The Panic Virus

by Seth Mnookin; Dan B. Miller

  On February 4, 1976, nineteen-year-old Army private David Lewis collapsed at his barracks in Fort Dix, New Jersey, shortly after completing a routine training hike. Later that day, Lewis was hospitalized with what looked like the flu. Less than twenty-four hours later, he was dead; soon, four of his fellow soldiers were hospitalized with what appeared to be similar symptoms.

  When health officials completed their autopsy on Lewis’s body, they were startled by what they found: Lewis had indeed died of influenza. More disturbing was their realization why a healthy teenager in excellent physical condition was felled by a disease most dangerous for infants and the aged or infirm: The strain of flu Lewis had been infected with was very similar to the one thought to have caused the 1918 flu pandemic, in which upward of 20 percent of everyone infected was killed. (Current estimates of the total number of fatalities that resulted from “the greatest medical holocaust in history” range from 50 to 100 million.) When CDC officials realized that hundreds of other soldiers at Fort Dix had been infected, they feared they had the makings of a disaster on their hands.

  For Gerald Ford, who’d become president just eighteen months earlier, the crisis was fraught with political peril. That November, he would ask voters to return to the White House the only person in the nation’s history to have served as both vice president and president without being elected to either office. Thus far, the lifelong Republican’s tenure as commander in chief had been defined by his unpopular pardon of his predecessor, the Democrats’ historic gains in the 1974 midterm elections, and the worst inflation since the collapse of the Confederate dollar in 1864. If he presided over the deaths of tens of thousands of U.S. citizens, he’d go down as one of the biggest failures in American political history. If, on the other hand, he rushed to vaccinate the population against an epidemic that was at that point only speculative, he risked being seen as having stirred up a panic and having subjected citizens to unnecessary risks.

  The unanimity of Ford’s advisors made his decision as to which course of action to adopt easier to make. On March 11, CDC director David Sencer delivered a memo to the president in which he wrote, “The Administration can tolerate unnecessary health expenditures better than unnecessary death and illness.” Two weeks later, Sencer took Jonas Salk, Albert Sabin, and a coterie of other leading virologists to meet with Ford in the White House. Sencer began by adding some urgency to what he’d written in his memo: With flu season only months away, it was “go or no go” time as far as a mass vaccination campaign was concerned. Salk spoke next, and he, too, unequivocally endorsed a mass vaccination campaign. (In a later interview, Salk acknowledged that he was considering other, long-term benefits as well: “I certainly thought of it as a great opportunity to fill part of the ‘immunity gap’ [between antigens in the environment and the antibodies of a given population]. We should close the gap whenever we can.”) At the end of the meeting, Ford asked the doctors in the room whether any of them had reservations about moving forward, or whether any of them thought a nationwide effort was an overreaction. None replied. He then announced that he would remain in his office for the next ten minutes if anyone wanted to express doubts to him privately. When no dissent emerged, Ford walked directly to the White House’s press room and live on national television urged “each and every American to receive an inoculation this fall.” It was, he said, a “subject of vast importance to all Americans.”

  The logistical and safety issues raised by Ford’s mass vaccination campaign were as numerous as they’d been in 1955, but unlike the polio trials, the country was not united in an effort to combat what was being referred to as “swine flu.” There were also legal concerns that hadn’t been present in the 1950s. The announcement on June 21 that no major side effects had been identified during the truncated CDC tests did nothing to mollify the leaders of the American insurance industry, who said that covering drug companies against liability from adverse reactions to such a hastily developed and widely circulated shot was not “feasible . . . at virtually any price.”

