Wednesday 1 January 2014

The Gay Plague


...Scientists also discount any connection between the official outbreak of AIDS in 1981 and the experimental hepatitis B vaccine program (1978-1981) at the New York Blood Center in Manhattan that used gays as guinea pigs shortly before the epidemic. Researchers claim HIV incubated in Africa for more that a half century until AIDS broke out there in 1982. However, in the U.S. there was no incubation period for gay men. As soon as homosexuals signed up as guinea pigs for government-sponsored hepatitis B vaccine experiments, they began to die with a strange immunodeficiency  of unknown origin. The hepatitis B experiments began in Manhattan in the fall of 1978; the first few cases of AIDS (all young gays from Manhattan) were reported to the CDC in 1979.

 Scientists have also failed to explain how a brand new herpes virus was also introduced simultaneously  into gays, along with HIV, in the late 1970s. This herpes virus is now believed to be the cause of Kaposi's sarcoma, the so-called "gay cancer" of AIDS. Before AIDS, Kaposi's sarcoma was never seen in healthy young American men. Identified a decade after HIV, in 1994, this KS-causing herpes  virus is closely related to a primate cancer-causing herpes virus extensively studied and transferred in animal laboratories in the decade before AIDS.

 Also downplayed to the public is a new microbe (Mycoplasma penetrans), also of unknown origin, that was introduced into homosexuals, along with HIV and the new herpes virus. Thus, not one but three new infectious agents were inexplicably transferred into the gay population at the start of the epidemic (HIV, the herpes KS virus, and M.penetrans).


In 1969 the military biowarfare experts predicted that a biological agent would be developed within a decade that would have a devastating effect on the immune system and for which there would be no treatment. 

(For details of this congressional testimony, Google: Donald M MacArthur + biowarfare.)
 
The VCP had a keen interest in acquiring "information and materials from carefully selected patients suffering from immunodeficiency diseases" (1972;318). This is made clear in a 1973 Progress Report (p249) from the University of Minnesota entitled, "The search for tumor virus related information in human immunodeficiency patients with cancer" The researchers proposed "continuation of studies linking immunodeficency, cancer, and oncogenic viruses."
 
As biowarfare expert MacArthur predicted, new cancer-causing monster viruses (like HIV) were created by the VCP which had a deadly effect on the immune system. In one experiment recorded in the 1973 Report (p169), later published in Cancer Research in 1974, newborn chimps were taken away from their mothers at birth and weaned on milk from cancer virus-infected cows. Some of the chimps sickened and died with two diseases that had never been observed in chimpanzees. The first was Pneumocystis carinii pneumonia (later known as the "gay pneumonia" of AIDS); the second was leukemia, a cancer of the blood.


"At Death row, I hear you're gettin treated like boot camp
Gotta follow ya sergeant's directions,
or get your ass pumped with a Smith & Wesson
Learn a lesson from the Eaze
Stay in your place and don't step to real muthafuckin G's."

The experimental hepatitis B vaccine injected into gays was unlike any other vaccine previously made. It was developed in chimpanzees and manufactured in a year-long process of sterilization and purification of the pooled blood of 30 gay men who were hepatitis B virus carriers. During the first gay experiment (November 1978-October 1979) at the New York Blood Center, there was great concern that the vaccine might be contaminated. According to June Goodfield's Quest for the Killers, p 86, "This was no theoretical fear, contamination having been suspected in one batch made by the National Institutes of Health, though never in Merck's." The men were given three inoculations of the vaccine over a period of time. The vaccine was successful with 96% of the men developing protective antibodies against the hepatitis B virus.
 
It has been assumed by some that these men were immunosuppressed due to their promiscuity and history of venereal disease. Although the young men in the study were indeed "promiscuous" (this was a requirement for entrance into the study), they were in excellent health. Despite many previous sexual partners, these volunteers had never contracted evidence of hepatitis B infection. Furthermore, immunosuppressed people often do not respond to the vaccine.
 
