Thursday, May 07, 2009

Deja Flu, All Over Again


# 3150




flushotsmall (3)

Yes, that’s me in 1976, giving Swine Flu Shots.

Helping to make Guillain-Barré a household name


Nearly 33 years ago, I - along with thousands of other health care workers- helped to vaccinate millions of people against a feared Swine Flu pandemic. 


It was an ambitious undertaking, and despite the fact that things did not go as planned (ok, it was a fiasco), there are lessons to be gleaned from the experience.


Today, now that we seem to be facing a similar threat, many people shake their heads and point to the Swine flu debacle of 1976.  The Pandemic that didn’t happen.


Of course, that was then.  This is now.  


And the spread of today’s virus is far greater than we saw in the first outbreak in February of that year.  


Also, despite the similar name – Swine Flu and H1N1 – today’s virus is genetically very different from the one that threatened three decades ago.

Many readers of this blog may be too young to remember this little exercise in public health, or only vaguely recall the details.


As I was there, and in a unique position to observe the process (albeit from the lowest possible rung on the public health ladder), I thought a review of the events might be in order.

In some ways, it was both Public Health’s finest and worst hour.


To the credit of the scientists and vaccine manufacturers, they were able to produce an enormous amount of vaccine – enough for 220 million people – in an incredibly short period of time.


We were also able to mount an amazing nationwide distribution system, to get the vaccine out to millions of people.


Sure, there were problems; things didn’t always run smoothly.


Instead of beginning the inoculations in August, as planned, we didn’t get delivery of the vaccine until late September, which was frightfully close to the beginning of flu season.


I was a young paramedic at the time, working in Florida, and was loaned out to the County Health Department to assist in their inoculation program and public awareness program.


This was my introduction to pandemic influenza, and to the world of emerging infectious diseases.


Basically, I was put on the `rubber chicken circuit’ over the summer (on my days off) and gave lectures at the Rotary, Kiwanis, Elks, etc. on Pandemic Flu and the importance of getting vaccinated.


I was also part of the Civil Defense planning commission, in-service training instructor for our County EMS, worked as a fulltime paramedic, and that fall, gave thousands flu shots for the health department.



But to tell the story properly, we need to back up about 6 months.  To put things in context, 1976 was an election year.


Richard Nixon had appointed Gerald Ford President after he stepped down from office, and Ford badly needed a public mandate. He was an un-elected President, and his administration got off to a bumpy start.


Today, some critics believe that Ford used the Swine Flu threat for political reasons. Possible, I suppose, but I honestly believe that the administration’s fears of a pandemic were genuine.

The emergence of Swine flu at Fort Dix, New Jersey in February of that year was a bit of a shock. The feeling was, we’d dodged a bullet just 8 years earlier with the Hong Kong Flu.


Compared to 1957 - or worse - 1918, the 1968 Hong Kong Flu barely passed muster as a pandemic. Roughly 750,000 people around the world died from the Hong Kong Flu.


For most Americans, it was a non-event.  I was in junior high school during that pandemic (the second one in my lifetime), and personally didn’t know anyone who was badly affected by the flu.

But in February of 1976, a young recruit at Ft. Dix fell ill and died within 24 hours.


Tests revealed he had a strain of influenza, previously unseen, dubbed `Swine Flu’.  It was an H1N1, a strain that had disappeared `from the wild’ after the 1957 Asian Flu pandemic. 


The alarm went out, and while no other deaths occurred at Fort Dix, many of the other soldiers tested positive for the virus. Most were without symptoms, but a few fell ill and recovered.


While the death rate was very low, this virus appeared to have the ability to be rapidly transmitted between people.

And the fear was, it might develop a higher mortality rate as it mutated.


Sound familiar?


Two weeks later, after consultation at the highest levels, the public was informed of the threat. It was debated, and decided, that waiting until an outbreak occurred would be too risky. Once an outbreak began, a vaccine would be too little, too late.


