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Thursday, May 7, 2009

Lessons of 1976: flu, fear, wasted millions

By LES PERREAUX From Saturday's Globe and Mail

Governments scrambling for solutions to current outbreak risk repeating mistakes of a decades-old health-scare fiasco

MONTREAL — The great swine-flu scare of 1976 is remembered in the United States as a costly public-health fiasco during which more people died from vaccinations than the dreaded influenza.

In Canada, it's hardly remembered at all, though it remains vivid to Marc Lalonde, who as federal health minister in 1976 ordered some 10 million doses of vaccine.

“Ah, mon Dieu, that was the time I threw away $10-million,” Mr. Lalonde said in an interview yesterday. “But that is the nature of these things. If you do too little, you are accused of negligence. If you do too much, you are wasting money and causing panic. These are very difficult calls.”

Canadian and international health authorities are facing similar tough decisions as the flu continued to spread yesterday.

In Canada, the number of confirmed flu cases climbed to 51, as Nova Scotia, Ontario and British Columbia reported several new cases each, all of them accompanied by dire warnings that additional cases were all but certain and deaths a very real possibility. Prime Minister Stephen Harper said he did not “sense a panic” in the country.

The government announced an expanded prevention campaign that will target mainstream media and social-networking sites such as Facebook, Twitter and YouTube, and emphasize the importance of hand-washing, covering sneezes and staying home when sick.

As the World Health Organization and public-health officials and scientists pursue a vaccine for the 2009 flu outbreak, the Canadian and U.S. experiences from 1976 offer contrasting cautionary tales.


The waste of some dollars in Canada back in 1976 was nothing next to the hysteria triggered in the U.S. by a toxic mix of flu, suspicion and politics.

When a sudden February outbreak of flu killed a single soldier at Fort Dix in New Jersey, officials in Ottawa warned Mr. Lalonde: Deadly swine flu could be on the way. With little fanfare, Mr. Lalonde ordered the vaccine and offered it to the provinces to distribute.

“There was no big announcement about it,” he said. “If there was a big announcement and nothing happened, we'd be accused of throwing away money afterward. But we wanted to go on the side of prudence.”

As it turned out, there was no flu pandemic. Only 800,000 Canadians, mostly in Ontario, bothered to get the flu shot. The next year, Canada's nine million unused doses of vaccine expired and were eventually flushed.

In the U.S., President Gerald Ford was in the thick of primary election campaigning when the flu struck down the soldier. In March of 1976, he assembled a summit of scientists and ordered vaccinations for all 220 million Americans.

By December, 45 million Americans had received the shot but the program was in tatters. Two dozen deaths from Guillain-Barré Syndrome were blamed on the vaccine, though no conclusive link was ever proven.

The swine influenza outbreak was limited to the one death and a couple hundred sick soldiers in the barracks at Fort Dix. Scientists never solved the mystery of the outbreak's origin and limited spread.

The head of the U.S. Centers for Disease Control was fired and Gerald Ford lost to his Democratic opponent, Jimmy Carter, although the flu fiasco was just one factor in his defeat.


The world was due for a flu pandemic on the chilly day in February, 1976, when Private David Lewis told a superior he was feeling under the weather.

The 19-year-old army recruit still insisted on setting out from Fort Dix on the day's big hike.

Twenty-four hours later, Pte. Lewis was dead. Within two weeks, public-health officials announced to Americans that the swine flu, which was erroneously believed to be at the root of the catastrophic 1918 pandemic, was back.

President Ford, fighting Ronald Reagan for the Republican nomination and desperate to show he was a man of action, quickly convened experts, including Dr. Jonas Salk and Dr. Albert Sabin, the men behind the polio vaccine.

Time was pressing. The full brunt of any influenza epidemic was expected with flu season the following autumn, and several months would be needed to produce enough vaccine. In an added twist, the flock of specialized chickens whose eggs were used to produce the annual flu vaccine was about to be slaughtered.

One month after Pte. Lewis's death, President Ford, with Dr. Salk and Dr. Sabin sharing the stage, announced on national television that the government would spend $135-million to “inoculate every man, woman and child in the United States.”

Mr. Ford tried to walk the now-familiar line between warning citizens and provoking panic.

“There is a very real possibility that unless we take effective counteractions, there could be an epidemic of this dangerous disease next fall and winter here in the United States,” President Ford said. He then added that the “facts suggest there is no cause for alarm.”

U.S. health authorities added to the anxiety, airing ominous public-service announcements warning how easily death could be spread. One TV sample is now the butt of jokes on YouTube. (Click on title above to see video)

In 1976, Dr. Ronald St. John was a public-health foot soldier mesmerized by the battle plan on the wall of his boss's office at the U.S. Centers for Disease Control in Atlanta. The chart mapped out how the government would implement President Ford's plan. But there were unexpected pitfalls.


The vaccine got a serious image problem after pharmaceutical companies loudly demanded and received immunity from civil suits that might arise from complications. And arise, they did. Within months, a spike in cases of paralysis from Guillain-BarrĂ© Syndrome – a disorder in which the body's immune system attacks part of the peripheral nervous system – was reported, including 25 deaths. The cases were quickly pinned on the vaccine and the U.S. government spent $90-million settling lawsuits. (Reports later surfaced of a few mild cases of GBS in Canada.) In the wake of Watergate and the Vietnam War, many U.S. citizens were prepared to believe that officials were trying to hide serious complications when they insisted the vaccine was safe.

“The deaths were never definitively proven to be caused by the vaccine … but nobody trusted the federal government with anything,” said Dr. Howard Markel, a physician and medical historian at the University of Michigan.

With no new flu cases, the U.S. vaccination program was halted in mid-December of 1976. Canada also mothballed the vaccine.

Dr. St. John, who had a 30-year career at the CDC before moving to Health Canada and eventually taking charge of pandemic preparedness, said it's too simplistic to write off the 1976 experience as a pointless fiasco.

“You had a difficult dilemma, making decisions with uncertain and incomplete information,” said Dr. St. John, who retired from Health Canada in 2006. “There was a possibility of a very high mortality rate and there were a lot of unknowns. The reaction cost the director of the CDC his job and it wasn't fair. Too late, too early – it's a tough decision.”

But history shows public co-operation may be a more effective tool than vaccine to fight flu pandemics, according to Andrew Nikiforuk, the author of Pandemonium: Bird Flu, Mad Cow Disease and other Biological Plagues of the 21st Century.

“In the course of any real pandemic, you're never going to have enough drugs, and the vaccine will not be there. Even if you did have the vaccine available, how the hell are you going to vaccinate people without spreading disease?” said Mr. Nikiforuk. “The interventions that have worked are really what Mexico has done. You shut down.”

Research by science historian Jane Jenkins has shown that a ban on gatherings and other public-health measures drastically reduced the death rate in New Brunswick during the 1918 flu outbreak.

“We tend to think modern science is going to save us, when washing your hands and avoiding getting sneezed on is probably what's going to save you,” said Prof. Jenkins of St. Thomas University in Fredericton.

“Having said that, vaccines today are pretty safe. I don't think I'd turn down a vaccine if one came along.”

The University of Michigan's Dr. Markel said his research has convinced him the 1976 U.S. program was far from a misguided disaster.

“The words ‘fiasco' and ‘failure' were attached to it forever, but political theatre is different from medical science, even if they sometimes collide in the field of public health,” he said.

“If I had been in the room, I would have done the same thing. And I suspect officials today will be making the same decision soon.”



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