Here is a summary-excerpt of a Harvard University Kennedy School of Government Case Study entitled, “Swine Flu: Analogies from the Past.” The main question it asks is, How to prevent pandemics through vaccination?
Key Points from the Paper:
• Spanish Flu 1918: The great pandemic of 1918 countered one tenet after another of what many perceived were basic features shared by all previous pandemics.
o It struck much faster than was normal with an unprecedented mortality rate.
o Apparently healthy people showed the full set of symptoms in an hour.
o Disease raced through communities at a phenomenal rate – worldwide it killed over twice as many people as was killed in combat in WWI (over 20 million lives including 50K in the US alone)
o Pandemic hit in three separate waves in less than a year with the second wave being the most deadly.
o Pigs also suffered from Spanish flu – thus the name swine flu. An Iowa veterinarian, J.S. Koen, noted that pigs and people would both pick up the virus.
• Asian Flu 1957: In 1957-58, another flu epidemic struck with a totally unknown variant. First reports of the flu came from China in late Feb 1957. In two months it spread to every continent.
o Since the 40 yrs since the Spanish flu, understanding of influenza and it prevention had greatly increased. Many in the public health service felt they were ready to deal with a flu outbreak. However, actions taken to combat the disease were viewed as “ too little, too late.”
o US Navy personnel were the first hit followed by children’s summer camps.
o At issue was mass immunization versus focused immunization on special groups based on potential exposure. Another issue was to what extent to raise public alarm and also financial expose drug manufacturers as it relates to vaccine production.
o From the drug makers’ point of view – the developing situation looked more like a gamble with little potential profit and great potential loss. In July, the Surgeon General asked for 60 million doses but the manufacturers said it would take six months to produce. Steps were taken to speed production if required.
o The PHS deferred speeding up production, based on two assumptions:
-That there would not be a replay of the 1918 outbreak
-That it wouldn’t appear before the fall or ideally the winter.
o Contrary to the second assumption, the pandemic exploded earlier than expected in August hitting rural Louisiana affecting 15% of the population mostly young children and adults.
o Given production timeline, the delivery of the flu vaccine was ineffective – the flu had already moved through the nation. Fortunately without the mortality rate of the 1918 variant. – Consequently, the epidemic “won the race” against effective vaccination.
• Hong Kong Flu 1968: Unlike 1957, flu researchers were not prepared for the breakout in 1968.
o By mid-August, 1968, scientists had confirmed that an unexpected pandemic was beginning. Only flu vaccine in the US was tailored on the previous Asian flu.
o On 4 Sept., US Advisory Committee on Immunization recommended that high-risk groups be vaccined with the current vaccine while manufacturers rushed to produce a vaccine that would be effective against the Hong Kong flu.
o This request ran again in problems: (1) Manufacturers, having filled the requested Asian Flu orders, had shut down their operations and shifted focus – gearing up would take time. (2) A shortage of embryonated eggs to grow the vaccine existed.
o In addition to inadequate vaccine supplies, the vaccine was poorly utilized; and, a large proportion of the vaccine used went to low and medium risk versus high-risk personnel.
• Polio: While less virulent than flu pandemics its effects left a lasting effect on its victims.
o While Jonas Salk found a cure through vaccination, problems in production resulted in 204 cases in which active polio was transferred to children who took the vaccine. This resulted in the Surgeon General shutting down the vaccination program and revising its safety standards. Eventually, vaccinations of both dead (Salk’s technique) and live (Sabin’s technique) would hit the market.
o Kennedy Administrations $35M Vaccine Assistance Act sought to vaccinate children from polio, whooping cough and tetanus.
The question during pandemics is over how quickly you vaccinate; who do you vaccinate and with what variant. This has both far reaching disease prevention as well as economic issues given the lead time required to produce drugs required.
Summary by: Peter Jones