The men in the Manhattan experiment had the highest rate of HIV ever recorded for that time period (over 20% of the men were HIV-positive in 1981, and over 40% in 1984). Therefore, it must be assumed that many, if not most, of these men eventually died of AIDS. The actual number of AIDS deaths among the men in the experiment has never been revealed, nor have their medical records been studied. Attempts to secure this information have been rebuffed due to the "confidential" nature of the experiment.


By 1980 the VCP came to an inglorious end with the inability to prove that viruses were involved in human cancer. More than any other program it built up the field of animal retrovirology, which led to a more complete understanding of how cancer and immunosuppressive retroviruses caused disease in humans. The VCP was the birthplace of genetic engineering, molecular biology, and the human genome project. I am convinced the VCP (and not Africa) is the birthplace of HIV/AIDS as well.
 
As the VCP was winding down in the late 1970s, the gay experiments began in New York City, and continued in other cities, such as San Francisco and Los Angeles. These cities would rapidly become the three primary epicenters of the new and unprecedented "gay-related immune deficiency syndrome," later known as AIDS.
 
The introduction of HIV and the KS herpes virus into gay men (along with some "novel" and now-patented mycoplasmas discovered at the Armed Forces Institute of Pathology) miraculously revived the career of Robert Gallo and made him the most famous virologist in the world. And, of course, turned the "failure" of the VCP into a triumph.
 
When Gallo's blood test for HIV became available in the mid-1980s, the New York Blood Center's stored gay blood specimens were reexamined. Most astonishing is the fact that 20% of the gay men who volunteered for the hepatitis B experiment in Manhattan were discovered to be HIV-positive in 1980 (one year before the AIDS epidemic became "official" in 1981). This signifies that Manhattan gays in 1980 had the highest incidence of HIV anywhere in the world, including Africa, the supposed birthplace of HIV and AIDS. In addition, in 1982, in an AIDS trial in New York City one out of five gay men (20%) tested positive for the new KS herpes-8 virus when stored blood samples were re-examined by epidemiologists at the NCI in 1999.
 
Rarely mentioned by AIDS historians is the fact that the New York Blood Center established a chimp virus laboratory for viral vaccine research in West Africa in 1974. One of the purposes of VILAB II, in Robertsfield, Liberia, was to develop the hepatitis B vaccine in chimps. The lab also prides itself by releasing "rehabilitated" (but virus-infected) chimps back into the wild.
 
Also conveniently forgotten in the history of AIDS is LEMSIP (The Laboratory for Experimental Medicine and Surgery), the primate colony located outside New York City. For many years, until disbanded in 1997, LEMSIP supplied scientists with primates and primate parts (and unknown primate viruses) for transplantation and virus research. Primate parts (and primate viruses) were experimentally transplanted in human beings as early as the 1960s.
 
LEMSIP was also affiliated with New York University Medical Center, where the first cases of AIDS-associated Kaposi's sarcoma were discovered in 1979. Researchers at NYU were also heavily involved in the development of the experimental hepatitis B vaccine used in gays. According to Leonard Horowitz, author of Emerging Viruses: AIDS and Ebola, NYU Medical Center received government grants and contracts connected with biological warfare research beginning in 1969.
 
The evidence gathered here is a tiny fraction of the circumstantial evidence supporting the man-made theory of AIDS. Scientists have along and proven history of covertly experimenting on people "in the name of science." Anyone who takes the time to study the reports of the VCP will recognize that human experimentation with cancer viruses was undoubtedly considered and ultimately desired. Is the fact that HIV/AIDS appeared within a decade of this dangerous cancer virus experimentation a coincidence? Should AIDS be blamed on human sexuality, gays, blacks, and monkeys? I think not.
 
There is nothing wrong or unpatriotic or "conspiratorial" in presenting the vast amount of evidence that connects out-of-control animal cancer experimentation and biowarfare research with the birth of AIDS. What is wrong, however, is the unwillingness of the scientific establishment and the media and the public to look at it.




