Here's a book I located in Global
Health Archive on what happened in 1976, when swine flu caused an outbreak
in man in the USA. This outbreak was dealt with using a mass vaccination campaign. The
political fallout was huge however because the vaccine produced cases of
paralysis. It illustrates public
health dilemmas when considering vaccination against disease.
At the time no action wasn't an option as the 1918 epidemic loomed large in
the public consciousness and that was linked to swine.
History, science and politics. Influenza in America 1918-1976. Editor:
OSBORN, J. E., 1977, 135 pp. Neale Watson Academic Publications, Inc., 156 Fifth
Avenue, New York, N. Y. 10010, U.S.A. ISBN: 0-88202-1761
This small book, which is based on a symposium held in 1977, sets forth the
various factors that led to the mass vaccination campaign against swine
influenza in the U.S.A. during 1976, and its eventual abandonment when some
cases of Guillain-Barre syndrome occurred among those vaccinated. In the first
chapter (The influenza pandemic of 1918, p. 5), A. W. CROSBY, Jr provides a
historical survey of the " Flu, " from its initial appearance in the
spring of 1918 to the end of its third wave of infection in the spring of the
following year. This is illustrated by a description of the impact of the
pandemic on the city of San Francisco, where there were 3500 deaths, mostly in
the 20-40 years age-group, in a total population of 550 000. J. D. MILLAR and J.
E. OSBORN (Precursors of the scientific decision-making process leading to the
1976 National Immunization Campaign, p. 15) outline the options open to the U.S.
Government when swine influenza virus was isolated from an outbreak at Fort Dix.
The extreme of doing nothing was rejected as irresponsible in the light of the
distastrous 1918 pandemic, so the choice lay between stockpiling a vaccine and
mounting a mass vaccination programme. The scientific consensus was for the
latter course, because of the danger of failure if vaccination was delayed until
the first signs of an imminent epidemic. A. J. VISELTEAR (A short political
history of the 1976 swine influenza legislation, p. 29) continues the saga by
recounting the political activities that led to the enactment of the "
National Swine Flu Immunization Program " of 1976. It was during this stage
that opposition to the proposed campaign became evident; this arose mainly from
the media, with the scientific community still predominantly in favour of
vaccination. In addition, the Government encountered problems with the
pharmaceutical industry and insurance companies over indemnity against claims
attributable to vaccination. The reader of this chapter cannot escape feeling
sorry for the administration in their dilemma. As Sabin is quoted as saying,
"We were damned if we did and damned if we didn't." Nevertheless it
was decided that it was " better to have an immunization program without an
epidemic, than an epidemic without an immunization program, " and mass
immunization was started. The deaths of three elderly and ill persons shortly
after they had been vaccinated, the apparent association of the Guillain-Barre
syndrome with vaccination in some others, together with the realization that
there was not going to be an epidemic brought an abrupt conclusion to the
ill-fated project. In fact, the conclusion was so abrupt that special
legislation was needed in order that influenza vaccine could be used when an
outbreak of influenza due to A/Victoria virus occurred. This, and other
aftermaths of the vaccination programme, are described in the final chapter by
the editor, J. E. OSBORN (Epilogue-the costs and benefits of the National
Immunization Program of 1976, p. 59). The book concludes with appendices
containing the relevant legislation and extracts from the Congressional Record.
It makes fascinating reading, not only for virologists and epidemiologists, but
for anyone interested in the interplay, in the U.S.A., of science, politics and
the media on matters of grave importance to public health. E. A. Boulter.