Lessons from 1976 flu "debacle"

Warren Ward, 48, was in high school when the swine-flu threat of 1976 swept the United States. The Whittier, Calif., man remembers the episode vividly because a relative had died in the 1918 flu pandemic and the '76 illness was feared to be a direct descendant of that deadly virus.

"The government wanted everyone to get vaccinated," Ward recalled. "But the epidemic never really broke out. It was a threat that never materialized."

What did materialize were cases of a rare side effect believed to be linked to the shot. The unexpected development cut short the vaccination effort — an unprecedented national campaign — after only 10 weeks. The episode triggered an enduring public backlash against flu vaccinations, embarrassed the federal government and cost the director of the U.S. Center for Disease Control, now known as the Centers for Disease Control and Prevention (CDC), his job.

The swine-flu brush of 1976 — some call it a "debacle" — holds critical lessons for the government and health officials who must decide how to react to the new swine-flu threat in the days and weeks ahead.

The question of whether politics overtook science in 1976 still haunts the people involved and has been the fodder of books, articles and discussions.

The panic in 1976 was blamed, in part, on the belief — now known to be erroneous — that the 1918-1919 flu pandemic, which killed half a million Americans and an estimated 20 million people worldwide, was caused by a virus with swine components. Recent research suggests instead that it was avian flu — but that seems unlikely to assuage the anxiety over the current outbreak.

The episode began in February 1976, when an Army recruit at Fort Dix, N.J., fell ill and died suddenly from a swine-flu virus thought to be similar to the 1918 strain. Several other soldiers at the base also became ill. Shortly thereafter, Dr. Richard Wenzel, chairman of internal medicine at Virginia Commonwealth University, and his colleagues reported two cases in Virginia.

"That raised the concern that the original cluster at Fort Dix had spread beyond New Jersey," said Wenzel, the immediate past president of the International Society for Infectious Diseases.

At CDC, Dr. David Sencer, the director who led the government's response to the '76 threat, solicited the opinions of infectious-disease specialists nationwide and, in March, called on President Ford and Congress to begin mass inoculations.

The $137 million program began in early October, but within days reports emerged that the vaccine appeared to increase the risk for Guillain-Barre syndrome, a rare neurological condition that can be fatal.

Waiting in long lines at schools and clinics, more than 40 million Americans — almost 25 percent of the population — were vaccinated before the program was halted in December after only 10 weeks.

More than 500 people are thought to have developed Guillain-Barre syndrome after receiving the vaccine and 25 died. No one completely understands what causes Guillain-Barre in certain people, but the condition can develop after a bout with infection or following surgery or vaccination. The federal government paid millions in damages to people who developed the condition or their families.

But the pandemic, which some experts estimated at the time could infect 50 million to 60 million Americans, never unfolded. Only about 200 cases of swine flu and one death were ultimately reported in the United States, according to the CDC.

The public viewed the entire episode as political farce, says Sencer, instead of a dedicated, science-based effort to protect public health. He says the government chose to err on the side of caution and risk scorn — something experts working on the current outbreak may also face.

"If we had that knowledge then, we might have done things differently," says Sencer, who is now retired. "We did not know what sort of virus we were dealing with in those days. No one knew we would have Guillain-Barre syndrome. The flu vaccine had been used for many years without that happening. If that hadn't happened, no one would have had any concern about the program."

Wenzel also recommended vaccination in 1976.

"It was a tremendous program," he says. "It was a great effort. It just had unexpected, unfortunate side effects."

In Mexico, where several dozen people have died from the current swine-flu outbreak, government officials are under fire. But people fail to understand the challenges faced by health officials in the face of a mysterious threat, says Dr. Peter Katona, an infectious-disease expert at the University of California, Los Angeles.

"You have to look at not only 1976 but 1918," he says. "The pandemic flu that occurred in 1918 lasted a year and a half. In 1976, we didn't know what was going to happen. The virus might burn out. It might proliferate. These viruses have a mind of their own, and we don't know how to predict what will happen."

CDC officials have been wisely circumspect in their comments about the current outbreak, Sencer says.

"I like the fact that they have said, 'We may change our minds,' " he says. "Don't expect health officials to have the answers overnight. These things need time to be sorted out. We're still in the learning curve."