San Francisco Chronicle
January 10, 1977    Front page

1971 Mystery

CIA Link to Cuban
Pig Virus Reported

New York

    With at least the tacit backing of U.S. Central Intelligence Agency officials, operatives linked to anti-Castro terrorists introduced African swine fever virus into Cuba in 1971.
    Six weeks later an outbreak of the disease forced the slaughter of 500,000 pigs to prevent a nationwide animal epidemic.
    A U.S. intelligence source told Newsday last week he was given the virus in a sealed, unmarked container at a U.S. Army base and CIA training ground in the Panama Canal Zone, with instructions to turn it over to the anti-Castro group.
    The 1971 outbreak, the first and only time the disease has hit the Western Hemisphere, was labeled the "most alarming event" of 1971 by the United Nations Food and Agricultural Organization. African swine fever is a highly contagious and usually lethal viral disease that infects only pigs and, unlike swine flu, cannot be transmitted to humans.
    All production of pork, a Cuban staple, halted, apparently for several months.
    A CIA spokesman, Dennis Berend, in response to a Newsday request for comment, said, "We don't comment on information from unnamed and, at best, obscure sources."
    Why the virus turned up in Cuba has been a mystery to animal investigators ever since the outbreak. Informed speculation assumed that the virus entered Cuba either in garbage from a commercial airliner or in sausages brought in by merchant seamen.
    However, on the basis of numerous interviews over four months with U.S. intelligence sources, Cuban exiles and scientists concerning the outbreak — which occurred two years after then-President Nixon had banned the use of offensive chemical and biological warfare — Newsday was able to piece together this account of events leading up to the outbreak.
    The U.S. intelligence source said that early in 1971 he was given the virus in a sealed, unmarked container at Ft. Gulick, an Army base in the Panama Canal Zone. The CIA also operates a paramilitary training center for career personnel and mercenaries at Ft. Gulick.
    The source said he was given instructions to turn the container with the virus over to members of an anti-Castro group.
    The container then was given to a person in the Canal Zone, who took it by boat and turned it over to persons aboard a fishing trawler off the Panamanian coast. The source said the substance was not identified to him until months after the outbreak in Cuba. He would not elaborate further.
    Another man involved in the operation, a Cuban exile who asked not to be identified, said he was on the trawler when the virus was put aboard at a rendezvous point off Bocas del Toro, Panama. He said the trawler carried the virus to Navassa Island, a tiny, deserted, U.S.-owned island between Jamaica and Haiti. From there, after the trawler made a brief stopover, the container was taken to Cuba and given to other operatives on the southern coast near the U.S. Navy base at Guantanamo Bay in late March, according to the source on the trawler. The base is 100 miles due north of Navassa.
    The source on the trawler, who had been trained by the CIA and had carried out previous missions for the agency, said he saw no CIA officials aboard the boat that delivered the virus to the trawler off Panama, but added: "We were well paid for this and Cuban exile groups don't have that kind of money . . ."
    He said he was revealing the information because he is a member of an exile group being investigated by the United States in connection with terrorist activity in Florida. His account was confirmed by another intelligence source in Miami. The source said he had no proof that the operation was approved by CIA officials in Washington, but added: "In a case like this, though, they would always give them (CIA officials in Washington) plausible deniability."
    The investigation referred to by the operative on the trawler involves a federal inquiry into terrorist acts allegedly carried out by Cuban exiles. Those include bombings and assassination attempts in the United States and Venezuela. Trained originally by the CIA for operations against Cuba, the exiles have become more restive as they view what they believe to be an increasing move toward rapprochement between Fidel Castro and the United States.



January 14, 1975 
[Letter from Bowie K. Kuhn to Henry Kissinger]

This letter records the first effort of the U.S. Baseball Commissioner, Bowie K. Kuhn, to arrange meetings between U.S. and Cuban baseball teams. In the letter, Kuhn tells Secretary of State Henry Kissinger that the Cuban Government Sports Agency (INDER) has indicated strong interest in having a U.S. professional team play a series of games in Havana, with possibilities for future games in the United States. He notes that he has inside information that Premier Castro favors the joint project and requests Kissinger’s guidance before meeting with INDER director Jorge García Bango in Mexico City the next week.



