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The Swine Flu Vaccine: 1976 Casts a Giant Shadow

As the United States struggles to vaccinate much of the population for the current H1N1 virus, it's worth casting a look at both 1918 and 1976.

America was one raw nerve. An unpopular Republican president had left office, leaving behind an unpopular war to wind down. Democrats now ruled both houses of Congress. The sitting president, a Midwesterner whose ascendancy had been historic, came in without executive experience. The country was deeply divided among itself and cynical distrust of government and corporations alike was rampant. It was 1976.

It had been 58 years since the 1918 flu pandemic, called the Spanish Flu because Spain's open reporting on the flu's ravages made it seem more awful than in more censored nations. Survivors of the deadly influenza often censored their own recollections, so the pandemic took a backseat to many of the 20th century's other tragedies. Then an outbreak of swine flu at Fort Dix, N.J, sickened five and on Feb. 6, 1976, one soldier died, and global health officials recalled just how awful a flu can be.

March 1918 was a difficult time for the nation. America had waded into the European nightmare of the Great War. Gripped by a patriotic fever, civilians endured food rationing and press censorship. When the call went out for medical personnel to support the troops, doctors and nurses answered in droves, leaving the home front with an inexperienced and depleted medical community.

On March 4, the flu broke out at Fort Riley, Kan. The illness was referred to as the "three-day fever," and as the soldiers left Kansas for Europe, this fever went with them. The afflicted were often hale and young — many older Americans still carried some immunity to it as a holdover from the 1889-90 Russian flu.

The virus thrived in the trenches and the putrid conditions troops were forced to endure. Many of the soldiers' lungs had been devastated by mustard gas. Casualties were jammed into temporary military hospitals that defied attempts at any meaningful hygiene practices.

In August 1918, a far more virulent form of the virus emerged simultaneously in Brest in France, Freetown in South Africa and in Boston. The appearance of this mutated influenza was so sudden and so deadly that some speculated it was a German biological weapon.

As the troops returned home on crowded ships and trains, they again brought the virus with them. On Nov. 11, 1918, Americans celebrated the end of the war and Armistice Day by attending large parties and parades. Although nearly 200,000 had perished during the month of October, the flu appeared to have peaked. But the public gatherings, from a public health view, poured gasoline onto a dying ember. The flu exploded across the country in another wave, killing young, healthy adults at 20 times the rate of previous influenzas.

Death by Spanish flu was particularly hideous. It often attacked and killed within hours, although secondary infections contributed significantly to the spiking mortality rates. The flu had morphed into a raging hemorrhagic virus. Once cyanosis set in, the patient's face would turn bluish-grey, their lungs filled with bloody froth and the edema slowly suffocated them as they gasped for air. Blood pouring from a victim's nose and mouth, ears and eyes became the hallmarks of this pandemic.

Fame and wealth offered no protection. Sigmund Freud's daughter, Sophie, died from influenza as did the daughter of Buffalo Bill Cody. William Randolph Hearst's mother died as did Donald Trump's grandfather and the author of "Cyrano de Bergerac," Edmond Rostand.

President Woodrow Wilson fell ill during the negotiations of the Treaty of Versailles and recovered, as did future president Franklin D. Roosevelt. British Prime Minister David Lloyd George, artist Georgia O'Keefe, author Katherine Anne Porter, Gen. John J. Pershing, and visionary Walt Disney all survived the flu.

The Spanish flu killed 675,000 Americans, many times more than died in the war. When it was over, the lifespan of Americans had been shortened by 12 years.

The world had never seen a devastating holocaust of disease like the 1918-1919 influenza. It killed so swiftly, it is estimated some 25 million died in the pandemic's first 25 weeks, as many as died in Europe's Black Plague and more than the dead from the Great War's battlefields. Approximately half of the world's population had been infected. Recent estimates of the flu's deadly toll range from at least 50 million up to 100 million.

The Fredericksburg, Va., Free-Lance Star on Feb. 20, 1976, picked up the Associated Press story about the swine flu death. The headline blared "Killer Flu Back On Scene: No Immediate Cause for Alarm."

The story read, "The Center for Disease Control has reported an outbreak of influenza in humans similar to a virus found in swine — and recalling the flu of a half-century ago..."

