The Coming Plague (31 page)
Authors: Laurie Garrett
The CDC investigation, led by veteran disease detective Dr. David Fraser, searched on all fronts, abandoning few theories, no matter how tenuous. All the disease survivors and their available relatives, and over 4,400 Legionnaires and families, were questioned repeatedly, cadavers were autopsied at the microscopic level, and hospital staff that had treated the ailing hotel guests were grilled for hours on end. Most of the victims were Legionnaires, or spouses who had accompanied their veteran husbands to the convention's cocktail parties and banquets. Some hotel staff got sick, but none of their families appeared to be affected. The only clue that tied all the cases together was the victims' presence in the five Philadelphia hotels that hosted the Legionnaires' convention.
By September, the focus shifted completely to the hotels in which the Legionnaires and their spouses had stayed during the convention. Heymann and half the CDC team were housed in the Bellevue-Stratford Hotel. As the investigation dragged on, they were just about the only patrons of Philadelphia's revered landmark hotel. Less than a year later, unable to counter the torrent of negative publicity, the Bellevue-Stratford's management would be forced to close the seventy-two-year-old hotel.
Like the lab boys, the CDC field team was stumped. Members collected air, water, soil, dirt, and materials samples from every room that had been occupied in Philadelphia hotels during July. They questioned hotel staff and reviewed pneumonia records from all local hospitals. None of the collected samples seemed to contain a questionable microbe or toxic chemical.
Grabbing at straws, Fraser sent Heymann out to track down a magician. Just prior to the Legionnaires' gathering, hundreds of magicians had held their annual convention in the Bellevue-Stratford. Heymann's task was to discern whether the conjurers had used any unusual devices or chemicals in the creation of their illusions. The sorcerers had not used anything,
however, that hadn't been part of the magicians' standard bag of tricks for centuries.
however, that hadn't been part of the magicians' standard bag of tricks for centuries.
Back in Atlanta, Sencer was taking phone calls twenty-four hours a day from anyone who had a helpful theory. Most came from “well-intentioned nuts,” as Sencer kindly called them, but some represented plausible explanations that the CDC director passed on to his crew in Philadelphia. Though it meant weeks of interrupted sleep, Sencer felt it necessary to make himself available at all hours to public suggestions in order to quell panic and head off accusations of cover-up or stonewalling at the CDC.
But accusations came anyway. From Congress.
On October 27 the congressional Subcommittee for Consumer Protection, part of the House Interstate and Foreign Commerce Committee, released a report that not only condemned the CDC's efforts in Philadelphia but accused the agency of sabotaging its own inquiry.
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Chaired by Congressman John M. Murphy, a Democrat from Staten Island, New York, the committee lashed out with unusual venom. The CDC spent too much time trying to prove Swine Flu had struck Philadelphia, the report charged, and in the course of its overly virus-focused investigation, lost tissue and urine samples that might have demonstrated that a toxin or chemical caused the ailments.
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Chaired by Congressman John M. Murphy, a Democrat from Staten Island, New York, the committee lashed out with unusual venom. The CDC spent too much time trying to prove Swine Flu had struck Philadelphia, the report charged, and in the course of its overly virus-focused investigation, lost tissue and urine samples that might have demonstrated that a toxin or chemical caused the ailments.
“It appears to be the consensus of opinion that the failure to save, take, and keep free from contamination the tissue of the victims of the epidemic is clearly the reason that ultimate resolution of the cause of the Legionnaires' disease may never be found,” the report accused. At the top of the list of potential chemical killers, the report concluded, was nickel carbonyl, an odorless, unstable compound that can produce some of the same symptoms seen among the Legionnaires.
Dr. William F. Sunderman, Jr., of the University of Connecticut School of Medicine, studied some Legionnaires' lung tissue samples in mid-September, concluding that unusually high levels of nickel were present. But by the time the congressional report was released, an embarrassed Sunderman was at pains to explain that he had never proven that the chemical caused deaths among the Legionnaires and he had reason to believe some of the nickel measured in the tissues actually came off surgical instruments used in the original autopsies.