So the decision was to inoculate the country as a prophylactic measure. More than 200 million doses of vaccine were hastily produced and a plan to inoculate the nation was announced.


Throughout the summer, we all waited for the vaccine to arrive. Waited, and worried. While summer is rarely a time of seasonal flu, we all knew that a pandemic strain respected no season. But we were lucky. No new cases were reported. 


And by Late September, the vaccine was delivered nationwide.

Discussions were held again, at the highest level. The vaccine was ready, but no new cases of Swine Flu had been reported.


Was it the right thing to do, to inoculate the country?


Some health officials argued against it. But most agreed, it was the best solution.

So in early October, we got the go ahead. We set up vaccination stations in schools, shopping malls, and community centers.  Basically, anyplace we could handle a large queue of people.


Back then; we often used the pneumo-jet system, instead of syringes with needles. Today, that has fallen out of favor. Too much chance, in this age of AIDS and Hepatitis, of spreading other diseases. And mishandled, the high pressure injection could rip the skin.

The first few days, we were inundated with people wanting the shot. Mostly elderly, many of who had been alive in 1918. Many remembered the horror of the Spanish Flu, and so they lined up early. Lines extended around the block.


During those early days of the program people were turned away once the lines were too long. On one occasion, our pneumo-jet system failed, and we had to quit early in the morning.


Sorry folks, come back tomorrow.

It quickly turned into a logistical nightmare, and this was before anyone was really panicked. We did land office business the first week or two.


Then the first reports of suspicious deaths, and a strange form of paralysis made the paper. Three people dropped dead in Philadelphia after receiving the injection, although it was never shown that the vaccine was responsible.


The newspapers had a field day.   The hastily created vaccine was dangerous, they said.   




Gerald Ford, in an attempt to reassure the nation, rolled up his sleeve on national TV to get the shot. But the seeds of mistrust had been sown.


Fewer and fewer people showed up to get their shot.


The vaccine was blamed for a number of deaths, and cases of Guillian-Berre syndrome (a form of paralysis). The fear of the vaccine was exacerbated by rampant newspaper speculation.


But the truth is, we were vaccinating a lot of elderly people, and many of their deaths, while attributed to the vaccine in the press, may have been from other causes.


Overall, the incidence of Guillian-Barre Syndrome was somewhere around 10 out of a million vaccinations. Or five times higher than the background level of this disease.  


Nationwide, we were seeing about 1 serious reaction to the vaccine per 100,000 recipients.  Twenty-five deaths were linked to the vaccine, as well. 


By early December, we’d managed to vaccinate 40 million people nationwide, far short of our goal.


As no cases of Swine Flu had been reported anywhere in the world, the decision was made to halt the vaccination program.


It was doing more harm than good.

To this day, some political observers blame the Swine Flu fiasco for Gerald Ford’s loss that November. Hindsight being 20/20, it’s easy to second-guess the decision to go ahead with the vaccinations now.


But the choice back then was to take a chance on a new and untried vaccine, or risk hundreds of thousands of deaths from a flu pandemic.


A difficult choice, indeed.

Of course, had the Swine Flu pandemic hit in the winter 1976, the incidence of side effects would have been considered acceptable. 


Looking back, I have a hard time faulting the government for going ahead with the vaccination program. 


I know, it is very popular now to paint them as incompetent, or worse, but I believe that they believed the threat was genuine.


Unfortunately,  good intentions don’t always guarantee good outcomes. 


As you can imagine, 33 years later, the emergence of this new A/H1N1 swine flu strain feels like a bit of Deja Flu for me, all over again.



In the next couple of weeks the CDC, HHS and the WHO (World Health Organization) will have to make a similar decision regarding the creation and eventual distribution of a new swine flu vaccine. 


In a future blog, I’ll discuss some of the challenges  governments may face should they decide to go ahead with an aggressive vaccine project.