The Coming Plague (116 page)
Authors: Laurie Garrett
6. The American Bicentennial
1
A great deal has been written about the Swine Flu crisis of 1976, and though interpretations of events differ markedly, the basic facts are fairly consistent. Key sources of such information include: P. M. Boffey, “Anatomy of a Decision: How the Nation Declared War on Swine Flu,”
Science
192 (1976): 636â41; P. M. Boffey, “Swine Flu Vaccination Campaign: The Scientific Controversy Mounts,”
Science
193 (1976): 559â63; P. M. Boffey, “Swine Flu Vaccine: A Component Is Missing,”
Science
193 (1976): 1224â25; P. M. Boffey, “GuillainâBarré: Rare Disease Paralyzes Swine Flu Campaign,”
Science
195 (1976): 155â59; W. Dowdle and J. LaPatra,
Informed Consent: Influenza Facts and Myths
(Chicago: NelsonâHall, 1983); General Accounting Office,
The Swine Flu Program: An Unprecedented Venture in Preventive Medicine,
report to the U.S. Congress, Washington, D.C., 1977; R. M. Henig, “Flu Pandemic, a Once and Future Menace,”
The New York Times Magazine,
November 29, 1992: 28â31, 55â67; R. M. Henig, “The Emergence of a New Flu,” Chapter 7 in R. M. Henig,
A Dancing Matrix
(New York: Alfred A. Knopf, 1993); R. E. Neustadt and H. V. Fineberg,
The Swine Flu Affair: Decision-Making on a Slippery Slope
(Washington, D.C.: U.S. Department of Health, Education, and Welfare, 1978); R. E. Neustadt and H. V. Fineberg,
The Epidemic That Never Was: Policy-Making and the Swine Flu Affair
(New York: Random House, 1982); J. E. Osborn, ed., “
Influenza in America 1918â1976 (
New York: Prodist, 1977); A. M. Silverstein,
Pure Politics and Impure Science: The Swine Flu Affair
(Baltimore: Johns Hopkins University Press, 1981); and Swine Flu Supplement,
Journal of Infectious Diseases
136 (December 1977).
Science
192 (1976): 636â41; P. M. Boffey, “Swine Flu Vaccination Campaign: The Scientific Controversy Mounts,”
Science
193 (1976): 559â63; P. M. Boffey, “Swine Flu Vaccine: A Component Is Missing,”
Science
193 (1976): 1224â25; P. M. Boffey, “GuillainâBarré: Rare Disease Paralyzes Swine Flu Campaign,”
Science
195 (1976): 155â59; W. Dowdle and J. LaPatra,
Informed Consent: Influenza Facts and Myths
(Chicago: NelsonâHall, 1983); General Accounting Office,
The Swine Flu Program: An Unprecedented Venture in Preventive Medicine,
report to the U.S. Congress, Washington, D.C., 1977; R. M. Henig, “Flu Pandemic, a Once and Future Menace,”
The New York Times Magazine,
November 29, 1992: 28â31, 55â67; R. M. Henig, “The Emergence of a New Flu,” Chapter 7 in R. M. Henig,
A Dancing Matrix
(New York: Alfred A. Knopf, 1993); R. E. Neustadt and H. V. Fineberg,
The Swine Flu Affair: Decision-Making on a Slippery Slope
(Washington, D.C.: U.S. Department of Health, Education, and Welfare, 1978); R. E. Neustadt and H. V. Fineberg,
The Epidemic That Never Was: Policy-Making and the Swine Flu Affair
(New York: Random House, 1982); J. E. Osborn, ed., “
Influenza in America 1918â1976 (
New York: Prodist, 1977); A. M. Silverstein,
Pure Politics and Impure Science: The Swine Flu Affair
(Baltimore: Johns Hopkins University Press, 1981); and Swine Flu Supplement,
Journal of Infectious Diseases
136 (December 1977).
2
According to base officials, windchills at Fort Dix during January 1976 ranged from 0°F to - 45°F, and snowfall was heavy and frequent.
