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The 1976 U.S. swine flu vaccinations may offer lessons for the COVID-19 pandemic – CBC.ca

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For Pascal Imperato, a communicable disease epidemiologist who in 1976 was in charge of immunizing New York City against a potential swine flu epidemic, the effort to vaccinate the population against COVID-19 feels like a familiar challenge.

“We were going to vaccinate six million people in six weeks,” he said in a phone interview. “And we were absolutely certain we could pull it off. And we would have.”

Would have, because, ultimately, the largest national immunization program that had ever been undertaken in the U.S. was cut short as the epidemic never materialized, and public skepticism about the program began to mount.

Still, while the COVID-19 pandemic is very real, and the population is much larger, the vaccination program of 1976 may offer some lessons as governments around the world prepare to inoculate the public at large.

“If the program is well organized, mobilizing all of the resources that are capable of administering this vaccine, there [shouldn’t] be any problem whatsoever,” Imperato said. 

In March 1976, the administration of then president Gerald Ford launched a $137 million US nation-wide vaccination program to immunize every American citizen by the end of the year.

The diagnosis of swine flu on a New Jersey army base had led to panic among top U.S. scientists and officials who feared the disease could spread and potentially precipitate a health crisis similar to the deadly Spanish flu outbreak of 1918.

Even though it was cut short, by December 1976 more than 40 million Americans — about one-fifth of the population — had been vaccinated, and about 650,000 in New York City.

Utilizing volunteers, setting up sites

Imperato said that on any given day they had about 900 people who were involved in getting the vaccine out to the general public. That included 500 to 600 volunteers who were recruited each day through the city’s chapter of the American Red Cross.

University graduates, sanitary inspectors and public health nursing assistants were also hired and trained to use automatic jet injectors and to give cardiopulmonary resuscitation. 

Sixty vaccination sites were established in places that included schools and police precincts.

“Anywhere we could,” said Imperato, who is the founding dean and distinguished service professor at SUNY Downstate Medical Center School of Public Health.

Mary O’Brien, 77, resident of the St. Augustine Home, Chicago, winces as she is inoculated against the swine flu in 1976. (Bettmann Archive/Getty Images)

As well, 15 mobile teams were created to vaccinate over 40,000 people in more than 200 nursing homes and about 100,000 people in 150 senior citizen centres.

“This required military organization, if you will, and we were able to put together a team and put into place the people that we needed to bring this about,” he said.

A great deal of administrative and clerical support goes into a program of this kind, he said.

“We have to have people register. We had to have as much information about them as possible, because we needed to know who we were vaccinating and if any of them had any reaction. We had to have teams of people checking on adverse events.”

Local capacity can be the ‘weak link’

Nationwide, however, there  were some logistical problems, said Harvey Fineberg, a physician who was tasked with co-authoring a review into the 1976 Swine flu vaccine program.

The actual immunizations were quite erratic in their frequency in different communities, he said.

“So a lesson that’s still relevant today, whether in different provinces in Canada or different states and counties and the U.S., is the local capacity,” he said.

“That last mile, getting the immunization into the arms of the recipients, that’s the weak link in the chain.”

What made the difference  was the degree of organization and capacity of the public health departments in each community to plan and administer the vaccine, Fineberg said.

“So it wasn’t that it was only cities or only rural, rich or poor, it boiled down to ability to deliver.”

WATCH | Experts discuss strategies for Canada’s COVID-19 vaccine rollout 

As Canada prepares to distribute millions of doses of COVID-19 vaccines in January, Chair of the National Advisory Committee on Immunization Dr. Caroline Quach-Thanh and David Levine, who managed the H1N1 vaccine rollout for Montreal, say this vaccination campaign won’t be without challenges. 3:56

Dealing with ‘coincident events’

But one of the more significant problems of the program was the poor job officials did in communicating to the public when headlines emerged linking potential adverse effects to the vaccine, experts say.