  Fears of vaccine-induced torts were not unfounded: In the years since the Gottsdanker decision, the legal barriers needed to successfully sue drug companies had declined even further. The decision with the biggest impact had come just two years earlier, when a jury ordered Wyeth Pharmaceuticals to pay $200,000 to the family of Anita Reyes, an eight-month-old who’d contracted paralytic polio two weeks after being vaccinated. In that case, Wyeth had gone to trial with a seemingly impregnable two-pronged defense: The chance that Anita Reyes had been infected by its vaccine was two thousand times less likely than the chance that she’d been infected by a naturally occurring strain of the virus, and the vaccine Anita Reyes received was packaged, like all of Wyeth’s vaccines, with an insert that listed its risks and potential complications. Despite those facts, the jury ruled that because the vaccine’s warning label was not shown to the Reyes family at the health clinic where Anita received the shot, the drug company itself was liable. If that standard were consistently applied, there was essentially nothing pharmaceutical companies could do to limit their liability. In the months following the Reyes ruling, half of the companies producing vaccines in the United States announced their withdrawal from the market.

  Months after Ford’s on-air announcement, Joseph Stetler, president of the Pharmaceutical Manufacturers Association, testified before Congress that the only way the drug companies would distribute the vaccine they’d been stockpiling was if they were indemnified against litigation arising from purported vaccine injuries. Otherwise, he said, the liability they faced was impossibly high, “particularly if you are talking about a nationwide immunization program.” Shortly after the Reyes verdict, an article had appeared in Pediatrics in which the author, a noted vaccine expert, wrote, “Society—not the manufacturer, the physician, or the patient—should support those who suffer the adverse consequences of our laws.” This argument was essentially the same one that drug companies were now adopting: By establishing herd immunity, vaccinations provided for the greater good; therefore, any unintended consequences should be borne by the country as a whole.

  Congress was unmoved—at least until that summer, when a false alarm about a swine flu outbreak in Pennsylvania spurred it into action. On August 12, Ford signed legislation that transferred responsibility for vaccine injuries from manufacturers to the federal government. In doing so, he not only restarted the stalled swine flu campaign, he established the basis for the federally funded vaccine compensation program that exists today.

  On October 1, the government’s massive immunization campaign officially began when the sick and elderly in Boston and Indianapolis were injected with doses of the vaccine. The first month of the program proved uneventful, with no reports of significant complications or further deaths from swine flu. Then, in late November, the news turned. The much feared flu pandemic hadn’t materialized—David Lewis was still the only recorded fatality—but there were reports of people developing Guillain-Barré syndrome soon after being immunized. By the end of December, five hundred cases of Guillain-Barré had been identified among the forty million people who’d received the swine flu vaccine, which was about seven times higher than what would normally have been expected—a figure that was certainly significant enough to raise questions but was nowhere near enough to prove causality. (Establishing a causal connection is especially difficult when dealing with uncommon conditions such as Guillain-Barré, which is so rare—it occurs at an incidence of about 1 per 100,000 members of a population—that its pathology remains a mystery.)

  With Ford having already lost that November’s presidential election to Jimmy Carter and the prospect of a large-scale outbreak looking increasingly less likely, there was no reason or incentive to continue the immunization campaign. On December 16, it was called off. By that time, Gerald Ford’s fumbling effort to vaccinate everyone in the country against a threat that never materialized was widely viewed as one more example of the federal government’s incompetence,
its engagement in nefarious conspiracies, or both. “Any program conceived by politicians and administered by scientists comes to us doubly plagued,” columnist Richard Cohen wrote at the time in The Washington Post. Few were inclined to disagree.

  In the coming years, the consequences of losing the public’s trust became all too apparent. By 1977, uptake of the pertussis vaccine in Great Britain had fallen to just over 30 percent. That year saw the first of three successive whooping cough epidemics. By the time they subsided, tens of thousands of children had been infected—and dozens, most of them infants, had died.

  15 Like the placement of periods before or after quotation marks and conventions about how to write out the date, the trivalent diphtheria-pertussis-tetanus vaccine is referred to differently depending on which side of the Atlantic you find yourself on, with “DTP” being the preferred abbreviation in the U.K. and “DPT” the accepted one in the United States. (The main consequence of this is the acronyms available for activist groups seeking to play off of the vaccine’s name.) Further confusing things, a combined vaccine with an acellular pertussis component was introduced in the 1990s; that is referred to both as the DTaP and the TDaP vaccine. For the sake of simplicity, I’ll use DPT throughout unless there is a specific reason to do otherwise.

