The 1976 swine flu outbreak at Fort Dix, New Jersey set a precedent in immunology through attempts to vaccinate an entire population of a nation against the potential for a swine flu epidemic. Even though vast numbers of people were successfully immunized in a short period of time, the National Influenza Immunization Program (NIIP) rapidly became recognized as a failure because the epidemic that had been greatly feared failed to surface. The evidence linked to the microbiology, pathology, and historical cycle of influenza and the outbreak at Fort Dix; however, suggests that the reactions of the scientists and personnel involved with the NIIP were appropriate. The complications and misjudgments which plagued the program following its initiation; to include logistical issues, biological difficulties, and tensions involving the media, must also be acknowledged.

The shifts in the influenza virus created a cycle of virility of the disease that pointed to the potential for a major outbreak in 1976. Because of the flu’s constant adaptation and re-emergence there is great reason for its label of, ‘The Last Great Plague,’ since the flu is essentially impossible to create a lasting solution to.

The flu has been recorded since the fifteen century, and the number of years between pandemics has decreased during the last century due to intercontinental travel that has accelerated the buildup of immunity to any given strain of the flu. It has been hypothesized that there is now an eleven year cycle between major antigen shift pandemics, with smaller epidemics occurring between that are linked to antigenic drift.

Another suggestion is that strains of the flu recycle themselves in approximately fifty-year cycles; enough time so that most of the original immunities have died out of a population. There were eleven years between the pandemics of 1946, 1957, and 1968. The 1957 flu was similar to the of 1889, and the flu of 1968 was similar to the flu of 1900.

From the various pathological, historical, and microbiological, evidence involved with the outbreak at Fort Dix it is easy to understand why the people in charge during 1976 chose to take the actions they did. The scientists of the time decided to create a vaccine against the swine flu they were faced with, deciding to pursue immunization because they had a good amount of time before the next flu season to use in order to organize the project. The threat seemed real enough, and if they waited until the flu hit they would not have enough time to begin vaccinations before the flu set in. The decision to immunize also gave the scientists the opportunity to demonstrate to the public at large the value of immunizations.

The operation itself involved preparation of nearly two-hundred million doses of vaccine. In order to create the vaccine, scientists injected an appropriate amount of the influenza strain into embyonated eggs, creating a culture for the viruses. Multiplied viruses were separated from the yolk of the eggs and rendered noninfectious by formaldehyde. Potency of the vaccine was measured in the amount of the vaccine using hemmagglutinin, clumped together using blood cells, and recored in terms of chick cell agglutination (CCA). Massive field tests were performed, and scientists decided that 200 CCA units would be effective for the majority of the population while causing a minimum of side-effects.

The scientific complications of the NIIP caused issues, yet the media of the time made matters worse in ways. The press was quick to criticize the program when no new incidents of swine flu appeared in the months after it broke out at Fort Dix, emphasizing criticisms from people such as Albert Sabin who is known for polio vaccinations and who originally supported the project. The media discouraged the immunization plan, but also helped to push the program forward. In August of that year, the NIIP Convention of the American Legion found an outbreak of a particularly lethal strain of pneumonia occurring, killing 29 out of 182 people who contacted it. While this was in no way connected to swine flu, the media made a connection between this strain of pneumonia known as, ‘Legionnaire’s Disease,’ and the swine flu. There was enough public agitation to push legislation through Congress, allowing the NIIP to move forward. The media had essentially helped to save the NIIP program through extravagant claims.

In another example of media sensationalism, a few days after the start of the immunization program, three elderly people died at a vaccination station. There was no evidence that the deaths were related to the vaccine itself, yet the media promptly exaggerated the story, presenting an imaged, ‘body-count, of supposed, ‘vaccine victims,’ prompting a hysteria that caused nine states to close their immunization programs until the CDC announced that the deaths were not connected to the vaccine. The leaders of the immunization program of the time are equally responsible for the presentations made by the media during this time frame for not establishing a better relationship between them, and not using the media as a means of public education concerning the immunization program and influenza.

The swine flu outbreak of 1976 at Fort Dix has taught us some important lessons. As one Senator explained, “We have raised the public’s awareness of the need to prevent disease from happening.” Establishment of a surveillance system for flu vaccinations was established, as well as increased ability to watch for outbreaks of the swine flu. The NIIP has helped to further knowledge about the flu, contributing to the fields of microbiology and epidemiology in general.

By Thomas C. Weiss