and lawsuits are the order of the day when millions are vaccinated. By comparison, the oral polio vaccine labeled “dangerous” by Salk has been given to some billions of children since 1961 and resulted in about 6 lawsuits annually for its harmful effects.
The lesson of 1976 is to look carefully at both the vaccine, and the campaign to deal with the administration of it. Experts can differ, of course, as they did in 1976. Today, experts abound on the internet and many distrust vaccination of any kind, especially for children. If our present swine flu virus reappears in a dangerous form, our public health authorities will be faced with resistance and confusion unimaginable in 1976.
This is not the first swine flu alarm to be presented to the American public. In March, 1976, President Ford asked Congress for $135 million to cover the cost of vaccine production against a swine flu thought to be related to the virus that killed 20 million people worldwide in 1918-1919. After consulting with dozens of governmental agencies and private health leaders, President Ford concluded a public health initiative of this magnitude was necessary. Ford announced his decision with Albert B. Sabin (1906-1993) and Jonas Salk (1914-1995) at his side. These two doctors had “conquered” polio, and their status as medical statesmen (or in Salk’s case, medical celebrity) lent authority and gravity to the situation. No one of comparable stature or fame was with President Obama when he urged the American people to take personal precautions, and gave assurances that federal health agencies were monitoring the unfolding epidemic.
In contrast to today, a vaccine did exist in 1976. Doctor Sabin, the developer of the superior oral polio vaccine, which had largely replaced Salk’s killed vaccine by the 1960s, quickly expressed reservations about the whole program. Older Americans did have immunity to the 1918 virus which circulated throughout the 1920s, but did no real harm in those years. Sabin became convinced the virus would not appear in 1976. The vaccine could not be ready by Labor Day for the necessary rapid mass immunization campaign if the virus did appear, as vaccine makers demanded protection from Congress in case of lawsuits against unpredictable reactions to the vaccine. “There is more chance of being killed by car or by the A-Victoria flu strain than by swine flu,” Sabin said. The United States was preparing to battle the wrong flu.
Sabin compared the vaccines of four pharmaceutical houses and found they varied significantly in potency and effectiveness for each age group. He thought the vaccines would render 20% of young children ill, with fevers of 102-104 degrees for a day or two. Only one manufacturer could prepare a vaccine acceptable for ages 6-17. The whole situation was “misleading” and “irresponsible.” Finally, using the vaccine in 1976 would provide little protection is the virus appeared the next year: people would think they were protected if vaccinated, when they were not. Certainly, this is a possible consequence for today.
Though Sabin was regarded as the most experienced authority on vaccines and immunization procedures, his warnings and criticisms were ignored. David Sencer of the CDC led the government’s alarmist claims about numbers of deaths approximating bubonic plague levels. Sencer, who was fired after the fiasco, could not command Sabin’s eminent authority, of course. The government program was supported by Jonas Salk, a genuine American hero. Salk felt that giving people the vaccine was better than having it sit on the shelf.
Frequently, Salk and Sabin are portrayed as rivals. Salk on numerous occasions suggested Sabin maliciously engineered a campaign to replace the “safe” Salk polio vaccine with the “dangerous” Sabin oral vaccine. By 1976, Salk was the master of his own institute at La Jolla, California, and was engaged in metaphysical writings about the meaning and direction of evolution. He gave little thought to how vaccines are administered. Sabin refrained from public criticism of Salk until 1990, when he referred to Salk’s work as “kitchen chemistry,” then said that Salk had “discovered nothing,” and he concurred with the eminent virologist Joseph Melnick that Salk’s polio vaccine research was like that of the director of product development at a pharmaceutical house.
Nothing came of the 1976 swine flu pandemic. Millions were vaccinated in the usual hit and miss manner. A tenuous link was established between Guillian-Barre syndrome and the vaccine. Sufferers of mild to severe paralysis filed 1,078 lawsuits, 67 for wrongful death, with 19 of those deaths for Guillian-Barre syndrome. No actual relationship has been verified clinically, but unpredictable consequences and unproven links and lawsuits are the order of the day when millions are vaccinated. By comparison, the oral polio vaccine labeled “dangerous” by Salk has been given to some billions of children since 1961 and resulted in about 6 lawsuits annually for its harmful effects.
The lesson of 1976 is to look carefully at both the vaccine, and the campaign to deal with the administration of it. Experts can differ, of course, as they did in 1976. Today, experts abound on the internet and many distrust vaccination of any kind, especially for children. If our present swine flu virus reappears in a dangerous form, our public health authorities will be faced with resistance and confusion unimaginable in 1976.