National Swine Flu Vaccination Program of 1976

By Alisha Khan

Viruses are organisms measured in mere nanometers, yet they have the power to upend entire populations, causing disease, poverty, panic, and death. The Spanish influenza of 1918, which infected one third of the world’s population, was known to be the deadliest pandemic in world history. It cast a dark shadow on disease research for the remainder of the 20th century. Later revealed to be a strain of H1N1 influenza, the Spanish influenza caused the media, government, and scientists to remain on high alert for years afterward, taking any action they could to prevent the disaster that ensued in 1918 [1]. When it emerged that there was a small influenza outbreak at New Jersey military base Fort Dix in 1976, which resulted in one death, the United States was determined to not see a repeat of the Spanish influenza pandemic. They took action immediately; one of the most significant preventative measures taken was the writing of the National Swine Flu Vaccination Program of 1976 [2]. This program included a campaign for immediate mass vaccination, the government claiming liability for any harm to an individual caused by a swine flu vaccination, prohibiting pharmaceutical companies from making any profit from a swine flu vaccine, and putting any legal defense job related to the vaccine in the hands of the Attorney General. [5] Looking back, this policy was passed without correctly assessing possible consequences. Written in response to a possible impending epidemic, the National Swine Flu Vaccination Program was unable to succeed because of media coverage, legal liability issues and miscommunication between scientists and the government.

The media (specifically newspapers at the time) and what stories it chose to prioritize greatly influenced the public’s perception of causal events. Public perception heavily influences policy formation, so inaccurate portrayals by the media generally result in hastily-made policy. In 1976, one soldier at Fort Dix died after contracting a “flu-like illness”. A few other soldiers were also infected, but symptoms were mild and their recovery was quick. Once it was reported that the strain of virus thought to have caused illness could be related to swine flu, the media went into a frenzy. [3] Media coverage blew the possibility of a swine flu pandemic out of proportion; as a result, many people did not have correct information about how the policy would affect them. One New York Times headline dated February 20, 1976, read “virus that caused the greatest world epidemic of influenza in modern history—the pandemic of 1918-19—may have returned” [3]. The wording of this headline and framing of the subsequent story made it easy to associate the 1976 “outbreak” with the 1918 pandemic. Fear is a common tactic used by the media in order to sell their stories. It is easy to deduce that the New York Times’ main goal was to profit off this headline rather than provide accurate information educating the public about the outbreak. The media even went as far as to associate a completely unrelated disease, Legionnaires’ Disease, with the swine flu “outbreak”. Legionnaires Disease emerged in between the time the program was announced and the time vaccines were being given out, at a convention in Philadelphia. The disease affected about 200 Legionnaires. [3] It was related to a strain of flu, but not swine flu. In Garrett’s The Coming Plague, Garrett describes the confusion caused by the media: “Phrases like ‘explosive outbreak’, ‘mysterious and terrifying disease,’, ‘Legionnaire killer,’ and ‘killer pneumonia’ filled press accounts, as well as the on-camera statements of Philadelphians and politicians”. [3] Once again, the media was clearly looking to instill fear in the public in order to make their content sell. 

In addition to the media, pharmaceutical companies also played a large role in the implementation of this policy. The deals that the Department of Health Education and Welfare made with U.S. pharmaceutical companies revealed that the timeline of this policy was very rushed, and that the policy plan was too extreme. Because the policy focused on vaccines, the government held pharmaceutical companies responsible for mass-producing the vaccine. This way, the government could run the National Influenza Immunization Program as part of the National Swine Flu Vaccination Program. [2] The program included that the government would hold themselves financially and legally responsible for any harm caused by the vaccine, which made the policy too extreme to work well for all groups involved. Firstly, pharmaceutical companies felt pressured as a result of this legislation, and required that the government “indemnify” them if anyone were to be harmed by a vaccine. Pharmaceutical companies most likely made this request because the timeline of the program required that they put out effective vaccines as soon as possible, making it difficult to ensure that the vaccine was mostly safe. When the public became aware of this, it created general distrust of both the vaccine and pharmaceutical companies. [5] By rushing the timeline of the policy, key stakeholders (such as pharmaceutical companies) felt pressured and scared to act rather than encouraged. The public ended up being scared of the vaccine, so the policy was having the opposite of the intended effect. Also, the fact that the government was claiming responsibility for any harm done by the vaccine was a very hasty, dangerous decision. If the vaccine had turned out to be dangerous to many people, the U.S. government would most likely be dealing with many lawsuits and reparations. 

