“The killer never came. The fact that it was feared is one of many things to show how little experts understand the flu, and thus how shaky are the health initiatives launched in its name. What influenza needs, above all, is research.” Neustadt and Fineberg, The Swine Flu Affair, 1978Reviewing the TV series Holocaust in 1978, Clive James said that “Santayana was probably wrong when he said that those who forget the past are condemned to relive it. Those who remember are condemned to relive it too.” We shall probably never know whether the scientists and politicians who led the global and national Charges of the Light Brigade into the Valley of Covid — theirs not to reason why, theirs but to tell the lie, ours not to question why, ours but to do and die — knew of the past, but chose to ignore it, or whether they were negligently unaware of it. But one thing is certain: the unprecedented — that poor overwrought and overworked word — arrival of a virus of pandemic potential eighteen months ago is anything but unprecedented. There have been a number of pandemics over the last century, and so there is much past to be remembered, including among the many others the 1976 swine flu nondemic.
In the same year that Clive James reviewed Holocaust, Richard E. Neustadt and Harvey V. Fineberg, two senior Harvard academics, published “The Swine Flu Affair: Decision-Making on a Slippery Disease”. Commissioned by an incoming American health secretary admirably keen to learn lessons from the mistakes of his predecessor, it took a candid look at what happens when scientists exaggerate, the media loses its head, and a government panics. The 1976 swine flu pandemic was the killer that never came. But it did trigger a full scale panicdemic that saw millions of Americans vaccinated against a disease that didn’t exist. Like all vaccines, it had side effects, some serious, some possibly even fatal. The swine flu affair was nothing short of a medical and political disaster. Perhaps that explains why none of those watching the arrival of covid–19 in early 2019 chose to forget the lessons it teaches.
In January 1976, new recruits at Fort Dix, an army barracks in New Jersey, started to develop flu like symptoms. There were cases — real clinical cases, diagnosed by real symptoms — in the low hundreds, thirteen admissions and one death, a cadet who joined a forced march after declining hospitalisation for symptoms. Lab tests confirmed most cases were caused by the then currently circulating H3N2 flu strain, but a small number, around a dozen, including the dead cadet, had been caused by H1N1 swine flu. By mid-February, the outbreak fizzled out, and that was that.
Only it wasn’t. A few sparks from the Fort Dix outbreak landed on some dry tinder lying about in public health departments. Before long, a crackling fire was ablaze. Bullish public health experts believed, on the slenderest of evidence, that a pandemic was due. The closed nature of the barracks — not even a piglet in sight — confirmed human to human spread of the new H1N1 strain. They also believed, incorrectly (we now know that it was an avian flu), that the Fort Dix H1N1 swine flu strain was the same strain as the one that caused the 1918 pandemic, that killed millions worldwide. This incendiary mix was more than enough to set the mainstream media on fire. If it sounds familiar, it is. Bullish scientists predicting imminent catastrophe, and a mainstream media agog with dire predictions of millions of deaths, were more than enough to panic the politicians into action. Flanked by two prominent medical scientists, on 24th March 1976, President Ford announced to the waiting press corps:
“I have been advised that there is a very real possibility that unless we take effective counteractions, there could be an epidemic of this dangerous disease next fall and winter here in the United States.
“Let me state clearly at this time, no one knows exactly how serious this threat could be. Nevertheless, we cannot afford to take a chance with the health of our Nation. Accordingly, I am today announcing the following actions.
“First, I am asking the Congress to appropriate $135 million, prior to their April recess, for the production of sufficient vaccine to inoculate every man, woman, and child in the United States.”
If it sounds familiar, it is. Following fast track approval of the vaccine, and indemnification by the government of the manufacturers against liability, the mass vaccination programme started on 1st October 1976. Within days, over a million Americans had been vaccinated — and reports appeared of three elderly folk dropping dead soon after receiving the vaccine. The all too familiar reassurance, that we expect to see some deaths in frail elderly folk, was wheeled out, and celebrity endorsements were called in, including the president himself getting jabbed in front of the cameras on 14th October. All the while, the killer virus was nowhere to be seen. Not a single case occurred after the last Fort Dix case was reported.
Meanwhile, the vaccination programme was rolled out at warp speed. By mid December, getting on for 50 million Americans, almost a quarter of the population, had been vaccinated. There were still no reports of swine flu cases, not a single one, but there were further reports of deaths following vaccination, along with other serious side-effects, including Guillain-Barré syndrome, a serious and potentially fatal neurological disorder. The nature of any causative link (if there is one) has never been established, but the association has, around one new case for every 100,000 vacinations. This sounds, and indeed is, rare, but when you vaccinate tens of millions of people in a crash vaccination programme, the numbers soon start to add up. Still, the Macavity virus was nowhere to be seen, but the vaccine associated deaths and side effects were all too visible. It was enough to kill the vaccination programme. On 16th December, the programme was suspended, and never restarted.
It was, in all respects, an immaculate pandemic, conceived without a single case outside the four walls of Fort Dix.
In their 1978 case study, Neustadt and Fineberg identify seven leading features that flawed decision making during the swine flu affair, all bar one of which resonate today. There was, say Neustadt and Fineberg, “overconfidence by specialists in theories spun from meagre evidence”, conflated with “conviction fueled [sic] by a conjunction of some preexisting personal agendas” and “zeal by health professionals to make their lay superiors do right”. These flaws in turn led to “premature commitment to deciding more than had to be decided”, a “failure to address uncertainties in such a way as to prepare for reconsideration” and “insufficient questioning of scientific logic and of implementation prospects”. The seventh flaw — “insensitivity to media relations and the long-term credibility of institutions” — seems rather quaint and old-fashioned in our time, given the gullibility and thick-headedness of today’s mainstream media, and harks back instead to a time when public institutions felt they had a duty to be credible.
Overconfidence in theories spun from meagre evidence; convictions fuelled by pre-existing personal agendas plugged by zealous health professionals: what has changed? Premature commitment to action, failing to address uncertainties, and insufficient questioning of scientific logic: what has changed? The lessons were there, in plain sight, and ready to be learnt. We shall probably never know whether the scientists and politicians who led the global and national Charges of the Light Brigade into the Valley of Covid — theirs not to reason why, theirs but to tell the lie, ours not to question why, ours but to do and die — knew of the past, but chose to ignore it, or whether they were negligently unaware of it. But one thing is certain: the over-arching lesson of the past, that it is not how much we know about respiratory viral diseases, but rather how little we know, that matters most in a time of crisis, and that decision making should always reflect this, has, for whatever reason, not been heeded. One way or another, perhaps Santayana was right after all. Those who forget the past are condemned to relive it.