“There are definitely — and this is going to be true this coming year — there will be coincident events,” Fineberg said.

“Preparing the public for expected coincidences simply because stuff happens every day, that’s really, really key,” he said.

During the 1967 vaccination program, three elderly people in Pittsburgh had heart attacks after receiving their vaccine. The publicity and headlines it generated led to a handful of states suspending their vaccination programs while they investigated a potential association, said George Dehner, an associate professor of history at Witchita State Univeristy and authour of Influenza: A Century of Science and Public Health.

While no link to the vaccination was found, polls at the time showed a significant decrease in the number of people who said they would get the vaccine because they feared some adverse effect, Dehner said.

A patient takes part in Pfizer’s COVID-19 vaccine clinical trial in May. On Sunday, a U.S. health official said the country’s first immunizations could begin on Dec. 12. (University of Maryland School of Medicine/File/The Associated Press)

There will be a certain expected death rate of people of a certain age on any given day, Pascal said. And what one has to look at is the death rate above the expected rate when running an immunization program.

“And so the CDC in this particular case did not do a good job of anticipating that and explaining that,” Dehner said.

But the vaccination rollout also saw dozens of people come down with the rare neurological disorder Guillain-Barre syndrome at a much higher rate than would be expected. Unlike the heart attacks, where no link was found, a scientific review has found there was an increased risk of Guillain-Barre syndrome after the swine flu vaccinations, according to the CDC. The exact reason for this link remains unknown.

In a 2009 interview with the The Bulletin, the health journal of the World Health Organization, Fineberg said those cases wouldn’t have been “a blip on the screen had there been a pandemic but, in the absence of any swine flu disease, these rare events were sufficient to end the programme.” 

Focus on science, not politics

When Guillain-Barre syndrome increased, some members of the public “became very skeptical and saw the whole thing as politically based, and not science-based,” said Richard Wenzel, emeritus chairman and professor of the Department of Internal Medicine at Virginia Commonwealth University.

“There was a concern that maybe politics was driving some public health responses.”

“One of the things that I would say we’re still trying to learn is policy should be scientifically based. What I mean is that whoever gives the message has to say, ‘Here’s what we know, here’s what we don’t know. And here are the assumptions we’re making currently that guide our policy.

“That sounds simple, but it’s rarely done, even today.”

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Alta. COVID-19 numbers back to early-Dec. levels, health-care system still under strain: Hinshaw – CTV News Edmonton

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EDMONTON —
Although more than 11,000 Albertans have been fully immunized for COVID-19 and infection and hospitalization rates are falling, officials are warning the province’s health-care system is still stressed.

In total, the province has administered more than 101,000 shots since December, Alberta’s chief medical officer of health said Wednesday.  

That afternoon, Dr. Deena Hinshaw reported 459 new cases of COVID-19. On Tuesday, labs conducted some 12,800 tests, leaving Alberta with a positivity rate of 3.6 per cent.

Hospitalizations, too, have dropped – but, Hinshaw said, not enough to significantly reduce the strain on Alberta’s health care system or justify easing restrictions.

Of news that several more businesses were defying public health orders with support of their local community and leadership, Hinshaw said the action could jeopardize Alberta’s recent progress.

“What I would say to those leaders is to think about not just what they see in front of them in their own town but to look at the province, and to recognize that every action that we take as individuals has repercussions and connections to our own communities and to the communities around us. And unfortunately, what we saw in the fall is that when we did take early targeted steps to try to minimize risk but not have businesses close, we continued to see our cases climb,” Hinshaw said.

She reminded the public that on Dec. 30, Alberta’s COVID-19 hospitalizations peaked at 943 people. Of those, 155 were in ICUs.

On Wednesday, Hinshaw said, 604 Albertans were in hospitals with the disease, 110 of whom were in intensive care units.

But the numbers are only on par with those seen on Dec. 4.