The National Swine Flu Vaccination Program of 1976 involved massive amounts of miscommunication between the government and CDC, which resulted in the legislation not having sufficient evidentiary research. When the initial case at Fort Dix first occurred, samples of the virus were sent to a research institute in New Jersey, where it was identified as a strain of the flu. Scientists at the CDC used this research to explain to government officials that there was a possibility of an epidemic ensuing [2]. The government interpreted this warning as a prediction rather than a possibility or a data point. At the time, there was no criteria for when to label an event as an epidemic. The Department of Health Education and Welfare proceeded to write policy based on the idea that an epidemic was almost certain to occur, even though this was not true. The bill required the Department of Health Education and Welfare to protect against liability and study the extent of liability of the vaccine. This seems like only two tasks, but these tasks required heavy communication with the CDC and public health officials which never occurred. Vaccine liability policy was created before it was confirmed that the Legionnaires outbreak was not caused by swine flu; the government thought that creating this policy would help combat an epidemic stemming from Legionnaires “epidemic” when in reality no such epidemic existed [3]. Without accurate communication with scientists, the policy did not have accurate backend research to support its envisioned outcomes. Without research, the government had no way of knowing the root cause of the issues. The policy’s goal was to immunize as many people as possible, but inaccurate information led to the creation of a policy without proper consideration of consequences.

With the media, pharmaceutical companies, and research institutes such as the CDC having played a role in this policy, they were all deemed major stakeholders in this policy. Other major stakeholders include President Ford, the Department of Health Education and Welfare, and people at risk for swine flu. President Ford and the Department of Health Education and Welfare were stakeholders because they had the biggest role in writing the policy, interpreting information from the CDC, and implementing the policy. President Ford especially had the most power, and had the motive of his re-election around the corner. If an epidemic were to occur, he would want to prepare for it as best as possible, as the public would then be voting for him based on how he handled the crisis. This would have motivated him to try and get ahead of the possible epidemic by trying to immunize as many people as possible. He played up to this motivation by advertising pictures of himself receiving the vaccine in an attempt to encourage the public to do the same. The Department of Health Education and Welfare had slightly less power than President Ford because he had more power over the written policy itself. The Department of Health Education and Welfare’s main purpose was to implement such a policy, and its main goal was to keep as many people disease-free as possible. For this reason, the Department of Health Education and Welfare was also in favor of implementing the National Swine Flu Vaccination Program of 1976 as soon as possible. The Department was also likely more interested than President Ford in communicating with CDC scientists. President Ford and the Department supported each other because they had very similar goals. 

Among the media, pharmaceutical companies, and research institutes , each group had a slightly different goal. The media played a role in how much another stakeholder (people at risk of infection) knew about the policy. [1] The goal of the media was to sell as many stories as it could. This meant dramatizing the situation as much as possible, i.e. insinuating that a deadly epidemic was on the horizon and everybody was at risk (even if this was not necessarily true). Consequently, dramatic reporting by the media caused public fear of both the disease and the vaccine, forcing the policy to be written and implemented hastily. Pharmaceutical companies, on the other hand, wanted to sell as much as possible as well– except the product was vaccines, not stories. Additionally, this policy placed restrictions on the companies; they were not able to make profit off of any vaccine produced against swine flu. Therefore, pharmaceutical companies had a conflicting interest with the government, because the government wanted as many vaccines produced as possible. The pharmaceutical companies, however, did not want to produce as many vaccines because of the lack of profit and use of extraneous resources. Research institutes played a stakeholder role because they had all the information needed for the government to make effective policy; in the end, this information was not taken into account, causing the policy to be ineffective. The CDC’s interests coincided with the Department of Health Education and Welfare because both agencies wanted to prevent an epidemic.