  CHAPTER 5

  “VACCINE ROULETTE”

  On April 19, 1982, WRC-TV, the local NBC affiliate in Washington, D.C., aired a special titled “DPT: Vaccine Roulette.” “For more than a year we have been investigating the P, the pertussis part of the vaccine,” Lea Thompson, the story’s on-air reporter, told viewers at the onset of the show, which focused on claims of vaccine-induced brain damage, mental retardation, and permanent neurological damage. “What we have found are serious questions about the safety and effectiveness of the shot. The overriding policy of the medical establishment has been to aggressively promote the use of the vaccine—but it has been anything but aggressive in dealing with the consequences.” “Vaccine Roulette,” Thompson said, would try to rectify that: “Our objective in the next hour is to provide enough information so that there can be an informed discussion about this very important subject. It affects every single family in America.”

  The most powerful segments of the show were the interviews with parents who described how their children had been left in near-comatose states after receiving a vaccine that was mandatory for public school children in the vast majority of states. Arresting visuals drove the point home: In one sequence, an image of a slack-jawed girl splayed on her family’s couch was followed by one of a boy with an off-center smile and corroded teeth who seemed incapable of focusing his eyes. When healthy children were shown, they served as portentous signs of future tragedies: Another segment started with footage of a blond boy with the left sleeve of his red-and-white-striped shirt rolled up to expose his arm. After focusing on a close-up of a syringe being prepared for injection, the camera cut back to show the child squirming anxiously in his mother’s lap. When the needle first broke the skin of the boy’s biceps, his mother winced; after his gasp turned into shrill screams, the mother’s look of unease became one of anguish and horror.

  Thompson did not rely solely on discomfiting images and despairing personal anecdotes to make her point. She cited one study that found that adverse reactions to the DPT vaccine could be as high as one in seven hundred. An impressive roster of experts testified that the vaccine’s dangers were being swept aside by unnamed powers-that-be. Bobby Young, who was identified as a former vaccine researcher at the Food and Drug Administration (FDA) and the University of Maryland, said that a shocking number of children were “rendered a vegetable” by the DPT vaccine, and that many others suffered from less extreme neurological damage. High-pitched crying after receiving the vaccine, Young said, “may be indicative of brain damage in the recipient child.” Robert Mendelsohn, who was described as the former head of pediatrics at the University of Illinois School of Medicine, told Thompson that the pertussis vaccine was “the poorest and most dangerous vaccine that we now have.” The most unsettling testimony came from Gordon Stewart, a doctor who was identified as a member of the British government’s committee on the safety of medicines. The DPT vaccine, he said, was a “crude brew” that protected against a disease that wasn’t even dangerous to begin with: “Whooping cough has not been a killing disease for a very long time.” Later in the show, Stewart articulated the anxieties of every parent who’d ever worried about the injections being given to his or her children:

  We start off with healthy infants, and we pop ’em not once but three or four times. . . . My greatest fear is that very few of them escape some kind of a neurological damage because of this. . . . I mean, if the child isn’t frankly rendered a vegetable and yet has a fever—and a very large fraction have the fever from it, also a large fraction have the screaming syndrome, which is surely an irritation of the central nervous system—you add all of this up, how many infants [are damaged]? And how can you prove that they haven’t been—or that they have been? All of them are vaccinated.

  “Vaccine Roulette” was the first time the American public was confronted with many of these questions. “[DPT] was without a doubt our most reactogenic [vaccine],” says Paul Offit, the chief of the Division of Infectious Diseases and the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “It’s the only whole cell, whole bacterial vaccine we’ve ever used in our nation’s history.” Doctors had known for years that the DPT vaccine could cause seizures, high fevers, and fainting. (My younger sister ran an extremely high fever after her first DPT injection, which she received in the late 1970s.) There was not, however, any evidence that it caused the type of permanent damage Thompson’s show warned of.