February 15, 1975 
[Response to "Baseball Team to Cuba"] 
Department of State, Confidential Cable

In response to the cable sent the previous day by William Rogers and Lawrence Eagleburger, Henry Kissinger informs them that he is against sending a baseball team to Cuba "at this time," but requests their arguments as to why it should be done.




Abstract

In 1976, 2 recruits at Fort Dix, New Jersey, had an influenzalike illness. Isolates of virus taken from them included A/New Jersey/76 (Hsw1n1), a strain similar to the virus believed at the time to be the cause of the 1918 pandemic, commonly known as swine flu. Serologic studies at Fort Dix suggested that >200 soldiers had been infected and that person-to-person transmission had occurred. We review the process by which these events led to the public health decision to mass-vaccinate the American public against the virus and the subsequent events that led to the program's cancellation. Observations of policy and implementation success and failures are presented that could help guide decisions regarding avian influenza.

Edwin D. Kilbourne, New York Times, February 13, 1976 (1)

"Grounding a Pandemic"

Barack Obama and Richard Lugar, New York Times, June 6, 2005 (2)

"It has been 37 years since the last influenza pandemic, or widespread global epidemic, so by historic patterns we may be due for another."

New York Times, July 17, 2005 (3)

Kilbourne in 1976 (1) noted that pandemics of influenza occur every 11 years. Since the latest prediction in the New York Times (3) suggests that after 39 years we may be overdue for a pandemic, and since 2 US senators have recently headlined the possibility (2), that observation may become a political fact. Whether it becomes a scientific fact and a policy fact is yet to be seen. Some reflections on 1976 from 2 insiders' viewpoints may identify some of the pitfalls that public health policymakers will face in addressing potential influenza pandemics.

Swine Flu at Fort Dix

On February 3, 1976, the New Jersey State Health Department sent the Center for Disease Control (CDC) in Atlanta isolates of virus from recruits at Fort Dix, New Jersey, who had influenzalike illnesses. Most of the isolates were identified as A/Victoria/75 (H3N2), the contemporary epidemic strain. Two of the isolates, however, were not typeable in that laboratory. On February 10, additional isolates were sent and identified in CDC laboratories as A/New Jersey/76 (Hsw1N1), similar to the virus of the 1918 pandemic and better known as "swine flu."

A meeting of representatives of the military, the National Institute of Health, the Food and Drug Administration (FDA), and the State of New Jersey Department of Health was quickly convened on Saturday, February 14, 1976. Plans of action included heightened surveillance in and around Fort Dix, investigation of the ill recruits to determine if contact with pigs had occurred, and serologic testing of recruits to determine if spread had occurred at Fort Dix.

Surveillance activities at Fort Dix gave no indication that recruits had contact with pigs. Surveillance in the surrounding communities found influenza caused by the current strain of influenza, A/Victoria, but no additional cases of swine flu. Serologic testing at Fort Dix indicated that person-to-person transmission had occurred in >200 recruits (4).

In 1974 and 1975, 2 instances of humans infected with swine influenza viruses had been documented in the United States. Both persons involved had close contact with pigs, and no evidence for spread of the virus beyond family members with pig contact could be found (5).

The National Influenza Immunization Program

On March 10, 1976, the Advisory Committee on Immunization Practices of the United States Public Health Service (ACIP) reviewed the findings. The committee concluded that with a new strain (the H1N1 New Jersey strain) that could be transmitted from person to person, a pandemic was a possibility. Specifically, the following facts were of concern: 1) persons <50 years of age had no antibodies to this new strain; 2) a current interpandemic strain (A/Victoria) of influenza was widely circulating; 3) this early detection of an outbreak caused by A/New Jersey/76/Hsw1N1 (H1N1) provided an opportunity to produce a vaccine since there was sufficient time between the initial isolates and the advent of an expected influenza season to produce vaccine. In the past when a new pandemic strain had been identified, there had not been enough time to manufacture vaccine on any large scale; 4) influenza vaccines had been used for years with demonstrated safety and efficacy when the currently circulating vaccine strain was incorporated; 5) the military vaccine formulation for years had included H1N1, an indication that production was possible, and no documented adverse effects had been described.