Lastly, people at risk for swine flu were affected greatly by this policy. The National Swine Flu Vaccination Program encouraged them to get vaccinated, but President Ford and the Department of Health Education of Welfare caused general mistrust in the vaccine. People at risk for swine flu care about being vaccinated, so they have aligned interests with President Ford and the Department of Health Education and Welfare. The people at risk for swine flu (which was most of the general population) hold the least power in this situation, because they have little hand in writing the legislation or doing the research, but are affected most greatly. 

As a stakeholder, President Ford’s interests most undermined the National Swine Flu Vaccination Program of 1976. With his reelection campaign around the corner, he had more pressure than ever to save as many American lives as possible without plunging the country into debt. More importantly, in the eyes of the public, President Ford needed to be seen as solely responsible for saving Americans from an oncoming epidemic. This was one of the main reasons the vaccination program was fast-tracked, causing many consequences of the policy to be overlooked. He signed off on policy without verifying with other advisors, all in an effort to achieve credit for the policy. [4] Him signing off early exemplifies the idea that policy is written by people who are influenced by external factors such as public image.

Overall, the failure of the National Swine Flu Vaccination Program of 1976 amounted to much more than how the policy was written. Stakeholders, who influence policy after it has been written, can ultimately decide whether the policy achieves its goals. When stakeholders have conflicting interests, a policy cannot work to achieve one singular goal. For example, the pharmaceutical companies and government healthcare groups had conflicting interests: pharmaceutical companies wanted to produce vaccines without over-using resources and without extraneous financial expenditure, while government healthcare groups wanted as many effective vaccines sent to the public as possible. The misalignment led to pharmaceutical companies being less motivated to create efficacious vaccines, therefore creating public mistrust in the vaccine. Because people did not trust the vaccine, they were less likely to voluntarily get vaccinated. If the government had put less restrictions on pharmaceutical companies and instead directed more government funds towards creating an efficacious vaccine as soon as possible, the policy would have achieved its goal. Additionally, President Ford’s reelection agenda, which ultimately caused the government to overlook advice from public health officials, in part led the government to rush the policy-writing process and claim legal responsibility for harm caused by the vaccine to individuals. Instead of claiming legal responsibility, the government should have promoted trust in the vaccines by releasing statistics showing the effectiveness of past flu vaccines. The Department of Health Education and Welfare could have also led an education campaign about why the public should get vaccinated. 

The National Swine Flu Vaccination Program was an extremely short-sighted policy. Policy in times of crisis certainly calls for urgency in terms of timeline, but also calls for effectiveness. The Vaccination Program was passed in time, but was ineffective because of miscommunication between the government and researchers, media coverage, political agendas, and legal liability.

 

References

[1] “1918 Pandemic (H1N1 Virus).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 Mar. 2019, www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html. 

[2] “Swine Flu of 1976: Lessons from the Past.” Bulletin of the World Health Organization, June 2009, www.who.int/bulletin/volumes/87/6/09-040609/en/. 

[3] Garrett, Laurie. The Coming Plague: Newly Emerging Diseases in a World out of Balance. Virago Press, 2020. 

[4] Perlstein, Rick. “Opinion: Gerald Ford Rushed Out a Vaccine. It Was a Fiasco.” New York Times, 2 Sept. 2020. 

[5] Sencer, David J, and J. Donald Miller. “Reflections on the 1976 Swine Flu Vaccination Program.” Emerging Infectious DIseases, vol. 12, no. 1, Jan. 2006.