3
Centers for Disease Control,”Current Trends: InfluenzaâUnited States,”
Morbidity and Mortality Weekly Report
25 (1976): 47â48.
Morbidity and Mortality Weekly Report
25 (1976): 47â48.
4
W. I. B. Beveridge,”The Chronicle of Influenza Epidemics,”
History and Philosophy of Life
Sciences 13 (1991): 223â35.
History and Philosophy of Life
Sciences 13 (1991): 223â35.
Influenza is an ancient microbe that has appeared in millions of different forms over the millennia, periodically producing devastating epidemics. Some outbreaks caused debilitating illnesses in well over half the populations of vast areas, such as all of continental Europe. Only a few epidemics are thought to have also produced mass mortality, claiming the lives of over 5 percent of those infected with the influenza virus. A rough estimate of historic pandemics follows:
5
Beveridge (1991), op. cit., note 1.
6
It may well be the case that the AIDS epidemic will by 1999 surpass the horrible toll taken by influenza in 1918â19, making AIDS the worst pandemic of the twentieth century. In early 1993, the World Health Organization forecast a cumulative total of 40 million HIV infections by the end of 1999, and 8 million cumulative AIDS deaths. A more frightening projection from the Harvard-based Global AIDS Policy Coalition predicts up to 120 million cumulative HIV infections by that time and 20.4 million deaths. Regardless of the horrible eventual toll of AIDS, however, it will undoubtedly remain the case that the influenza pandemic merits the gruesome ranking of the number one global killer in this century, as the bulk of the planet's HIV-infected population will not die until after the millennium.
7
Beveridge (1977), op. cit.
8
D. Scott,
Epidemic Disease in Ghana 1901â1960
(London: Oxford University Press, 1965).
Epidemic Disease in Ghana 1901â1960
(London: Oxford University Press, 1965).
9
A. W. Crosby, “The Influenza Pandemic of 1918,” in Osborn (1977), op. cit., pp. 5â13.
10
Excellent anecdotal accounts of the 1918 epidemic can be found in A. A. Hoehling,
The Great Epidemic
(Boston: Little, Brown, 1961); and A. W. Crosby,
Epidemic and Peace, 1918
(London: Greenwood Press, 1976).
The Great Epidemic
(Boston: Little, Brown, 1961); and A. W. Crosby,
Epidemic and Peace, 1918
(London: Greenwood Press, 1976).
11
R. E. Shope, “Swine Influenza,” Harvey Lectures 31 (1936): 183â213.
12
The CDC's
Morbidity and Mortality Weekly Report
chronicles the spread of A/Victoria/75 week after week. The week Private Lewis fell ill at Fort Dix, for example, there were A/Victoria/75 outbreaks in Johannesburg, the United Kingdom, and the American states of Arizona, Washington, Iowa, Minnesota, Massachusetts, New York, and New Jersey. See
MMWR
25 (January 24, 1976): 23â24.
Morbidity and Mortality Weekly Report
chronicles the spread of A/Victoria/75 week after week. The week Private Lewis fell ill at Fort Dix, for example, there were A/Victoria/75 outbreaks in Johannesburg, the United Kingdom, and the American states of Arizona, Washington, Iowa, Minnesota, Massachusetts, New York, and New Jersey. See
MMWR
25 (January 24, 1976): 23â24.
13
H. M. Rose, “Influenza: The Agent,”
Hospital Practice
, August 1971: 49â56.
Hospital Practice
, August 1971: 49â56.
14
A. D. Langmuir, “Influenza: Its Epidemiology,”
Hospital Practice,
September 1971: 103â8.
Hospital Practice,
September 1971: 103â8.
15
E. D. Kilbourne, “An Explanation of the Interpandemic Antigenic Mutability of Influenza Viruses,”
Journal of Infectious Diseases
128 (1973): 668â70. For an excellent detailing of widely accepted influenza theories of the day, see Edwin Kilbourne's
Influenza
(New York: Plenum, 1987).