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Congressman Murphy's attack on the CDC was not waylaid by the demise of the nickel carbonyl hypothesis, however, and by December he had escalated his assault, charging it was outrageous that in a country “supposedly with the most advanced technology in the world, we find ourselves in a position of not knowing what happened in Philadelphia.”
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For CDC director Sencer, Congressman Murphy became a haunting nemesis, whose name and actions provoked unusual outbursts of anger. The Staten Island representative was, in Sencer's mind, living proof that politicians shouldn't be allowed to meddle in ongoing scientific investigations.
Over a decade later, Sencer would speak with a happy gleam in his eyes and a lightened tone of voice about Congressman John M. Murphy's 1981 indictment and later conviction for conspiracy and accepting bribes in the so-called Abscam scandal.
Over a decade later, Sencer would speak with a happy gleam in his eyes and a lightened tone of voice about Congressman John M. Murphy's 1981 indictment and later conviction for conspiracy and accepting bribes in the so-called Abscam scandal.
“What goes around comes around,” Sencer would say.
As the CDC toiled over its very full load of enterprises in the fall of 1976, the public became increasingly skeptical of the nation's premier public health agency. And in a year that was dedicated to the celebration of Americanism, the public came to question the “can do” outlook that had dominated the culture ever since World War II.
Here it was, 1976, and the leaders of the scientific community appeared to many members of the public and the political arena to be in absolute disarray. Record amounts of taxpayers' money, including a then breathtaking sum of $135 million for the Swine Flu campaign, were being expended for biomedical investigation and public health, yet the nation felt besieged by confusing medical threats. A dizzying array of common chemicals seemed to be implicated in cancer, everything Americans loved to eat seemed to play a role in heart disease, their long romance with cigarettes appeared destined to send millions of people to early graves, the Pentagon's Vietnam War chemical weapons may have also harmed American troops âeven their offspring.
And now the scientists couldn't shoot straight. They were pointing their guns, it seemed, incorrectly at Swine Flu, and couldn't figure out what had killed the Legionnaires.
For many members of Congress and the press, the operative terms now used to describe the government's Swine Flu effort were “fiasco,” “debacle,” “farce,” “travesty,” and “waste of taxpayers' dollars.”
At the CDC this sudden public revulsion was hard to stomach. Not accustomed to such controversy, or to juggling so many epidemic crises simultaneously, the agency was overwhelmed. Its four-man public relations effort became entirely defensive, reacting day by day to a torrent of accusations raining down from hundreds of sources. And every one of the roughly three hundred scientists at the agency, including junior EIS officers like Heymann, was up to his or her neck in work.
By early October, Karl Johnson and Joel Breman had been dispatched to Zaire to quell Ebola. Heymann was pulled back to Atlanta to coordinate emergency rescue operations and backup for the multinational team in Yambuku. The Legionnaires' Disease problem dragged on, mysteriously defying McDade and Shepard's resolution. And the Swine Flu vaccination campaign, which officially commenced on October 1, continued to draw fire.
On October 11 the night edition of the
Pattsburgh Post-Gazette
broke the story that two elderly people died shortly after getting their Swine Flu shots from the Allegheny County Health Department. Within a couple of hours, newspapers all over America were hurriedly remaking their final morning editions, having grabbed the report off the United Press International wire service.
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Pattsburgh Post-Gazette
broke the story that two elderly people died shortly after getting their Swine Flu shots from the Allegheny County Health Department. Within a couple of hours, newspapers all over America were hurriedly remaking their final morning editions, having grabbed the report off the United Press International wire service.
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Within forty-eight hours the story had escalated radically, though the actual number of dead never exceeded three, all over the age of seventy. Reporters led the investigation. The CDC was strangely silent for several days, giving the public the impression that journalists were the only professionals doing any detective work on the cases. Or that the CDC was covering up something insidious. The allegations poured forth: all the dead had received vaccine manufactured by Parke-Davis, which had two months earlier admitted making an entire batch of vaccine against the wrong flu antigen; the vaccine was made by “recombining genetic elements,” a point of great confusion at the time; deaths seemed also to be occurring in other cities all over America.