ACIP recommended that an immunization program be launched to prevent the effects of a possible pandemic. One ACIP member summarized the consensus by stating "If we believe in prevention, we have no alternative but to offer and urge the immunization of the population." One ACIP member expressed the view that the vaccine should be stockpiled, not given.

Making this decision carried an unusual urgency. The pharmaceutical industry had just finished manufacture of the vaccine to be used in the 1976–1977 influenza season. At that time, influenza vaccine was produced in fertilized hen's eggs from special flocks of hens. Roosters used for fertilizing the hens were still available; if they were slaughtered, as was customary, the industry could not resume production for several months.

On March 13, an action memo was presented to the Secretary of the Department of Health Education and Welfare (DHEW). It outlined the problem and presented 4 alternative courses of action. First was "business as usual," with the marketplace prevailing and the assumption that a pandemic might not occur. The second was a recommendation that the federal government embark on a major program to immunize a highly susceptible population. As a reason to adopt this plan of action, the memo stated that "the Administration can tolerate unnecessary health expenditures better than unnecessary death and illness if a pandemic should occur." The third proposed course of action was a minimal response, in which the federal government would contract for sufficient vaccine to provide for traditional federal beneficiaries—military personnel, Native Americans, and Medicare-eligible persons. The fourth alternative was a program that would represent an exclusively federal response without involvement of the states.

The proposal recommended by the director of CDC was the second course, namely, for the federal government to contract with private pharmaceutical companies to produce sufficient vaccine to permit the entire population to be immunized against H1N1. The federal government would make grants to state health departments to organize and conduct immunization programs. The federal government would provide vaccine to state health departments and private medical practices. Since influenza caused by A/Victoria was active worldwide, industry was asked to incorporate the swine flu into an A/Victoria product to be used for populations at high risk.

Before the discussions with the secretary of DHEW had been completed, a member of his staff sent a memo to a health policy advisor in the White House, raising the specter of the 1918 pandemic, which had been specifically underemphasized in the CDC presentation. CDC's presentation highlighted the pandemic potential, comparing it with the 1968–69 Hong Kong and 1957–58 Asian pandemics. President Gerald Ford's staff recommended that the president convene a large group of well-known and respected scientists (Albert Sabin and Jonas Salk had to be included) and public representatives to hear the government's proposal and make recommendations to the president about it. After the meeting, the president had a press conference, highlighted by the unique simultaneous appearance of Salk and Sabin. President Ford announced that he accepted the recommendations that CDC had originally made to the secretary of DHEW. The National Influenza Immunization Program (NIIP) was initiated.

The proposal was presented to 4 committees of the Congress, House and Senate authorization committees and House and Senate appropriation committees. All 4 committees reported out favorable legislation, and an appropriation bill was passed and signed.

The estimated budgeted cost of the program was $137 million. When Congress passed the appropriation, newspapers mischaracterized the cost as "$1.9 billion" because the $137 million was included as part of a $1.9 billion supplemental appropriation for the Department of Labor. In the minds of the public, this misconception prevailed.

Immediately after the congressional hearing, a meeting of all directors of state health departments and medical societies was held at CDC. The program was presented by CDC, and attendees were asked for comments. A representative from the New Jersey state health department opposed the plan; the Wisconsin state medical society opposed any federal involvement. Otherwise, state and local health departments approved the plan.

