Pandemic Preparation and the 1976 Swine Flu Outbreak

Pandemic Preparation and the 1976 Swine Flu Outbreak

(Original Caption) President Ford gets swine flu shot from Wm. Lukash. 10/14/76.

Since the emergence of COVID-19, commentators have looked for lessons in the 1918 Influenza pandemic, an outbreak of swine flu that killed 500,000 people in the United States and 20 million across the world. Journalist Ronald G. Shafer wrote in the Washington Post about the xenophobia associated with coining the pandemic the “Spanish Flu.” Historian John Barry talked to Vox about how the U.S. government initially underplayed the outbreak. The Guardian even talked to the last survivor, 105-year-old José Ameal Peña.

Little ink has been spilled, however, on the significance of the second major confrontation with the swine flu in the United States: The 1976 Fort Dix outbreak. The scare led to a massive—and arguably unnecessary—U.S. response, including mass immunization of more than 25% of the population. Retrospective analyses of the panic have struggled to make sense of the incident’s significance—was this a moral way to respond to the perceived threat of mass death, a harmless overreaction, or a dangerous mistake?

The crisis started in January 1976. Two hundred soldiers at the Fort Dix army post in New Jersey came down with a brutal flu. In early February, an 18-year-old private, David Lewis, who had refused to be hospitalized for his symptoms, died after an overnight hike drill. Doctors at Fort Dix sent throat swabs from Lewis’ body to public health officials. Within a week, the CDC determined that the virus was not the typical flu, but a variant of the 1918 pandemic strain. Swine flu had been confined to pigs since 1930, meaning that no one under 50 had any resistance.

Dr. David Sencer, the head of the CDC, had grown up researching tuberculosis in New York and had provided crucial support in the global quest to eradicate smallpox. He was a “wily and able autocrat,” according to Richard Neustadt and Harvey Feinberg’s account of the response. In other words, Sencer was the unequivocal authority over the government’s reaction to the news out of Fort Dix. He embraced the view that a sudden reemergence of swine flu could trigger an epidemic. They prepared several options, ranging from doing nothing and assuming the outbreak wouldn’t expand to jumpstarting a massive public-private partnership to immunize and surveil every American. Despite the lack of evidence that the virus had spread beyond Fort Dix, Sencer quickly went with the most ambitious plan.

Sencer was not a voice in the wilderness. A close advisor, the influential “fluologist” and Mt. Sinai School of Medicine microbiology chairman Edwin Kilbourne, happened to pen an alarming op-ed in the New York Times just days before the Fort Dix crisis broke. The article, complete with an etched illustration of a sinking ship and the title, “Flu to the Starboard! Man the Harpoons! Fill ’em With Vaccine! Get the Captain! Hurry!” argued that pandemics occurred roughly every 11 years—1946, 1957, and 1968 being the three most recent—and called for preventive vaccinations by the CDC even without immediate threat of pandemic. Sencer set Kilbourne to work on delivering a vaccine, to be cultured in chicken eggs.

For more content like this, join the CAFE Insider community, where we explore issues at the intersection of law and politics.

In a series of tense March meetings at the White House, President Ford—advised by polio vaccine legends Jonas Salk and Albert Sabin—mulled over the plan. The legacy of 1918 loomed large, with Heath, Education, and Wellness Secretary David Mathews distributing copies of Alfred Crosby’s Epidemic and Peace, 1918. Ford decided to approve Sencer’s $134 million plan for delivering a nationwide swine flu vaccine. “I think you ought to gamble on the side of caution,” Ford later recalled. “I would always rather be ahead of the curve than behind it.” Congress voted the plan into law in mid-April. Over the summer, drug companies produced the vaccine en masse while the government produced TV ads advising Americans to “Get a Shot of Protection” and prepared testing centers.

Then things fell apart. In late June, Leslie Cheek, Washington chief of the American Insurance Association, called the CDC to let them know that insurance refused to cover the vaccine-makers for fear of huge lawsuits. The manufacturers—led by iconic chemical companies Merck, Merrell, Park-Davis, and Wyeth—refused in turn to vial the vaccines unless Congress agreed to pick up the tab if things went awry. The House Health Subcommittee held contentious hearings to determine whether indemnification was justified. Ford hung tough, saying in late July, “We are going to find a way, either with or without the help of Congress, to carry out this program that is absolutely essential, a program that was recommended to me unanimously by 25 or 30 of the top medical people in this particular field.”

By this time, some of the CDC higher-ups were beginning to doubt the necessity of the program. Assistant Director H. Bruce Dull even publicly questioned the historical allusions to the Spanish Flu: “There is no reason to raise this specter of 1918 and 1919. It’s probably misleading.” Ford and friends soldiered on, though, and managed to secure liability funding from Congress in late August.

Doctors began administering vaccines from jet injectors on October 1, 1976. Ten days later, three elderly Pennsylvanians with heart problems dropped dead of cardiac arrest shortly after getting their shots. A press panic followed, with the New York Post headline reading, “The Scene at the Pennsylvania Death Clinic” and further claims that the vaccine was connected to an increase in cases of Guillain-Barré syndrome, a usually temporary paralysis. Ford desperately tried to reassure the public by getting his own vaccine in front of cameras, but the program petered out by late November, right alongside Ford’s defeat by Jimmy Carter, Sencer’s resignation, and a stack of government liability payouts. The epidemic never came, and Ford’s response became fodder for the burgeoning anti-vaxxer movement and, later, for those looking to malign President Obama when the swine flu reemerged in 2010.

Obviously, COVID-19 is a problem of an altogether different magnitude than the 1976 swine flu outbreak. But the same difficult decisions around pandemic preparation—between convenience and risk, bureaucracy and anarchy, cruelty and overreaction—exist then and now. What looked like a fiasco 44 years ago may have saved millions of lives had the swine flu spread from Fort Dix, particularly since recent scholarship has suggested that the World Health Organization would have been dramatically under-equipped for a global crisis. Late in his life, Sencer defended the choice to treat the outbreak as if it could have been 1918: “When lives are at stake, it is better to err on the side of overreaction than underreaction,” adding, “this requires personal courage and a reasonable level of understanding by the politicians to whom these public health leaders are accountable.” 

The concept of an early and aggressive response to a potential pandemic certainly looks wiser by the day…

For more on the 1976 immunization effort, check out journalist Gina Kolata’s riveting 2001 book Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It.

For more content like this, join the CAFE Insider community.