Medicine: Off-Again, On-Again Flu Shots

On the list of diseases that have been troublesome to Americans lately, swine flu ranks somewhere below spring fever. Only three cases have been discovered since the flu-related death last year of a soldier at Fort Dix, N.J., and none was fatal. In fact, the massive swine flu vaccine program proved to be more of a threat than the disease: it has been implicated in nearly 400 cases of a little-understood, usually temporary paralysis called Guillain-Barré syndrome. Yet last week, while acknowledging the risks, federal authorities ordered a partial resumption of the on-again, off-again swine flu program, which had been suspended since Dec. 16.

The goal of the renewed campaign is not to immunize those uninoculated against swine flu. It is to protect elderly and chronically ill people against what may be a more immediate menace, the A/Victoria flu strain, which contributed to an estimated 20,000 deaths in the U.S. last year. As some experts had feared, the A/Victoria bug returned, striking 59 elderly people in a Miami nursing home in late January; five of them have died. But no vaccine produced solely to protect against A/Victoria was on hand; all that was available had been mixed with the swine flu vaccine at the height of the swine flu scare.

The reasoning behind that move—which in hindsight seems questionable —was that since most Americans were to be vaccinated against swine flu, those at highest risk might as well be immunized against A/Victoria at the same time. All this posed a dilemma for federal decision makers: Should they risk giving the double-mix vaccine again, despite the hazard of Guillain-Barré syndrome, to guard the most vulnerable against the resurgent A/Victoria strain?

To answer the question, HEW's new Secretary, Joseph Califano, quickly assembled a panel of experts, chaired by Dr. John H. Knowles, president of the Rockefeller Foundation. During briefings by health officials, the panel was presented with a persuasive statistical argument: deaths from Guillain-Barré had occurred in about one out of every million high-risk people vaccinated. By contrast, there were 1,260 deaths per million high-risk people who came down with A/Victoria flu last year. In other words, the chance that an uninoculated person would die from A/Victoria flu was many times greater than that an inoculated person would succumb to Guillain-Barré syndrome. The panel's choice was clear: it advised Califano to make the flu shots available, which he promptly did. At the same time, because of an outbreak in some states of another flu strain, B/Hong Kong (for which a single vaccine is available), Califano announced he was encouraging local authorities to resume vaccinations against that strain as well.