We Need a Covid-19 Vaccine—Let’s Get It Right the First Time

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On a rainy night in January, 1976, a batch of new Army recruits training at Fort Dix, New Jersey were sent on a 5-mile march. The next day, one of the recruits, Private David Lewis, collapsed with severe pneumonia. Lewis died, and a whole swath of his platoon fell ill with chest congestion and fever: almost 200 men, 13 of whom had to be hospitalized. January is within flu season, and military physicians assumed that the flu had somehow made its way onto the base—a problem for the group and a tragedy for the dead soldier, but not unexpected.

Tests upended that thinking. The soldiers did have the flu, but among some of them at least, the virus that was causing their illness was not the common strain that was circling the globe that year. It was instead an unfamiliar virus to which almost no one had immunity. It was among the strains of flu designated H1N1, and it was genetically related to a flu epidemic that some people in medicine at the time were old enough to still remember: the world-spanning, millions-killing pandemic of 1918.

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The discovery of what came to be known as the 1976 swine flu electrified the country. Before the end of that March, President Gerald Ford declared the US would vaccinate “every man, woman and child” in the United States against it. Congress appropriated emergency funds. Manufacturers rushed to make a new vaccine formula. By Thanksgiving, almost 45 million Americans, a quarter of the population at the time, received the new shot. Ford led the way: He was photographed receiving it in the Oval Office on October 14.

But unlike 1918, this time there was no pandemic. The cases among the soldiers were a spark that did not catch. And by the time that became clear, more than 500 people out of that 45 million had come down with an extremely rare condition, a paralysis called Guillain-Barré syndrome. Thirty-two of them died.

President Ford receives a swine flu inoculation from his White House physician, Dr. William Lukash. Courtesy of Gerald R. Ford Library

The events of 1976 had a profound effect on the US public health system. Congress held hearings for months. The director of the CDC (then called the Center for Disease Control) was fired. The rush to counter the apparent threat came to be seen as a mistake, and the possibility of a pandemic came to seem so unlikely that it took another 27 years before the federal government drafted a plan to respond to one.

“That campaign cost the government a great deal of credibility,” says Howard Markel, a physician and historian of epidemics who is director of the University of Michigan’s Center for the History of Medicine. “It created for many years a Chicken Little response by government officials: They were afraid to act too quickly. Yet the thing about epidemics is, when they begin, you have to act quickly, without a lot of data.”

The pandemic that didn’t happen in 1976 did arrive 33 years later, when a different flu strain—another H1N1, but not the virus of 1976 or 1918—swept the world. It arose after the flu season should have ended, starting in April, 2009, with a cluster of cases in Mexico, California and Texas. By June, the World Health Organization declared the new strain was causing a pandemic. Eventually, more than 60 million people were infected just in the United States, and an estimated 203,000 people died worldwide.

Yet that response was troubled, too. A new vaccine was ginned up to respond, and though there were no obvious adverse reactions, there were significant stumbles in organizing manufacturing, and in getting the new formula out where it was needed most.

The flaws in these past campaigns matter, because they are among the largest, fastest emergency vaccination efforts to occur in the United States in the lifetimes of people making policy and practicing science today. Covid-19 isn’t influenza, but it is a pandemic, and it too is triggering a rapid search for a vaccine that could end in giving millions of shots to those who are vulnerable. So the lessons learned in 1976 and 2009 are important—especially since some of their mistakes are being made again.

Health experts see one in particular being repeated right now: Letting politicians, instead of scientists, be the spokespeople for what the country needs to do. “Politicians always want to over-promise, and then you’re at risk of under-delivering when the time comes,” says William Schaffner, a physician and professor of infectious diseases at Vanderbilt University School of Medicine, who in 1976 had just joined the Vanderbilt faculty after serving as a CDC disease detective. “You should always aim to do it the other way—under-promise and over-deliver—because then you’re a hero.”

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