“The Scene at a PA Death Clinic” was a
New York Post
headline. United Press International ran a daily tally of additional suspected vaccine-caused deaths.
New York Post
headline. United Press International ran a daily tally of additional suspected vaccine-caused deaths.
Science enthusiast Walter Cronkite, whose anchorman status with the American public was so prominent that insiders at the CBS-TV network referred to him as “VOG” or “Voice of God,” brought President Ford before the cameras on October 13, giving the political leader a massive evening platform from which to argue that 215 million Americans should ignore the scare stories and get their shotsâjust as he and First Lady Betty Ford would do the following day during a photo opportunity.
But two days later, the national immunization tally had reached only 40 million. While that was the best two-week immunization turnout in U.S. history, it could hardly be considered cause for joy among those who still believed a repeat of the 1918â19 pandemic was likely. After all, by October 16, 1918, influenza had already killed millions. The gathering of international influenza experts in Switzerland just ten months earlier had concluded that a minimum of 85 percent of high-risk populations would have to be vaccinated to ensure society's protection against an analogous epidemic.
Though the agency fought hard to put a positive spin on the campaign's progress, many CDC insiders quietly despaired and military officials openly declared that the less than satisfactory turnout was evidence that the American people would fail to respond in an appropriate and timely fashion should an enemy hurl biological weapons at the country.
The CDC tried to counter the impact of the Pittsburgh deaths with an analysis of the statistical relationship between public campaigns of any kind and cardiac deaths among senior citizens. Their conclusion: the three deaths were statistical anomalies, not events caused by the vaccine.
“Persons vaccinated in the [Pittsburgh] clinic died at a rate of 5/100,000/day in contrast to the expected rate of 17/100,000/day for persons 65 years and older in Pennsylvania,” CDC scientists argued.
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The FDA tested the Parke-Davis vaccine immediately following the Pittsburgh deaths and proclaimed it free of contamination.
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The FDA tested the Parke-Davis vaccine immediately following the Pittsburgh deaths and proclaimed it free of contamination.
By mid-December the number of deaths and illnesses allegedly linked to Swine Flu vaccines would reach 283, more than half limited to headaches or mild fevers.
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Two months later, the agency would report that the fall of 1976 marked an unusually disease-free time, with the numbers of pneumonia and influenza-associated deaths at their lowest points since 1972. This terrific record would not be ascribable to the vaccine campaign; rather, it would be the result of a virtual absence of influenza virus in North America.
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Two months later, the agency would report that the fall of 1976 marked an unusually disease-free time, with the numbers of pneumonia and influenza-associated deaths at their lowest points since 1972. This terrific record would not be ascribable to the vaccine campaign; rather, it would be the result of a virtual absence of influenza virus in North America.
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So it was that long-haired hippies and close-cropped businessmen found common ground on something: the Swine Flu shot was not to be trusted.
A year later, President Jimmy Carter's tactless brother Billy would best capture the mood by averring that if he “had to get stoned to death,” he'd rather do it with booze than a Swine Flu shot.
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On November 2, Gerald Ford lost his bid for the presidency, and Georgia governor Jimmy Carter, a liberal Democrat, was elected. The already demoralized federal public health establishment now had a lame-duck champion for its efforts. Fewer than 5 million Americans would voluntarily get vaccinated after November 1; virtually none after word got out of Guillain-Barré syndrome.
The first case of Guillain-Barré syndrome appeared in Minnesota, during the third week of November. Days after he got his flu shot, a man's arms and legs grew increasingly weak; his reflexes worsened, eventually ceasing altogether; he lost feeling in his hands and feet. For all intents and purposes, he was paralyzed. His physician correctly diagnosed the ailment as Guillain-Barré syndrome and, suspecting an association with the flu vaccine, reported the ailment to officials at the CDC.
