Is yesterday's swine flu today's bird flu?
By Marc Siegel

In 1976, a flu scare prompted a rash government response that was foolish, even dangerous, then. Now there are lessons.

A newly mutated flu virus infects a man in New Jersey, and he dies within a day. Health officials fear that the general public has no immunity to this new strain and predict a severe pandemic on the order of the 1918 "Spanish flu." The president holds a news conference and recommends that all Americans be inoculated.

This scenario reads like something from our near future. Experts predict that the bird flu virus might hit our shores within a year. In fact, it's a news flash from three decades ago. The events of the so-called swine flu in the USA seem hauntingly familiar to those of us who are focused on the current bird flu, and they can serve as a useful guide on what to do now and — perhaps as important — what not to do.

Despite the fact that H5N1 — the bird flu virus — remains essentially a bird disease, Anthony Fauci, esteemed director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, has spoken of the need to make more than 100 million doses of a vaccine for H5N1 available to Americans.

We've been here

The rush to make vaccines for a flu virus to which we have no immunity is not a new concept. This is what happened during the swine flu fiasco of 1976, when the fear of another killer outbreak provoked a national political response and a rushed vaccination program. More than 40 million people received the swine flu vaccine that year against a new pig virus that ultimately never took hold.

It was later determined that the swine flu wasn't as virulent or as deadly as originally thought. But more than 1,000 cases of Guillain-Barré syndrome, a life-threatening ascending paralysis, occurred in those who received the vaccine, which had been rushed into production. The public relations nightmare and lawsuits against the government helped to drive many drug companies away from making flu vaccine at all. (Of 27 companies that manufactured flu vaccines at the time, only three still do.)

So what happened to ignite this overreaction? It all started when David Lewis, a military recruit at Fort Dix, N.J., became ill in February of that year and died within a day, apparently of a mysterious new flu virus. Over the next two weeks, more than 200 other recruits were found to have antibodies to this swine flu, meaning they had caught it and survived. At least one recruit became ill. Public health officials jumped to the conclusion that this was the first wave of flu, and that it would return with a vengeance in the fall. They feared millions of deaths.

In 1976, health experts believed that history gave them plenty of reasons to be afraid. It was thought, incorrectly, as it turns out, that the Spanish flu had jumped from birds to pigs before mutating into a massive killer of humans. Nevertheless, there is a disturbing similarity between 1976 and today: A worst-case scenario, just a prevailing theory, is used to justify a massive public reaction.

'Forecasts of doom'

David Sencer, then the head of the Centers for Disease Control, began to make proclamations and forecasts of doom, just as current agency head Julie Gerberding has done recently. In a memo March 18, 1976, Sencer wrote, "The entire U.S. population under the age of 50 is probably susceptible to this new strain." Sencer still maintained, in a CDC publication earlier this year, that "when lives are at stake, it is better to err on the side of overreaction than underreaction."

Sencer's recent statement shows a continuing lack of insight because it assumes that the only choices available to a public health official are either protecting all of civilization or not protecting it at all. In fact, decisions on potential health threats are never so clear-cut.

Thirty years ago, Sencer headed a group of distinguished scientists (including the polio vaccine inventors Jonas Salk and Albert Sabin) who met in Washington with President Ford for the purpose of persuading the federal government to take action. Ford, with flagging public support and in the midst of a presidential election campaign, attached himself to the issue and held a national TV news conference announcing a plan to vaccinate every American by the fall.

A similar scene played out late last year. President Bush, supported by several of today's greatest scientists and public health experts, responded to the risk of the bird flu virus by announcing a $7.1 billion plan for pandemic preparedness. At the time, Bush was reeling in the aftermath of Hurricane Katrina and found that linking the bird flu with the historical precedent of the 1918 "blue death" gave him an issue in which he could be perceived as our protector.

Lessons for today

The president can't be faulted for leading an aggressive public reaction to the global fears, but he and his administration would be wise to revisit the errors of 1976 while mapping out a strategy for today.

What are some of the rational lessons our government can take from the swine flu scare?

• A rushed production of vaccines could lead to premature use. That could mean significant side effects, or perhaps worse, for any American who is inoculated.
• Currently, $3.8 billion of Bush's plan has been approved for this year and $2.6 billion budgeted for 2007. But the majority of the money is set aside for emergency stockpiles of vaccines and anti-virals. More money should be budgeted for upgrading how vaccines are made.
• Even if the worst-case scenario occurs and the bird virus mutates into a form that can pass easily from human to human, it might still not signal the next pandemic. As science advances, predictions are still often wrong. There is much about flu genetics that we don't know, such as whether the virus will cause the human population significant harm.

Three decades ago, there was no course correction when the supposed "first wave" of the outbreak never made it out of Fort Dix. Today, while the United States is helping to create a global health net in response to bird virus fears, we can ill afford swine-flu type scare messages that put the public prematurely on alert while compromising scientific complexity.

Marc Siegel is an associate professor of medicine at New York University School of Medicine and author of Bird Flu: Everything You Need To Know About the Next Pandemic.

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