The Los Angeles Times ran a brief update from AP on Feb. 25, 1976. "Blood tests on 241 GIs 'showed evidence' that 63 may have contracted and recovered from a swine-type variation of Influenza A, the Army said Tuesday. An Army spokesman said that in some of the 63 men, the virus apparently created antibodies that helped dispel the disease. He said all of the men had been in recent contact with five soldiers who were stricken with swine flu. One of the five died."

The Washington Post on March 24 wrote that President Gerald Ford was considering a flu immunization program that would be the largest in this country's history. "Government experts, backed by the recommendations of two advisory committees, decided that all 215 million Americans should receive protection against the swine flu. ... Most health experts believe that the new type of swine flu will spread around the country next winter."

The publicity machine of the federal government was gearing up with the full cooperation of the press.

On March 30, the Toledo (Ohio) Blade played down the flu danger. A microbiologist at the Mayo Clinic was quoted saying the same swine flu virus that was so worrisome to the government had been isolated from a cancer victim. The scientist concluded that this virus may have been "occurring undetected for years in America without causing the epidemic officials now fear."

On the same day, the AP reported the government line: "Nobody knows for certain whether there will be a flu outbreak in the U.S. this coming winter, but the risks are too high to gamble on doing nothing, officials said as the medical drama unfolded."

The director of Public Citizen's Health Group, Dr. Sidney M. Wolfe, sounded a warning of possible serious side effects from the vaccine. On April 11, he wrote an essay in the Los Angeles Times in which he cast doubt on the similarity between the one case of swine flu at Fort Dix and the 1918 pandemic.

Most worrying to Wolfe was a request by one of the four pharmaceutical manufacturers for the federal government to relax standards for testing the toxicity of the vaccine in order to ensure an adequate supply. He said now the risk of illness had switched to the vaccine itself.

Citing a complete absence of the reappearance of the swine flu in the two months since the death of the one soldier at Ft. Dix, Wolfe said, "Unless there is a real need and unless the preventive measure is effective and safe, relative to the disease it seeks to prevent, the prevention or 'cure' may be worse than the disease."

A new wrinkle in the government mass immunization plans appeared on April 12 in the Los Angeles Times. The president of the Pharmaceutical Manufacturers Association explained that since the industry had not been able to get statutory immunity in the case of possible adverse reactions to the vaccine, the companies now were simply refusing to make it. "The planned mass immunization against the swine flu next fall may be jeopardized by a Senate committee's recommendation that vaccine makers be liable for any adverse reactions," he said.

Two weeks later, in its April 26 issue, Time magazine wrote that the vaccine makers had been granted their request by the federal government to lower the manufacturing standards. "It has obliged them by dropping one of its new mandatory measurements for impurities in vaccines."

Polio vaccine developer Dr. Albert Sabin voiced second thoughts about the vaccination program. The Los Angeles Times on May 18 reported on an address that Sabin had recently given at the College of Pharmacy at the University of Toledo. "In my own mind now I am wondering very seriously if it would not be very prudent to make as much vaccine as possible and not use it until there is evidence this virus is spreading in the United States," he was quoted. Sabin was concerned that if the virus returned, an early vaccination might not provide immunity long enough.

The Los Angeles Times ran a UPI story on May 19 comparing the 1918 flu pandemic and the 1976 swine flu. It said the 1918 Spanish Flu first occurred at a U.S. Army camp, as did the one case of swine flu in 1976. It mentioned that the 1918 flu killed more than 10 times as many Americans as died in World War I, with 852 deaths occurring in New York City in one day. The article said the 1918 flu virus simply disappeared at the end of the pandemic and scientists had been at a loss to explain where it went or whether it would ever reappear.

On June 3, a UPI story in Ellensburg (Wash.) Daily Record stated that one of the four companies making the vaccine, Parke-Davis, had made a huge error. Among the 2.6 million doses that it had manufactured, an unknown number had been based on a similar but different flu virus. "Some human test subjects were given the wrong vaccine in the clinical trials which began in April and have covered 3,200 volunteers, 600 of them children."

The immunization program appeared to be headed for complete failure on June 16 when The Spokesman-Review out of Spokane, Wash., reported that two of the four manufacturers no longer had liability insurance coverage for the vaccine and that a third firm was about to lose its insurance.

What might have been the death knell for the program occurred June 29. The St. Petersburg Times reported that based on the clinical trials of 5,000 people, Sabin had recommended the plan should be scrapped. The studies had shown that older people were already armed with antibodies to the swine flu, and there wasn't enough vaccine to provide so-called "herd immunity" in the rest of the populace.