  Within days of the initial airing of “Vaccine Roulette,” it was clear that it would have an impact that extended far beyond its initial Washington broadcast area. With little to no independent reporting, national media outlets repeated the story. A UPI wire dispatch was typical of the focus and tenor of many of the follow-ups. “Hundreds of American children may be left brain damaged and retarded each year by a common vaccination that many states require, a year-long investigation concluded,” it began. Acknowledgment of a dissenting viewpoint was essentially limited to the following: “The Department of Health and Human Services had no immediate comment.” In one of several stories it published on the broadcast, The Washington Post gave Thompson a platform to snipe at her critics: “Lea Thompson, Channel 4’s respected investigative reporter/producer who is responsible for the program, says she did not intend to panic parents into rejecting the shot, only to spotlight facts about its dangers, facts she believes have been ‘suppressed by the medical establishment.’ ”

  After months of accolades, it came as no surprise when Thompson won an Emmy for her work. At the awards ceremony, she was serenaded to the stage with the jazz standard “Satin Doll” (“She’s nobody’s fool/So I’m playing it cool as can be”). During her acceptance speech, she gave her own evaluation of the long-term effects of her work: “I think babies will be saved because of this special.”

  In the midst of all these hosannas, Thompson’s journalistic peers neglected to ferret out the reality of the situation. One of the only publications to do the minimal amount of reporting necessary to research Thompson’s accusations was the Journal of the American Medical Association. What it found was a dispatch rife with mistakes and misrepresentations. There were quotes that sources said were taken out of context: Edward Mortimer, who’d previously headed up the committee in charge of the American Academy of Pediatrics’ book of guidelines on childhood infectious diseases, said that over the course of a five-hour interview, Thompson had asked him the same question “repeatedly in slightly different ways, apparently to develop or obtain an answer that fitted with the general tone of the program.” There was a reliance on inaccurate statistics: The one-in-seven-hundred ratio of adverse reactions to total vaccinations, which Thompson attributed to a study
done by researchers at UCLA, was 25 percent higher than the figure the study actually reported. There were warped interpretations of independent research: The conclusions Thompson drew from the report were “totally distorted,” according to James Cherry, the paper’s lead author and the chief of pediatric infectious diseases at UCLA. (As an example, Cherry noted that Thompson neglected to report that not one of the more than six thousand children in his study had shown any lasting reactions to the vaccine, and that there had not been a single case in which there was evidence of even temporary neurological damage.) There were unfounded claims so laced with conditionals and so lacking in specificity as to be essentially meaningless: What precisely was the “screaming syndrome” that was “surely an irritation of the central nervous system”? What was the basis for the assertion that high-pitched crying “may be indicative of brain damage”? What, for that matter, is the difference between high-pitched and regular crying?

  Some of the most troubling errors involved the extent to which Thompson misstated the titles, history, and affiliations of the sources she relied upon to make her case—errors that were all the more egregious because they were also among the easiest to verify. According to his former colleagues, Bobby Young, who had died by the time the program aired, had never researched the pertussis vaccine. Robert Mendelsohn, a family practitioner in Evanston, Illinois, had never been the head of pediatrics at the University of Illinois School of Medicine—although he was a well-known and outspoken opponent of all vaccines. Then there was Gordon Stewart, a medical professor at the University of Glasgow who believed that the positive impact of antibiotics and medical interventions had been greatly exaggerated. By the mid-1970s, Stewart’s reputation within anti-vaccine communities was such that he’d become a magnet for parents convinced their children were vaccine-injured, and in 1977, he published a paper in which he cited many of those children as proof that the DPT vaccine caused brain damage. By the time he appeared on Thompson’s show, he’d been for years the go-to guy for reporters looking for pithy quotes about the dangers of vaccines.