[Paleopsych] NYT: Lessons From a Plague That Wasn't
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Thu Oct 27 01:58:59 UTC 2005
Lessons From a Plague That Wasn't
By ANDREW POLLACK
PUBLIC health experts warn that the world might be close to a repeat
of the flu pandemic of 1918, which killed millions. But could it
instead be close to a reprise of the 1976 pandemic that never
That is the year President Gerald R. Ford announced a crash program to
"inoculate every man, woman and child in the United States" against
swine flu. But the virus never became a killer, and vaccinations were
halted two months after they began after reports that 500 people who
received the shot developed a paralyzing nerve disease and more than
30 of them died.
If scientists were wrong in 1976, could they be wrong now? Some
arguments being made about why a pandemic is looming echo those made
three decades ago. But many experts say the situation now is different
enough that a false alarm is less likely.
"We just know a lot more about the influenza virus than we did in
1976," said Ira M. Longini Jr., a professor at Emory University who is
an expert on epidemics.
Still, a lot can be learned both from what did and did not happen back
The 1976 scare started in February when a handful of soldiers at Fort
Dix in New Jersey got sick and one of them died. Scientists determined
that the virus was one that infected pigs and was different from the
human influenza viruses circulating then. On March 24, barely a month
later, President Ford announced the vaccination plan.
One reason for the concern was that scientists thought the 1918
pandemic had been caused by a swine virus and that the Fort Dix
outbreak marked its second coming. Furthermore, experts warned that
pandemics tended to be cyclical and that another one was about due.
Today, thanks to genetic analysis - a technique not available in 1976
- scientists know the 1918 virus was a bird virus that mutated. So now
there is concern that the H5N1 avian strain ravaging birds in Asia
could in like fashion evolve into a form that can spread easily among
people. The avian virus shows some mutations similar to those in the
1918 virus, said Jeffery K. Taubenberger of the Armed Forces Institute
of Pathology. And experts are again warning that the world is overdue
for a pandemic.
Edwin M. Kilbourne, a professor emeritus at New York Medical College
who argued for the vaccination program in 1976, said there was
actually less reason to be concerned about a pandemic today. That is
because the swine flu virus at Fort Dix clearly passed easily from
person to person, while the current avian flu has not.
Many experts disagree, however. In retrospect, they say, the 1976
decision to vaccinate was based on much less solid evidence than is
"Part of the problem was convictions outpacing evidence," said Harvey
V. Fineberg, president of the Institute of Medicine, part of the
National Academies, and co-author of "The Epidemic That Never Was," a
book about the 1976 experience. "I don't think that's happening
Even in 1976 there seemed to be more doubt than there is today about
the issue. The World Health Organization and many European nations,
for instance, did not see what the fuss was about. Today, they are
busily preparing for a pandemic.
Doubts grew through the summer of 1976 when the virus was not detected
outside Fort Dix. That first death turned out to be the only known one
from the virus. Moreover, studies suggested that several hundred
people at Fort Dix had been infected but most never got sick.
"That's very different from 120 cases with half the humans dying,"
said Dr. Fineberg, referring to the approximate toll so far from the
Asian bird flu.
Perhaps the biggest mistake in 1976 was giving the vaccine to millions
of people rather than just stockpiling it until clearer signs of an
epidemic emerged. W. Paul Glezen, a professor at Baylor College of
Medicine in Houston, said the prevailing belief was "we should use it
because if it started spreading there wouldn't be time."
The vaccination program had problems. Production was delayed after one
company produced the wrong vaccine. Another delay occurred when
manufacturers demanded that Congress protect them from liability. Mass
inoculations did not start until October, which might have been too
late had a pandemic begun.
Still, by the time the program was halted in December, only 10 months
after the virus was identified, about 150 million doses had been made
and 45 million given.
There are lessons from 1976 that might be applied to today's
preparations. A 2004 draft of a government plan for a pandemic listed
One is that "making clear what is not known is as important as stating
what is known." Another is that a program should be re-evaluated
periodically rather than left on autopilot.
And this time, federal officials said, the vaccine won't be used until
there are signs a pandemic is under way.
Dr. Fineberg said another lesson is that Congress should provide
liability protection for vaccine makers now, rather than waiting until
the crisis occurs.
He said the wrong lesson to draw from 1976 would be "the superficially
obvious one" - that because it didn't happen then it won't happen now
and preparations are not necessary.
Still, repeated cries of wolf can make the public blasé.
"There's so much expectation for it to develop into a pandemic that if
it does not in the next year or two it's quite possible you would see
a backlash like the 1976 experience," said Dr. Taubenberger. "What I
fear is that people would make the conclusion, falsely, that influenza
is not such an important public health problem."
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