Journal of Infectious Diseases
128 (1973): 668â70. For an excellent detailing of widely accepted influenza theories of the day, see Edwin Kilbourne's
Influenza
(New York: Plenum, 1987).
16
E. D. Kilbourne,
New York Times
, February 13, 1976: A33.
New York Times
, February 13, 1976: A33.
17
N. Masurel and W. M. Marine, “Recycling of Asian and Hong Kong Influenza A Virus Hemagglutinins in Man,”
Scientific American
97 (1973): 48â49.
Scientific American
97 (1973): 48â49.
18
Rose (1971), op. cit.
19
Beveridge (1977), op. cit.
20
The proceedings of the Rougemont gathering were later published by the Sandoz Institute for Health and Socio-Economic Studies,
Influenza: Virus Vaccines and Strategy
, ed. Philip Selby (New York: Academic Press, 1976).
Influenza: Virus Vaccines and Strategy
, ed. Philip Selby (New York: Academic Press, 1976).
21
In 1980 over 100 wild seals washed ashore around Boston and Cape Cod, victims of influenza. Webster and his colleagues studied the viral RNA, matching it to influenza strains then common among ducks and sea gulls. Three years later, influenza, apparently spread by migratory bird droppings, broke out in Pennsylvania in a massive commercial chicken house. Every single chicken died. From “Influenza,” in S. S. Morse, ed.,
Emerging Viruses
(Oxford, Eng.: Oxford University Press, 1993, R. G. Webster, 37â45.
Emerging Viruses
(Oxford, Eng.: Oxford University Press, 1993, R. G. Webster, 37â45.
22
During a 1993 interview, Sencer took a deep breath when the subject of Swine Flu was broached, smiled, and discussed an old
Peanuts
cartoon strip in which the pooch is sitting atop his doghouse typing a manuscript entitled “Swine Flu.” The first words of the manuscript read, “It was a dark and stormy night ⦔
Peanuts
cartoon strip in which the pooch is sitting atop his doghouse typing a manuscript entitled “Swine Flu.” The first words of the manuscript read, “It was a dark and stormy night ⦔
23
Centers for Disease Control, “Current Trends: InfluenzaâUnited States,”
Morbidity and Mortality Weekly Report
25 (1976): 47â48.
Morbidity and Mortality Weekly Report
25 (1976): 47â48.
24
Ibid., 55â56.
25
Ibid., 124.
26
Dowdle and LaPatra (1983), op. cit.
27
A. S. Beare and J. W. Craig, “Virulence for Man of a Human Influenza-A Virus Antigenically Similar to âClassical' Swine Viruses,”
Lancet,
July 3, 1976, 4â5.
Lancet,
July 3, 1976, 4â5.
28
C. Stuart-Harris, “Swine Influenza Virus in ManâZoonosis or Human Pandemic?”
Lancet,
July 3, 1976: 31â32.
Lancet,
July 3, 1976: 31â32.
29
“Planning for Pandemics,”
Lancet,
July 3, 1976: 25â26.
Lancet,
July 3, 1976: 25â26.
30
Centers for Disease Control, “Influenza VaccineâSupplemental Statement,”
Morbidity and Mortality Weekly Report
25 (1976): 221â27: and Boffey, “Swine Flu Vaccination Campaign” (1976), op. cit.
Morbidity and Mortality Weekly Report
25 (1976): 221â27: and Boffey, “Swine Flu Vaccination Campaign” (1976), op. cit.
31
There are several sources for valuable insights into the 1976â77 Legionnaires' Disease investigation. Particularly useful are
Annals of Internal Medicine
90, No. 4 (1979) (special issue devoted to Legionnaires' Disease); Centers for Disease Control,
Legionnaires
':
The Disease, the Bacterium and Methodology,
(Atlanta: U.S. Department of Health, Education, and Welfare, 1979); F. W. Chandler, M. D. Hicklin, and J. A. Blackmon, “Demonstration of the Agent of Legionnaires' Disease in Tissue,”
New England Journal of Medicine
297 (1977): 1218â20; D. W. Fraser et al., “Legionnaires' Disease: Description of an Epidemic of Pneumonia,”
New England Journal of Medicine
297 (1977): 1189â97; G. L. Lattimer and R. A. Ormsbee,
Legionnaires' Disease
(New York: Marcel Dekker, 1981); J. E. McDade et al., “Legionnaires' Disease: Isolation of a Bacterium and Demonstration of Its Role in Other Respiratory Disease,”
New England Journal of Medicine
297 (1977): 1197â1203; and Silverstein (1981), op. cit., Chapter 10.