Within CDC, a unit charged with implementing the program, which reported to the director, was established. This unit, NIIP, had complete authority to draw upon any resources at CDC needed. NIIP was responsible for relations with state and local health departments (including administration of the grant program for state operations, technical advice to the procurement staff for vaccine, and warehousing and distribution of the vaccine to state health departments) and established a proactive system of surveillance for possible adverse effects of the influenza vaccines, the NIIP Surveillance Assessment Center (NIIP-SAC). (This innovative surveillance system would prove to be NIIP's Trojan horse.) In spite of the obstacles discussed below, NIIP administered a program that immunized 45 million in 10 weeks, which resulted in doubling the level of immunization for persons deemed to be at high risk, rapidly identifying adverse effects, and developing and administering an informed consent form for use in a community-based program.

Obstacles to the Vaccination Plan

The principal obstacle was the lack of vaccines. As test batches were prepared, the largest ever field trials of influenza vaccines ensued. The vaccines appeared efficacious and safe (although in the initial trials, children did not respond immunologically to a single dose of vaccine, and a second trial with a revised schedule was needed) (6). Hopes were heightened for a late summer/early fall kickoff of mass immunization operations.

In January 1976, before the New Jersey outbreak, CDC had proposed legislation that would have compensated persons damaged as a result of immunization when it was licensed by FDA and administered in the manner recommended by ACIP. The rationale given was that immunization protects the community as well as the individual (a societal benefit) and that when a person participating in that societal benefit is damaged, society had a responsibility to that person. The proposal was sent back from a staff member in the Surgeon General's office with a handwritten note, "This is not a problem."

Soon, however, NIIP received the first of 2 crippling blows to hopes to immunize "every man, woman, and child." The first was later in 1976, when instead of boxes of bottled vaccine, the vaccine manufacturers delivered an ultimatum—that the federal government indemnify them against claims of adverse reactions as a requirement for release of the vaccines. The government quickly capitulated to industry's demand for indemnification. While the manufacturers' ultimatum reflected the trend of increased litigiousness in American society, its unintended, unmistakable subliminal message blared "There's something wrong with this vaccine." This public misperception, warranted or not, ensured that every coincidental health event that occurred in the wake of the swine flu shot would be scrutinized and attributed to the vaccine.

On August 2, 1976, deaths apparently due to an influenzalike illness were reported from Pennsylvania in older men who had attended the convention of the American Legion in Philadelphia. A combined team of CDC and state and local health workers immediately investigated. By the next day, epidemiologic evidence indicated that the disease was not influenza (no secondary cases occurred in the households of the patients). By August 4, laboratory evidence conclusively ruled out influenza. However, this series of events was interpreted by the media and others as an attempt by the government to "stimulate" NIIP.

Shortly after the national campaign began, 3 elderly persons died after receiving the vaccine in the same clinic. Although investigations found no evidence that the vaccine and deaths were causally related, press frenzy was so intense it drew a televised rebuke from Walter Cronkite for sensationalizing coincidental happenings.

Guillain-Barré Syndrome

What NIIP did not and could not survive, however, was the second blow, finding cases of Guillain-Barré syndrome (GBS) among persons receiving swine flu immunizations. As of 1976, >50 "antecedent events" had been identified in temporal relationship to GBS, events that were considered as possible factors in its cause. The list included viral infections, injections, and "being struck by lightning." Whether or not any of the antecedents had a causal relationship to GBS was, and remains, unclear. When cases of GBS were identified among recipients of the swine flu vaccines, they were, of course, well covered by the press. Because GBS cases are always present in the population, the necessary public health questions concerning the cases among vaccine recipients were "Is the number of cases of GBS among vaccine recipients higher than would be expected? And if so, are the increased cases the result of increased surveillance or a true increase?" Leading epidemiologists debated these points, but the consensus, based on the intensified surveillance for GBS (and other conditions) in recipients of the vaccines, was that the number of cases of GBS appeared to be an excess.

