March 17, 2003

IOM's Fineberg recalls swine flu

By Eric Rangus

The government’s preparations for a possible bioterrorist attack using smallpox have similarities to a late-1970s response to what was believed to be an impending influenza outbreak, according to the latest speaker in the Woodruff Health Sciences Center’s Future Makers Lecture Series.

Harvey Fineberg, president of the Institute of Medicine (IOM), told a crowd of about 150 in WHSCAB Auditorium that preparation for low-likelihood, high-consequence public health crises is important, but sometimes can be controversial.

“The positive almost certainly outweighs the negative,” said Fineberg, who spoke March 10. “Vaccination may still be worthwhile, but it is not the sure winner that public health professionals are comfortable about recommending.”

Before being named head of the IOM, Fineberg served as dean of the Harvard School of Public Health, then as Harvard’s provost. He has written widely on HIV/AIDS and other infectious diseases, evaluation of diagnostic tests and vaccines, ethical and social implications of new medical technologies, risk assessment and decision-making, medical education and global health.

Fineberg devoted much of his talk, “In an Age of Bioterrorism: Lessons of Swine Flu,” to the controversial immunization program to fight the virus that was implemented, then halted, in 1976. He co-wrote a book on the subject, The Epidemic That Never Was: Policy-Making & the Swine Flu Affair, published in 1983.

Early in 1976 several cases of a strain of influenza called swine flu were found at Fort Dix, N.J. While there was no sign of any spread outside the fort, experts believed the virus was related to Spanish influenza, a pandemic that killed 500,000 people in the United States and more than 20 million worldwide in 1918–19.

One of the slides Fineberg showed during his presentation was of a 1918 hospital filled wall-to-wall with Spanish influenza cases. “This was on people’s minds when they heard about swine flu at Fort Dix,” Fineberg said.

The government moved quickly and, in hindsight, a bit heavy-handedly. Then-President Gerald Ford convened a panel of experts to gauge the threat of epidemic; the assistant secretary of health, education and welfare wrote in a memo that 1 million people could die from swine flu within the year.

In the end, $135 million was appropriated for a national immunization program against swine flu. That fall, more than 40 million Americans received the vaccination, but the entire program was plagued with problems, not the least of which was a resistance among insurers to provide liability coverage to drug manufacturers. The vaccine also had side effects, such as an increased susceptibility to Guillain-Barré Syndrome, a neurological disorder that can cause weakness in the extremities, respiratory organs and even paralysis.

On Dec. 16, 1976, the program was halted, and swine flu, which never came close to the pandemic that was predicted, became a public health footnote.

With smallpox vaccinations going on now among the military and health care workers, Fineberg said the current situation has several parallels with the 1976 swine flu scare.

As then, the government moved quickly to begin a vaccination program, only this time the scope was smaller (public statements about swine flu predicted 95 percent of the country’s population could be inoculated), its complexities better understood, side effects of the vaccination have been discussed in detail, and the entire process has been more media savvy.

While the hope is that such precautions will be unnecessary, Fineberg said, they may play a role in deterring a biological attack. “Swine flu is naturally occurring, while smallpox is a terrorist risk,” he said. “Nature cannot be deterred no matter what we do, but preparation can be a means of protection against smallpox.”