First identified in the 1920s by French neurologists Jean Alexander Barré and Georges Guillain, the syndrome was rare, usually reversible, occasionally lethal, and normally occurred in the absence of any other associated illness. No cause or treatment for Guillain-Barré was known, nor could anybody explain why some individuals recovered completely after about a month of paralysis, a few were permanently paralyzed, and still fewer died of respiratory distress when neurological symptoms affected their lungs, hearts, or diaphragms.
The first Guillain-Barré report was quickly followed by others, and the
CDC ordered nationwide active surveillance for syndrome cases in all fifty states.
CDC ordered nationwide active surveillance for syndrome cases in all fifty states.
On December 14 the CDC issued a press release announcing that thirty people had developed the syndrome within a month after their Swine Flu vaccinations; an additional twenty-four Guillain-Barré cases had occurred in people following a lapse of more than thirty days after immunization.
Two days later Sencer called a halt to the Swine Flu campaign, pending further investigation of the Guillain-Barré cases.
On Christmas Eve the CDC revealed that 172 Guillain-Barré cases had turned up in twenty-four states. Ninety-nine cases involved flu vaccinesâsix of whom had died. The cases spanned all age groups, genders, and races, and no geographic clustering of cases could be seen.
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Something was going on.
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Something was going on.
By New Year's Eve the reported number of cases had soared to 526; of these, 257 had received flu shots.
Though CDC officials tried to argue that, like the three Pittsburgh cardiac arrest cases, these Guillain-Barré episodes might represent a normal background rate of the syndrome, the American peopleâand their politicians âwere appalled. Ralph Nader and his consumer action group called for Sencer's immediate resignation. In congressional hearings during December, Senator Edward Kennedy declared the Swine Flu campaign dead.
The CDC continued to downplay the association between the vaccine and the syndrome, though agency insiders had already concluded that the Guillain-Barré rate among those vaccinated against Swine Flu was at least four times that in the unvaccinated population. As further syndrome reports poured in during the early weeks of 1977, some agency representatives suggested that the publicity had created hysteria, prompting cases nationwide of psychologically induced paralysis and limb weakness. But studies in various communities showed no such panic, and found that most cases had been diagnosed by qualified neurologists.
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By the time Jimmy Carter had been inaugurated and named Joseph Califano as his nominee for Secretary of Health, Education, and Welfare, the CDC's Guillain-Barré total had topped 1,100, half of whom had received Swine Flu shots, with cases reported in all fifty states. Fifty-eight deaths had occurred. Agency analysis showed a clear clustering of cases around the months of November and December, coming on the heels of the Swine Flu campaign's peak. The average lag time between vaccination and developing the syndrome was six weeks. Over 5 percent of cases were lethal, and nearly a quarter of the Guillain-Barré sufferers had to be placed on respirators.
The researchers concluded that America's normal, inexplicable Guillain-Barré rate was about one case in every million people per year, for an expected 1976 total of some 215 cases. But among Swine Flu vaccine recipients, the attack rate was about ten times greater, at one case in every 100,000 Americans.
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Overnight, lawyers filed claims with the U.S. Attorney General's office on behalf of clients alleging they had suffered ailments of various kinds due to the Swine Flu vaccine. So great was the deluge that the White House Office of Management and Budget was forced to approve an emergency allocation on January 28, 1977, of $1.2 million for immediate processing of claims. Justice Department attorney Jeffrey Axelrod and his staff of ten lawyers worked in twenty-four-hour shifts for several months, rushing to meet the letter of Congress's August 1976 liability law to determine which claims should receive immediate settlement, which appeared bogus, and which should go to court.
In the end, 4,181 claims would be filed seeking a total of $3.2 billion. For over sixteen years, the cases would wend their way through the legal system: by 1993, three cases would still be pending. Axelrod's team would end up deciding that bona fide cases of Guillain-Barré syndrome among vaccine recipients represented vaccine-caused ailments and would settle those without court proceedings.
After a decade and a half of legal proceedings, the U.S. government would settle 393 claims for $37,789,000. Another 1,605 cases would end up in the courts, with 53 resulting in judgments against the federal government (for a total of $17 million) and another 56 cases lost in litigation (for another $30,683,000).
By 1993 the U.S. government had paid out nearly $93 million in taxpayer dollars to Swine Flu claimants.
