1976 swine flu outbreak

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U.S. President Gerald Ford receiving his vaccine for the swine flu

In 1976, an outbreak of the swine flu, influenza A virus subtype H1N1 at Fort Dix, New Jersey caused one death, hospitalized 13, and led to a mass immunization program. After the program began, the vaccine was associated with an increase in reports of Guillain-Barré Syndrome, which can cause paralysis, respiratory arrest, and death. The immunization program was ended after approximately 25% of the population of the United States had been administered the vaccine.

Richard Krause, director of the National Institute of Allergy and Infectious Diseases from 1975 to 1984, writes that the government response to the swine flu outbreak was considered to be too fast and the response to the AIDS epidemic too slow.[1]

Chronology[edit]

In January 1976 [2] several soldiers at Fort Dix complained of a respiratory illness diagnosed as influenza. The next month, Private David Lewis, who had the symptoms, participated in a five-mile forced march, collapsed and died. The New Jersey Department of Health tested samples from the Fort Dix soldiers. While the majority of samples were of the more common A Victoria flu strain, two were not. The atypical samples were sent to the Centers for Disease Control in Atlanta, Georgia, which found evidence of Swine Influenza A, related to the 1918 flu pandemic which killed 50-100 million people worldwide.

The Center for Disease Control (now the Centers for Disease Control and Prevention) verified the findings and informed both the World Health Organization and the state of New Jersey. On February 13, CDC Director David Sencer completed a memo calling for mass immunization for the swine flu. The CDC Assistant Director for Programs of the Center for Disease Control, Bruce Dull, held a press conference on February 19[3] to discuss the flu outbreak at Fort Dix and, in response to questions from reporters, mentioned the relationship of the flu strain to the 1918 outbreak.[4]

President Gerald Ford was officially informed of the outbreak memo on March 15 [5] and the suggested immunization program. He met with a "blue ribbon" panel which included Jonas Salk and Albert Sabin.[6] Ford then made a televised announcement in support of the mass immunization program. A hearing was held before the United States Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, and C. Joseph Stetler, drug company spokesman, requested government indemnity for the vaccine manufacturers.[7]

The House Appropriations Committee reported out a special appropriations bill including $135 million for the swine flu immunization program. It was approved on April 5. Two days later, the World Health Organization held a conference to discuss the implications of a swine flu outbreak for poorer nations.

On April 8, an official from the Federal Insurance Company informed Merck & Co., a manufacturer of the swine flu vaccine, that it will exclude indemnity on Merck's product liability for the swine flu vaccine starting July 1, 1976. T. Lawrence Jones, president of the American Insurance Association, informed the Office of Management and Budget that the insurance industry will not cover liability for the vaccine unless the government extends liability protection. The chairman of Merck wrote a memo a day later, April 13, to various government agencies including the White House emphasizing the "duty to warn." In May, other vaccine manufacturers including Marion Merrell Dow, Parke-Davis, Wyeth were notified of indemnity problems by their respective insurers. Assistant Secretary Theodore Cooper (HEW) informed the White House on June 2 that indemnity legislation will be needed to secure Merrell's cooperation. During June other vaccine manufacturers requested the same legislation. A little more than two weeks later, the Ford Administration submitted a proposal to Congress offering indemnity to vaccine manufacturers.

Bruce Dull stated at a flu conference on July 1 that there were no parallels between the 1918 flu pandemic and the current situation. Later that month, J. Anthony Morris, a researcher in the Food and Drug Administration's Bureau of Biologics (BoB), was dismissed for insubordination and went public with findings that cast doubt on the safety of the vaccine. Three days later, several manufacturers announced they had ceased production of the vaccine. In the latter part of the month, investigations into alleged swine flu outbreaks in other parts of the world found no cases of the strain. On July 23, the President sent a letter urging Congress to take action on indemnification.

In early August an outbreak of illness in Philadelphia was thought to be related to swine flu.[8] It was later found to be an atypical pneumonia thereafter called Legionnaires' disease. On August 6, President Ford held a press conference urging Congress to take action on the indemnification legislation. Four days later, both Houses of Congress passed the legislation.

Merrill became the first company to submit samples to the FDA's Bureau of Biologics for safety testing, which approved it on September 2. Merck made the first shipment of vaccines to state health departments by September 22. The first swine flu inoculations were given at the Indiana State Fair.

Jet injector used for immunization program

In October, three people died of heart attacks after receiving the vaccine at the same Pittsburgh clinic, sparking an investigation and recall of that batch of vaccine. Investigation showed that the deaths were not related to the immunization. The President and his family received their immunizations before the television cameras.[9] On November 2, Gerald Ford lost the presidential election to Jimmy Carter.

