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Volume 12, Number 1—January 2006
THEME ISSUE
Influenza
History

Reflections on the 1976 Swine Flu Vaccination Program

David J. Sencer*Comments to Author  and J. Donald Millar†
Author affiliations: *Atlanta, Georgia, USA; †Murraysville, Georgia, USA

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Table

Lessons learned from the 1976 National Influenza Immunization Program (NIIP).

     1.Expect the unexpected: it will always happen. Some examples:
     •Children did not respond to the initial formulation of vaccine.
     •Liability for untoward events after immunization became a major issue.
     •Deaths occurred in Pittsburgh that were coincidental with but unrelated to the vaccines (8).
     •Cases of a new and unrelated disease, Legionnaires disease, appeared (9).
     •"Excess" cases of Guillain-Barré syndrome appeared among recipients of vaccines (10).
     •Erroneous laboratory reports of viral isolates or serologic conversions occurred in Washington, DC, Boston, Virginia, and Taiwan.
     •The pandemic failed to appear.
     2.Surveillance for influenza disease worked well. This was plain, "old-fashioned" surveillance without computers. A new strain of influenza was identified within weeks of the first recognized outbreak of illness.
     3.Interagency cooperation works without formal agreements. The state health departments, military, National Institutes of Health, US Food and Drug Administration, and Center for Disease Control all worked together in a cooperative and mutually beneficial manner.
     4.Surveillance for untoward events demonstrated that only when large numbers of people are exposed to a vaccine or drug are adverse reactions identified (Guillain-Barré syndrome with influenza vaccines; paralysis with the Cutter poliovirus vaccine in 1955).
     5.Health legislation can and should be developed on the basis of the epidemiologic picture.
     6.Media and public awareness can be a major obstacle to implementing a large, innovative program responding to risks that are difficult, if not impossible, to quantitate.
     •Creating a program as a presidential initiative makes modifying or stopping the program more difficult.
     •Explanations should be communicated by those who can give authoritative scientific information.
     •Periodic press briefings work better than responding to press queries.
     7.The advisability of the decision to begin immunization on the strength of the Fort Dix episode is worthy of serious question and debate (see text).
     8.The risk of potentially unnecessary costs in a mass vaccination campaign is minimal. (The direct cost of the 1976 program was $137 million. In today's dollars, this is <$500 million.) The potential cost of a pandemic is inestimable but astronomical.

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References
  1. Kilbourne  ED. Flu to the starboard! Man the harpoons! Fill with vaccine! Get the captain! Hurry! New York Times. 1976 Feb 13. p. 32, col. 4.
  2. Obama  B, Lugar  R. Grounding a pandemic. Op-ed section. New York Times. 2005 Jun 6. [cited 1 Nov 2005]. Available from http://www.nytimes.com/2005/06/06/opinion/06obama.html? ex=1130994000&en=1b199f715505a19c&ei=5070
  3. Unprepared for a flu pandemic [editorial]. New York Times. 2005 Jul 17; Sect. 4:11 (col. 1).
  4. Hodder  RA, Gaydos  JC, Allen  RG, Top  FH Jr, Nowosiwsky  T, Russell  PK. Swine influenza A at Fort Dix, New Jersey (January–February 1976). III. Extent of spread and duration of the outbreak. J Infect Dis. 1977;136:S369–75. DOIPubMedGoogle Scholar
  5. Dowdle  WR, Hattwick  MAW. Swine influenza virus infections in humans. J Infect Dis. 1977;136:S386–9. DOIPubMedGoogle Scholar
  6. Denny  FW, Glezen  WP, Karzon  DT, Katz  SL, Krugman  S, McIntosh  K, Swine-like influenza vaccine: a commentary. J Pediatr. 1976;88:1057. DOIPubMedGoogle Scholar
  7. Schwartz  H. Swine flu fiasco. New York Times. 1976 Dec. 21. p. 33, col. 1–2.
  8. Schmeck  HM Jr. More deaths reported after shots but no link to flu vaccine is found. New York Times. 1976 Oct 14; Sect. A:1+.
  9. Fraser  DW, Tsai  TR, Orenstein  W, Parkin  WE, Beecham  HJ, Sharrar  RG, Legionnaires' disease: description of an epidemic of pneumonia. N Engl J Med. 1977;297:1189–97. DOIPubMedGoogle Scholar
  10. Schonberger  LB, Hurwitz  ES, Katona  P, Holman  RC, Bregman  DJ. Guillain-Barré syndrome: its epidemiology and associations with influenza vaccination. Ann Neurol. 1981;9(Suppl):31–8. DOIPubMedGoogle Scholar
  11. Department of Health and Human services. Annex 11: Pandemic influenza response and preparedness plan. Washington: The Department; 2003 Aug 26.
  12. Dowdle  WR. Influenza pandemic periodicity, virus recycling, and the art of risk assessment. Emerg Infect Dis. 2006;12.PubMedGoogle Scholar
  13. Schoenbaum  SC, McNeil  BJ, Kavat  J. The swine-influenza decision. N Engl J Med. 1976;295:759–65. DOIPubMedGoogle Scholar

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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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