Had H1N1 influenza been transmitted at that time, the small apparent risk of GBS from immunization would have been eclipsed by the obvious immediate benefit of vaccine-induced protection against swine flu. However, in December 1976, with >40 million persons immunized and no evidence of H1N1 transmission, federal health officials decided that the possibility of an association of GBS with the vaccine, however small, necessitated stopping immunization, at least until the issue could be explored. A moratorium on the use of the influenza vaccines was announced on December 16; it effectively ended NIIP of 1976. Four days later the New York Times published an op-ed article that began by asserting, "Misunderstandings and misconceptions... have marked Government ... during the last eight years," attributing NIIP and its consequences to "political expediency" and "the self interest of government health bureaucracy" (7). These simple and sinister innuendos had traction, as did 2 epithets used in the article to describe the program, "debacle" in the text and "Swine Flu Fiasco" in the title.

On February 7, the new secretary of DHEW, Joseph A. Califano, announced the resumption of immunization of high-risk populations with monovalent A/Victoria vaccine that had been prepared as part of the federal contracts, and he dismissed the director of CDC.

Lessons Learned

NIIP may offer lessons for today's policymakers, who are faced with a potential pandemic of avian influenza and struggling with decisions about preventing it (Table). Two of these lessons bear further scrutiny here.

Media and Presidential Attention

While all decisions related to NIIP had been reached in public sessions (publishing of the initial virus findings in CDC's weekly newsletter, the Morbidity and Mortality Weekly Report (MMWR); New York Times reporter Harold Schmeck's coverage of the ACIP sessions, the president's press conference, and 4 congressional hearings), effective communication from scientifically qualified persons was lacking, and the perception prevailed that the program was motivated by politics rather than science. In retrospect (and to some observers at the time), the president's highly visible convened meeting and subsequent press conference, which included pictures of his being immunized, were mistakes. These instances seemed to underline the suspicion that the program was politically motivated, rather than a public health response to a possible catastrophe.

Annex 11 of the draft DHEW pandemic preparedness plan states, "For policy decisions and in communication, making clear what is not known is as important as stating what is known. When assumptions are made, the basis for the assumptions and the uncertainties surrounding them should be communicated" (11). This goal is much better accomplished if the explanations are communicated by those closest to the problem, who can give authoritative scientific information. Scientific information coming from a nonscientific political figure is likely to encourage skepticism, not enthusiasm.

Neither CDC nor the health agencies of the federal government had been in the habit of holding regular press conferences. CDC considered that its appropriate main line of communication was to states and local health departments, believing that they were best placed to communicate with the public. MMWR served both a professional and public audience and accounted for much of CDC's press coverage. In 1976, no all-news stations existed, only the nightly news. The decision to stop the NIIP on December 16, 1976, was announced by a press release from the office of the assistant secretary for health. The decision to reinstitute the immunization of those at high risk was announced by a press release from the office of the secretary, DHEW. In retrospect, periodic press briefings would have served better than responding to press queries. The public must understand that decisions are based on public health, not politics. To this end, health communication should be by health personnel through a regular schedule of media briefings.

Decision To Begin Immunization

This decision is worthy of serious question and debate. As Walter Dowdle (12) points out in this issue of Emerging Infectious Diseases, the prevailing wisdom was that a pandemic could be expected at any time. Public health officials were concerned that if immunization was delayed until H1N1 was documented to have spread to other groups, the disease would spread faster than any ability to mobilize preventive vaccination efforts. Three cases of swine influenza had recently occurred in persons who had contact with pigs. In 1918, after the initial outbreak of influenza at Fort Riley in April, widespread outbreaks of influenza did not occur until late summer (13).

The Delphi exercise of Schoenbaum in early fall of 1976 (13) was the most serious scientific undertaking to poll scientists to decide whether or not to continue the program. Its main finding was that the cost benefit would be best if immunization were limited to those >25 years of age (and now young children are believed to be a potent source of spread of influenza virus!). Unfortunately, no biblical Joseph was there to rise from prison and interpret the future.

