A ripple effect passed through the CDC and congress. Although only a few other recruits fell ill from H1N1 influenza that month, many felt that this initial outbreak could be a harbinger of a more widespread outbreak in the following influenza season. Public health officials and politicians were unwilling to take a "wait and see" approach to a possible, albeit improbable re-emergence of the 1918 flu. By early spring, a plan had been hatched to vaccinate every person in the United States against influenza. Then President Gerald Ford pitched the plan on national TV, sitting beside vaccination gurus Sabin and Salk of polio fame. Congress quickly fell in line behind the plan.
An early stumbling block came in the form of resistance from vaccine manufacturers. Unwilling to shoulder the liability for this compulsory vaccination, the companies pressured Congress into assuming total liability for vaccine related complications. The end result of these negotiations was Public Law 94-380, better known now as teh Swine Flu Act. Under this bill, the United States assumed full liability for "personal injury or death" from the swine flu vaccine. In a disconcertingly socialistic step teh bill also prohibited "any" profit to be earned by the manufacturers of this vaccine. This abomination of legislation would soon devastate the future of public health campaigns.
The vaccination effort officially commenced on October 1. Early support had been spurred on by a large number of deaths at the American Legion convention in Philadelphia from respiratory illness. Many ascribed this outbreak to Influenza early on, but further study would uncover the cause, a new bacterium dubbed Legionella. An innate American mistrust of anything mandated by teh governmnet soon swelled into widespread opposition to the vaccination campaign. This was fueled early on by reports of deaths after recieving the vaccine in several elderly people. Media sensationalism made the story into a much larger deal than it was, further demonstrating the media's focus selling papers rather than reporting the truth. The fact was that death rates among those vaccinated were actually lower than an unvaccinated control population, but this made little difference to the reporters and editors of the time. A lack of a significant number of influenza cases also contributed to the resistance, and this low number of cases could not be attributed to the vaccine. Later that fall, cases of Guillain-Barre syndrome (GBS) began to emerge, causing the death of the vaccination effort..
GBS is a rapidly progressive paralysis caused by the destruction of the "insulation", or myelin, that surrounds nerve fibers. The disease is idiopathic, meaning that the cause is not known, though it usually follows a viral illness or episode of dysentery. A link to vaccines has been suggested by some as well. The paralysis is generally self limited, but may require temporary ventilator support if the respiratory muscles fail. A minority of patients will die of complications or have lasting muscle weakness or paralysis. That fall and winter, a total of 526 cases had been reported, 257 of those had been vaccianted against the flu. The rate among vaccine recipients was 10 times the expected rate. Support for further swine flu vaccinations collapsed as the rising toll of GBS was reported. In the end, less than 60 million out of a target of over 200 million were vaccinated.
A legal feeding frenzy soon erupted. Over 4000 claims were filed against the government. In the end, close to 100 million dollars were paid out in settlements over the swine flu campaign. The greater damage done, though was to the credibility of public health officials. The collapse of public trust and support for the CDC could not have come at a worse time, as AIDS would make its first appearance on the public stage only a few years later. The fallout from the 1976 campaign continues to complicate immunization efforts to this day.
Flu Virus sequenca database from Los Alamos National Labs
Great flu site with lots of basic science and clinical flu information
Web site to accompany PBS special on the 1918 flu pandemic
Time Magazine article on the flu