Also in early November, Albert Sabin published a New York Times editorial, "Washington and the Flu." [10] He agreed with the decision to create the vaccine and be prepared for an outbreak, but criticized the "scare tactics" used by Washington to achieve the goal. He suggested stockpiling the vaccine and having a wait-and-see strategy. Cases of Guillain-Barré syndrome affecting vaccinated patients were reported in several states, including Minnesota, Maryland, and Alabama.[11]

Three more cases of Guillain-Barré were reported in early December and the investigation into cases of it spread to eleven states. On December 16, a one-month suspension of the vaccination program was announced by CDC head Sencer. William Foege of the CDC estimated that the incidence of Guillain-Barré was four times higher in vaccinated people than in those not receiving the swine flu vaccine. The President told reporters that he agreed with the suspension, but defended the decision to create the immunization program. Joseph A. Califano, Jr. was sworn in as Secretary of Health, Education, and Welfare on January 20, 1977. On February 4, Sencer was informed that he would be replaced as the head of the CDC. The immunization program was not reinstated.

Dr. David Sencer returned to public service, serving as health commissioner for New York City in 1982, and was criticized by the gay community for dragging his feet in response to the AIDS epidemic.[12]

Aftermath[edit]

External video
Booknotes interview with Gina Kolata on Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It, February 27, 2000, C-SPAN

Laurence Gostin in his article At Law: Swine Flu Vaccine: What Is Fair?[13] writes that "…the swine flu affair fails to tell us whether, in the face of scientific uncertainty, it is better to err on the side of caution or aggressive intervention." There is not even complete agreement about the causal relationship between the swine flu vaccine and Guillain-Barré syndrome, as noted in Gina Kolata's book Flu: The story of the great influenza pandemic of 1918 and the search for the virus that caused it.[14] She writes that the CDC did not have a "specific set of tests and symptoms to define Guillain-Barré" and that doctors who reported cases already knew that a link was suspected, so a bias in reporting was introduced. She quotes Keiji Fukuda, "...if a new virus gets identified or reappears, you don't want to jump the gun and assume a pandemic is happening."[14]

See also[edit]

References[edit]

  1. ^ Krause, Richard (January 2006). "The Swine Flu Episode and the Fog of Epidemics". Emerging Infectious Diseases. Washington, DC: National Institutes of Health. 12 (1): 40–43. doi:10.3201/eid1201.051132. PMC 3291407. PMID 16494715.
  2. ^ Neustadt, R.E. "Swine Flu Chronology January 1976—March 1977". The National Center for Biotechnology. The National Center for Biotechnology. Retrieved November 10, 2017.
  3. ^ Schmeck, Harold M. Jr. (February 20, 1976). "On Possible Return Of Epidemic's Virus". New York Times. p. 69. ProQuest 122565338.
  4. ^ Schmeck, Harold M. Jr. (February 20, 1976). "U.S. Calls Flu Alert On Possible Return Of Epidemic's Virus". New York Times: 1.
  5. ^ Neustadt, R.E. "Swine Flu Chronology January 1976—March 1977". The National Center for Biotechnology. The National Center for Biotechnology. Retrieved November 10, 2017.
  6. ^ Boffey, Philip M (September 5, 1976). "Soft evidence and hard sell". New York Times. p. 137. ProQuest 122583791.
  7. ^ Spivak, Jonathan (June 18, 1976). "Shot in the Army: Program to Inoculate All Americans for Flu Appears to Be Ailing". Wall Street Journal. p. 1. ProQuest 134035690.
  8. ^ Altman, Lawrence K. (August 3, 1976). "Deaths of 6 to 14 Who Attended Convention Studied". New York Times. p. 12. ProQuest 122608464.
  9. ^ "Fords get their flu shots; some clinics, closed after deaths, are reopened". The Sun (Baltimore). Associated Press. October 15, 1976. p. A1. ProQuest 538320129.
  10. ^ Sabin, Albert (November 5, 1976). "Washington and the Flu". New York Times: 21.
  11. ^ "Illness found in 10 states: Swine flu shot link to paralysis studied". Chicago Tribune. December 15, 1976. p. 2. ProQuest 171470249.
  12. ^ Weber, Bruce (May 10, 2011). "David J. Sencer – Nov. 10, 1924 - May 2, 2011 – Headed Federal Agency Fighting Some of the World's Toughest Diseases". Pittsburgh Post Gazette.
  13. ^ Gostin, Lawrence (2009). "At Law: Swine Flu Vaccine: What Is Fair?". The Hastings Center Report. 39 (5): 9–10. doi:10.1353/hcr.0.0184. JSTOR 40407644. PMID 19806769.
  14. ^ a b Kolata, Gina (1999). Flu: The story of the great influenza pandemic of 1918 and the search for the virus that caused it. New york: Farrar, Straus and Giroux. pp. 182–185. ISBN 0374157065.