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We need a Covid 19 vaccine – let's get it right the first time

On a rainy night in January 1976, a number of new army recruits trained in 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 part of his train fell ill with chest congestion and fever: nearly 200 men, 13 of whom had to be hospitalized. January is the flu season, and military doctors thought the flu had somehow gotten to the base – a problem for the group and a tragedy for the dead soldier, but not unexpected.

Tests have turned this thinking upside down. The soldiers had the flu, but at least for some of them, the virus that caused their illness was not the usual burden that circulated around the world this year. Instead, it was an unknown virus that almost nobody had immunity to. It belonged to the flu strains called H1

N1, and it was genetically linked to a flu epidemic that some people in medicine could still remember at that time: the global, multi-million pandemic of 1918.

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The discovery of swine flu in 1976 electrified the country. Before the end of March, President Gerald Ford said the United States would vaccinate "every man, woman, and child" in the United States. Congress provided emergency funds. The manufacturers hurried to produce a new vaccine formula. Almost 45 million Americans, a quarter of the population at the time, received the new shot at Thanksgiving. Ford led the way: he was photographed when he received it in the Oval Office on October 14th.

But unlike 1918, there was no pandemic this time. The cases among the soldiers were a spark that didn't catch. And when it became clear that more than 500 out of 45 million people had an extremely rare disease, a paralysis called Guillain-Barré syndrome. Thirty-two of them died.

President Ford receives from his doctor in the White House, Dr. William Lukash, a swine flu shot. Courtesy of the Gerald R. Ford Library

The events of 1976 had a profound impact on the United States' public health system. The Congress held hearings for months. The director of the CDC (then known as the Center for Disease Control) was fired. The rush to counter the obvious threat was seen as a mistake, and the possibility of a pandemic seemed so unlikely that it took another 27 years for the federal government to come up with a plan to respond.

"This campaign has cost the government a lot of credibility," says Howard Markel, an epidemic doctor and historian who is director of the Center for the History of Medicine at Michigan University. “It has triggered a small reaction from government officials for many years: they were afraid to act too quickly. The thing about epidemics, however, is that you have to act quickly and without a lot of data at the beginning. “

The pandemic that did not occur in 1976 occurred 33 years later when another flu – another H1N1 – appeared, but not the virus of 1976 or 1918 – conquered the world. It emerged after the end of the flu season in April 2009 with a number of cases in Mexico, California and Texas. Until June, the World Health Organization said that the new tribe triggered a pandemic. After all, over 60 million people were infected in the United States alone, and an estimated 203,000 people died worldwide.

But this reaction was also unsettling. A new vaccine was developed to respond, and while there were no obvious side effects, there were significant stumbling blocks in the organization of the manufacture and release of the new formula where it was most needed.

The shortcomings in this past campaign are important because they are among the largest and fastest emergency vaccination efforts in the United States that take place during the lifetime of people who do politics and science today. Covid-19 is not influenza, but it is a pandemic, and it also triggers a quick search for a vaccine that could result in millions of shots being given to vulnerable people. The lessons from 1976 and 2009 are therefore important, especially since some of their mistakes are made again.

Health experts see that just one thing is repeating itself: politicians instead of scientists have to let the country's spokesman do it. "Politicians always want to promise too much, and then there is a risk that they will deliver too little in due course," says William Schaffner, doctor and professor of infectious diseases at the Vanderbilt University School of Medicine, who joined the Vanderbilt Faculty in 1976 her work as a CDC detective. "You should always try to do it the other way – too little promised and too much to deliver – because then you'll be a hero."

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