On July 2, an AP story in The Free-Lance Star reported that in light of the vaccine makers' inability to obtain liability insurance, the only option would be for the federal government to indemnify those companies, an idea that was not getting support in Washington. "A House Health subcommittee ... refused to consider an administration bill that would have freed manufacturers of most liability in the massive inoculation program and would have put the responsibility on the government."

The grand plan to ward off a deadly influenza virus pandemic through a massive vaccination program had all but collapsed.

In July, Americans celebrating the nation's 200th birthday saw large groups gather in patriotic fervor, particularly in Philadelphia. But a mysterious illness at a veterans' gathering in that city breathed a new spark into the near-extinguished immunization plan: Men present earlier at an American Legion convention suddenly became ill; some died within days of the first symptoms.

On July 23, Michigan's Ludington Daily News printed a UPI story, "The medical mystery over the American Legion killer disease deepened today. Dreaded swine flu has become less likely and bacteria was eliminated from the list of possible causes of the illness that killed 22 persons and hospitalized scores more."

Still, newspapers began to refer to this new and deadly illness as a "flu-like" disease. In a Los Angeles Times story on Aug. 3, the Pennsylvania health secretary was asked if it could be swine flu. "That's a possibility," he said.

A spokesman for that same department added, "It doesn't seem to be related to food poisoning. ... They have flu symptoms. It looks like flu."

The article went on to quote the personal physician of a 60-year-old man who died July 26: "I've had several influenza deaths over the last 30 years, and there are some influenza symptoms here. First you get a cold, and the next thing you know you're sicker than hell, and the next thing you're dead."

On August 17, the Los Angeles Times reported the death toll was still climbing. A total of 26 people — all at the American Legion convention — had died within a few weeks.

What would turn out to be a new and novel illness called "Legionnaires' Disease" revived the lifeless government immunization program. The August 23 issue of Time magazine reported the lopsided vote in Congress to shoulder all liability for the swine flu vaccination program.

Scrutiny of the vaccine's possible side effects was intense. The Los Angeles Times reported on Oct. 14 that the CDC unwaveringly continued to support the program, saying, "There is no evidence that the program should be curtailed in any way," even after the post-vaccination deaths of 24 elderly people. The bottom of the article noted, "The average age of those who died was 72.1, and all but one had a history of heart disease."

Also on Oct. 14, newspapers reported President Ford publicly receiving his own vaccination in an effort to calm concerns about the vaccine.

On Oct. 26, the Los Angeles Times ran a feature referencing the 1918 Flu. Elderly people standing in line to receive their vaccinations recalled what it had actually been like to live through the pandemic. They said they were disgusted that younger people were more afraid of the vaccine than they were of the flu. Remembering the horrors of it, one woman said, "Oh, it's just terrible, dreadful. You get a sore throat, high fever, vomiting, and finally you can't breathe anymore at all. It's the worst way to watch someone die."

On the first day that swine flu shots were available to the general public, only 5,030 people in Los Angeles County showed up to receive the immunization.

On Dec. 15, a new reason to skip the vaccine made headlines. The St. Petersburg Times combined AP and UPI reports and wrote, "Federal health officials said ... they are investigating reports that at least 30 persons who received swine flu shots later developed a temporary paralysis. The national CDC said it picked up reports of the paralysis, known as Guillain-Barre syndrome, through its own extensive flu surveillance network." The syndrome's cause is unknown but the onset is often associated with infections, surgery, influenza and vaccines.

On Dec. 16, 1976, the federal government shut down the mass swine flu immunization program. A statistical association between the vaccine and the syndrome had been calculated by the CDC.

Guillain-Barre is extremely rare, usually affecting one person in 100,000. In the 1976 swine flu immunization program, 48 million Americans were vaccinated; Guillain-Barre infected 532 people and 25 died.

As of November 2009, more than 1,000 Americans had died from the current H1N1 influenza, with 48 states reporting this flu. The flu season typically runs from October through March.

Whether the current strain of H1N1, still considered to be mild, will mutate into a more virulent form in another wave, as did the 1918 flu pandemic, remains to be seen.

In 1976, one person died from the swine flu. That strain quickly faded away and has not reappeared. To say that more people died from the vaccine than from the flu is not a universal truth but a highly unusual set of facts. Had the swine flu reappeared, the historic record on the value of the vaccinations would have been different.

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