[Paleopsych] NYT: Lessons From a Plague That Wasn't

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Lessons From a Plague That Wasn't
http://www.nytimes.com/2005/10/23/weekinreview/23pollack.html

    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
    happened?

    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
    then.

    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
    available today.

    "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
    today."

    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
    some.

    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."