Annals of Internal Medicine
90, No. 4 (1979) (special issue devoted to Legionnaires' Disease); Centers for Disease Control,
Legionnaires
':
The Disease, the Bacterium and Methodology,
(Atlanta: U.S. Department of Health, Education, and Welfare, 1979); F. W. Chandler, M. D. Hicklin, and J. A. Blackmon, “Demonstration of the Agent of Legionnaires' Disease in Tissue,”
New England Journal of Medicine
297 (1977): 1218â20; D. W. Fraser et al., “Legionnaires' Disease: Description of an Epidemic of Pneumonia,”
New England Journal of Medicine
297 (1977): 1189â97; G. L. Lattimer and R. A. Ormsbee,
Legionnaires' Disease
(New York: Marcel Dekker, 1981); J. E. McDade et al., “Legionnaires' Disease: Isolation of a Bacterium and Demonstration of Its Role in Other Respiratory Disease,”
New England Journal of Medicine
297 (1977): 1197â1203; and Silverstein (1981), op. cit., Chapter 10.
32
Some of the most important features of Public Law 94â380 are as follows:
Informed Consent
. The law required that the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research draft “a written informed consent form and procedures for assuring that the risks and benefits from the swine flu vaccine are fully explained to each individual to whom such vaccine is to be administered. Such consultation shall be completed within two weeks after enactment of this Act, or by September 1, 1976, whichever is sooner. Such procedures shall include the information necessary to advise individuals with respect to their rights and remedies arising out of the administration of such vaccine.”
. The law required that the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research draft “a written informed consent form and procedures for assuring that the risks and benefits from the swine flu vaccine are fully explained to each individual to whom such vaccine is to be administered. Such consultation shall be completed within two weeks after enactment of this Act, or by September 1, 1976, whichever is sooner. Such procedures shall include the information necessary to advise individuals with respect to their rights and remedies arising out of the administration of such vaccine.”
Pharmaceutical Industry Profiteering
. “Any contract for procurement by the United States of swine flu vaccine from a manufacturer of such vaccine shall ⦠be subject to renegotiation to eliminate any profit realized from such procurement ⦠as determined pursuant to criteria prescribed ⦠and the contract shall expressly so provide.”
. “Any contract for procurement by the United States of swine flu vaccine from a manufacturer of such vaccine shall ⦠be subject to renegotiation to eliminate any profit realized from such procurement ⦠as determined pursuant to criteria prescribed ⦠and the contract shall expressly so provide.”
Litigation.
“ ⦠in order to be prepared to meet the potential emergency of a swine flu epidemic, it is necessary that a procedure be instituted for the handling of claims by persons alleging such injury or death until Congress develops a permanent approach for handling claims arising under programs of the Public Health Service Act.”
“ ⦠in order to be prepared to meet the potential emergency of a swine flu epidemic, it is necessary that a procedure be instituted for the handling of claims by persons alleging such injury or death until Congress develops a permanent approach for handling claims arising under programs of the Public Health Service Act.”
“The Attorney General shall defend any civil action or proceeding brought in any court against any employee of the Government ⦠or program participant ⦠based upon a claim alleging personal injury or death arising out of the administration of vaccine under the swine flu program.”
Timing
. The bill did not take effect until September 30, 1976. Prior to that date, pharmaceutical manufacturers, or their insurers, carried full liability.
. The bill did not take effect until September 30, 1976. Prior to that date, pharmaceutical manufacturers, or their insurers, carried full liability.
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