As Dowdle further states (12), risk assessment and risk management are separate functions. But they must come together with policymakers, who must understand both. These discussions should not take place in large groups in the president's cabinet room but in an environment that can establish an educated understanding of the situation. Once the policy decisions are made, implementation should be left to a single designated agency. Advisory groups should be small but representative. CDC had the lead responsibility for operation of the program. Implementation by committee does not work. Within CDC, a unit was established for program execution, including surveillance, outbreak investigation, vaccine procurement and distribution, assignment of personnel to states, and awarding and monitoring grants to the states. Communications up the chain of command to the policymakers and laterally to other directly involved federal agencies were the responsibility of the CDC director, not the director of NIIP, who was responsible for communications to the states and local health departments, those ultimately implementing operations of the program. This organizational mode functioned well, a tribute to the lack of interagency jealousies.

Decision-making Risks

When lives are at stake, it is better to err on the side of overreaction than underreaction. Because of the unpredictability of influenza, responsible public health leaders must be willing to take risks on behalf of the public. This requires personal courage and a reasonable level of understanding by the politicians to whom these public health leaders are accountable. All policy decisions entail risks and benefits: risks or benefits to the decision maker; risks or benefits to those affected by the decision. In 1976, the federal government wisely opted to put protection of the public first.

Dr Sencer was director of CDC from 1966 to 1977.

Dr Millar was director of NIIP in 1976.

References

  1. Kilbourne ED. Flu to the starboard! Man the harpoons! Fill with vaccine! Get the captain! Hurry! New York Times. 1976 Feb 13. p. 32, col. 4.
  2. Obama BLugar R. Grounding a pandemic. Op-ed section. New York Times. 2005 Jun 6. [cited 1 Nov 2005]. Available fromhttp://www.nytimes.com/2005/06/06/opinion/06obama.html? ex=1130994000&en=1b199f715505a19c&ei=5070External Web Site Icon
  3. Unprepared for a flu pandemic [editorial]. New York Times. 2005 Jul 17; Sect. 4:11 (col. 1).
  4. Hodder RAGaydos JCAllen RGTop FH JrNowosiwsky TRussell PKSwine influenza A at Fort Dix, New Jersey (January–February 1976). III. Extent of spread and duration of the outbreak. J Infect Dis1977;136:S36975DOIExternal Web Site IconPubMedExternal Web Site Icon
  5. Dowdle WRHattwick MAWSwine influenza virus infections in humans. J Infect Dis.1977;136:S3869DOIExternal Web Site IconPubMedExternal Web Site Icon
  6. Denny FWGlezen WPKarzon DTKatz SLKrugman SMcIntosh KSwine-like influenza vaccine: a commentary. J Pediatr1976;88:1057DOIExternal Web Site IconPubMedExternal Web Site Icon
  7. Schwartz H. Swine flu fiasco. New York Times. 1976 Dec. 21. p. 33, col. 1–2.
  8. Schmeck HM Jr. More deaths reported after shots but no link to flu vaccine is found. New York Times. 1976 Oct 14; Sect. A:1+.
  9. Fraser DWTsai TROrenstein WParkin WEBeecham HJSharrar RGLegionnaires' disease: description of an epidemic of pneumonia. N Engl J Med1977;297:118997DOIExternal Web Site IconPubMedExternal Web Site Icon
  10. Schonberger LBHurwitz ESKatona PHolman RCBregman DJGuillain-Barré syndrome: its epidemiology and associations with influenza vaccination. Ann Neurol.1981;9(Suppl):318DOIExternal Web Site IconPubMedExternal Web Site Icon
  11. Department of Health and Human services. Annex 11: Pandemic influenza response and preparedness plan. Washington: The Department; 2003 Aug 26.
  12. Dowdle WRInfluenza pandemic periodicity, virus recycling, and the art of risk assessment. Emerg Infect Dis2006;12.PubMedExternal Web Site Icon
  13. Schoenbaum SCMcNeil BJKavat JThe swine-influenza decision. N Engl J Med.1976;295:75965DOIExternal Web Site IconPubMedExternal Web Site Icon

Table

Suggested citation for this article: Sencer DJ, Millar JD. Reflections on the 1976 swine flu vaccination program. Emerg Infect Dis [serial on the Internet]. 2006 Jan [date cited].http://dx.doi.org/10.3201/eid1201.051007External Web Site Icon




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