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Though the final liability to the U.S. government was well below early dire forecasts of “hundreds of millions of dollars,” it would prove to be great enough in the eyes of Congress to have a long-lasting impact on global immunization programs. A gun-shy Congress, afraid for years to come of approving any federal immunization efforts for fear of repeating the Swine Flu fiasco, would prove only part of the vaccination problem.
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Though the final liability to the U.S. government was well below early dire forecasts of “hundreds of millions of dollars,” it would prove to be great enough in the eyes of Congress to have a long-lasting impact on global immunization programs. A gun-shy Congress, afraid for years to come of approving any federal immunization efforts for fear of repeating the Swine Flu fiasco, would prove only part of the vaccination problem.
Swine Flu also left its mark in the judiciary system, setting precedents for government culpability in cases of large-scale public health efforts. In years to come, lawyers would file suits on behalf of clients claiming damages from all sorts of vaccines. Even the sacred cow of public healthâthe polio vaccineâwould come under fire. In the 1970s and 1980s, individuals would sue the U.S. government claiming they got polio from the 1962 Sabin oral vaccine. In 1993, the federal district court for Maryland would rule that individuals had a legal right to sue the government even though the 1962 polio campaign was originally considered above the law because it was deemed an extraordinary humanitarian effort.
From the perspective of the microbes, no immunized
individuals
mattered: the issue for microbial survival was the overall rate of immunity in an entire population of potential human targets. If a critical percentage of the human population was rendered immune by virtue of vaccination, the microbes, unable to thrive and reproduce, would either retreat into an animal reservoir or vanish.
individuals
mattered: the issue for microbial survival was the overall rate of immunity in an entire population of potential human targets. If a critical percentage of the human population was rendered immune by virtue of vaccination, the microbes, unable to thrive and reproduce, would either retreat into an animal reservoir or vanish.
Nobody knew in 1962 in the case of polio, in 1976 in the case of influenza, or in 1993 for the majority of the world's diseases precisely what percentage of a human population had to be vaccinated in order to defeat the microbes; the assumption was, and would continue to be, that greater than 80 percent of a population had to be immune to stop most communicable microbes.
Public health advocates worldwide welcomed the dawn of mass immunization in the 1950s and 1960s, feeling that any possible risk to a few individuals far outweighed the extraordinary benefit to society as a whole that would follow defeat of such terrible microbial scourges as polio, pandemic influenza, diphtheria, whooping cough, and typhus. And for two decades in the United Statesâthe center of more than 80 percent of the world's vaccine productionâinsurance carriers, politicians, drug companies, and the judicial system adhered to the basic principle that the rights of an immunized society superseded those of small numbers of individuals. Indeed, the courts in some states ruled that officials had the right to overrule the objections of family members in some cases, forcing vaccination of elderly residents of nursing homes and children entering the public school system.
Swine Flu threw ice water on the previously warm relationship between public health and individual rights. It set a precedent that would haunt
all
vaccine efforts inside the United States for decades, and shatter the confidence of vaccine manufacturers (and their insurers), not only vis-Ã -vis their U.S. markets but globally. Many in coming years would abandon vaccine production entirely; by 1993, only four U.S. pharmaceutical companiesâConnaught Laboratories, Inc., Lederle-Praxis Biologicals, Merck & Co., Inc., and Wyeth-Ayerstâwould remain committed to production of vaccines.
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all
vaccine efforts inside the United States for decades, and shatter the confidence of vaccine manufacturers (and their insurers), not only vis-Ã -vis their U.S. markets but globally. Many in coming years would abandon vaccine production entirely; by 1993, only four U.S. pharmaceutical companiesâConnaught Laboratories, Inc., Lederle-Praxis Biologicals, Merck & Co., Inc., and Wyeth-Ayerstâwould remain committed to production of vaccines.
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In early 1993, as a result of the courts' decisions, the U.S. Department of Justice would settle five 1960s polio vaccine cases, each individual receiving “seven-figure sums,” according to Axelrod. Precise figures were sealed by the courts.
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