The New York City program began on 12 October 1976. The ceremonial opening of the program was held at 9:00 a.m. that morning at one of the department’s 60 immunization stations. Mayor Beame, who had always been skeptical of the pandemic threat of swine flu and the necessity for the immunization program, declined to be publicly vaccinated. Instead, this writer, as Chair of the Swine Influenza Immunization Task Force, was immunized before the press and media. Turnout at all 60 stations was excellent that morning, but during the opening ceremonies, at which most of the New York City radio and television stations and newspapers were represented, the Associated Press and United Press International reported that three people were said to have died in Pittsburgh, PA following swine influenza immunizations.
Because New York City is a world media center, the local swine influenza program received intense scrutiny. By midday, several state health departments had suspended their immunization programs. However, the decision of the New York City Department of Health was to continue the program. After an emergency meeting at midday, the staff of the Department of Health recommended continuing the program, even though the lot of bivalent vaccine being used was that alleged to have caused deaths in Pennsylvania. The department’s staff could see no causal relation between three cardiac deaths in Pennsylvania and the swine influenza vaccine.
Rubin summarized press coverage of the swine flu program, and said the following of the October crisis, “Many reporters complained about the CDC’s level of cooperation during the October crisis. They realized that phones were ringing off the hook, but, when calls did get through, reporters said they were treated in a haughty manner” . No comments were made by the Center on the issue until late in the day. By this time, the hysteria which began at midday had mushroomed. Television, radio, and newspapers were reporting on the alleged mounting death toll. By the time the CDC came out with a statement, radio and television had been broadcasting the story for close to 5 h, and copy had been set for the next day’s newspapers. Headlines in New York City newspapers the following day included: “The Scene at The Death Clinic” and “Death Toll Mounting.”
Other adverse events during October lessened public confidence in the vaccine. On 23 October 1976, recommendations were made to immunize the 3–18-year-old age group. The recommendation of two inoculations 4 weeks apart was impractical, given the already complex bureaucratic processes and paperwork surrounding each inoculation. National advisory bodies making this decision decided that split virus monovalent vaccine was to be used in healthy youngsters three to 18 years of age, and whole virus monovalent vaccine in those 18–24 years. Whole virus bivalent vaccine was used in those over 65 years and high-risk individuals 25–65, but split virus bivalent vaccine was recommended for high-risk individuals 3–18 years. In effect, then, the program was being asked to administer four vaccines to different age groups, two of which required a booster after 4 weeks. Logistically, it was virtually impossible to implement so complex a protocol in a mass immunization program designed for millions within 8 weeks, and already weighted down by inordinate bureaucratic red tape.
In November 1976, the New York City Department of Health convened an Ad Hoc Expert Advisory Committee to advise the task force on swine influenza immunizations for children three to 18 years. This committee of ten consisted of the directors of pediatric services at the city’s leading university hospitals. In view of the poor antibody responses, the significant level of side reactions, and the fact that the flu season was already well underway with no swine flu in sight, this committee recommended that healthy children in this age group not be immunized unless an epidemic occurred. This became the policy of the New York City Department of Health. It sharply diverged from that recommended by the CDC (Table 7).
The threat of swine flu was increasingly seen as being very remote. By mid-November, less than 5 % of the New York City target population had been immunized. Widespread availability of the vaccine and the convenient location of the department’s 60 clinics, many of which saw few people each day, indicated that most did not wish to be immunized.
To obtain more precise data on public attitudes toward the program, a 1-week interview survey was conducted in two distinct areas of the city to assess the attitudes of middle-class commuters and those living in disadvantaged urban communities. In order to ascertain attitudes among the former, interviews were conducted on Wall Street and in Grand Central Station. To solicit attitudes among African American and Hispanic populations, interviews were conducted in the Bedford-Stuyvesant area of Brooklyn. Of the 436 people interviewed, only 70 (16.1 %) said they had received swine flu shots; 233 (53.4 %) had not and did not intend to. Of these, 51.5 % thought the inoculation was unnecessary, 33.5 % were afraid to get it, 12.8 % had been advised by their physicians not to get it, and 2.2 % had no reason (Table 8).
Table 8 shows that most middle-class commuters did not consider swine influenza immunizations necessary. Only a minority were afraid to get it. Among those in Bedford-Stuyvesant, fears of the vaccine were considerably greater, but most thought immunization unnecessary.
On 27 November 1976, the CDC, concerned by poor turnout across the nation, especially in the larger cities, stated that programs in large cities were failing to reach African American and other minority populations. This statement erroneously presumed that African American and other minority populations wanted immunization. The New York City Department of Health swiftly cited the results of its surveys, and pointed out that of all the populations in the city, the disadvantaged had the best access to the swine flu clinics because the department’s health centers were all built in the 1930s and 1940s in areas which had subsequently become disadvantaged. Most of the department’s swine flu clinics were located in these centers.
Shortly after the department’s surveys, one was undertaken by The New York News, one of the city’s two leading newspapers. Among 504 people interviewed, results were similar to those obtained by the Department of Health survey. Clearly most people did not intend to be immunized.
On 14 December 1976, the CDC reported a number of cases of Guillain-Barré paralysis among individuals after receiving swine influenza immunizations. On 16 December 1976, the program was suspended throughout the United States. The Guillain-Barré syndrome is known to occur after immunizations and a certain incidence was expected after swine influenza immunizations. Because of intense surveillance of vaccines for all kinds of side reactions and the litigious atmosphere surrounding the swine flu program, these cases surfaced very quickly. At the time the program was suspended, 40 million (17 %) of the national target population had been immunized.
On 15 January 1977, the Public Health Service Expert Advisory Committee on Immunization Practices recommended partial resumption of the program for the high risk population. In New York City, the Department of Health again made the vaccine available to private physicians, clinics, and hospitals, and opened an immunization clinic in each of the city’s five boroughs. No other elements of the program were reinstated. Less than half a dozen people showed up daily at each of the five clinics.
Table 9 presents the results of the swine influenza immunization program in New York City. A total of 639,144 doses were actually administered. There were 2357 untoward reactions, making for a rate of 3.7 per 1000. A total of 2,197,130 doses of vaccine were distributed to the three principal groups of providers, but only slightly more than a quarter of these were actually administered. These results were far below the targets established at the inception of the program, but reflected the public’s perception of little need for immunization. Table 9 presents the immunizations by age group and type of vaccine administered. Most immunizations were given in the 25–44 and 45–64-year age groups.