“This is encouraging news, and a signal that we are making meaningful progress,” Hinshaw said.

“We saw our health-care system come very close to a tipping point. We want to avoid that and we need to make sure that we are taking slow measured steps.”

She added Alberta Health was working on a “framework” that would help Albertans keep track of the metrics that would trigger more reopenings.

VARIANT, VACCINE UPDATE

There are 8,203 active cases of COVID-19 in Alberta.

To date, more than 112,500 Albertans have recovered from the disease.

With the addition of 12 more deaths on Wednesday, the province’s death tally rose to 1,599.

Hinshaw had no update on Alberta’s so far single, unsourced B.1.1.7 COVID-19 variant case, for which officials have found no transmission outside the person’s household.

“The knowledge that this particular variant of concern has been showing up in some other provinces and other countries around the world as a part of community transmission is concerning, and it does need to be factored into our decisions about timing of reopening,” Hinshaw told reporters. “Because if we do enable more activities, more opportunities for people to be in close contact with one another, we could potentially see quicker spreads if the variant is here in more locations than we currently are aware of.”

According to the latest data, reported at the beginning of the week, Alberta labs have confirmed 25 cases of the B.1.1.7 and 501Y-V2 strains first identified in the U.K. and South Africa. All but the one case have been linked to international travel.

Officials are calling immunization a key component of Alberta’s ability to prepare for any spread of two new strains, but say the work is hampered by vaccine supply delays.

Hinshaw said some Albertans who are eligible for a second dose may not yet have been given an appointment because the province is waiting to confirm its supplies arriving in two weeks.

However, she said the goal was to still administer all second shots within the maximum interval tested.

“While I can’t say with certainty at this point, what I can say is that everything possible will be done to provide that second dose to all who have had the first dose within that 42-day period.”

The top doctor asked for all those waiting to remain patient with the system and province. 

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'That’s about as un-Canadian as you can get': B.C. premier 'disappointed' at people travelling to jump the line for COVID-19 vaccine – Yahoo News Canada

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Local Journalism Initiative

Three more weeks of COVID-19 public health restrictions in Saskatchewan

Regina– Three more weeks. That’s the length of the most recent extension of public health orders in Saskatchewan meant to limit the spread of COVID-19. Premier Scott Moe made the announcement from the Legislature in Regina on Jan. 26 with chief medical health officer Dr. Saqib Shahab. The announcement came on a day when Saskatchewan posted yet another record for COVID-19 related deaths, 14, but has seen a slow drop in new case counts. There are now 2,665 cases are considered active, and on that day, 607 recoveries were reported. Moe said. “The number of new cases in Saskatchewan continues to gradually decline. Today we are reporting 232 new cases, and our seven-day average for new cases is now 254. This is down about 20 per cent from its peak of 321 on Jan. 12. Our active cases are now down to 2,665, the lowest level since Nov. 21, and down over 40 per cent from a peak of 4,763 on Dec. 7. “This gradual decline means that our current public health orders and restrictions are working, but we need to leave them in place a little longer. Therefore, all the current public health orders are being extended for three weeks until Feb. 19.” “These measures are working, when we follow them, as the vast majority of Saskatchewan people and businesses are doing. There have been a small number of mainly bars and restaurants who may not have been following those putting their staff putting their customers and essentially putting their communities at risk. So, I have asked that we increase enforcement on those who choose to break the rules, and in recent days there has been three significant tickets.” Moe also said that two bars in Saskatoon and one in Regina had been issued $14,000 fines. He held out the hope that three weeks from now, Saskatchewan may be able to look at reducing the number of restrictions in place. He pointed out that the province has made a lot of progress in vaccinations. To date, 34,080 doses have been delivered, and those administering it are quite literally getting the most out of every bottle, getting 104 per cent of expected dosages. Moe said, “But we continue to be limited by the slow pace of vaccine deliveries, from to and from the federal government. Saskatchewan now has the highest percentage of vaccines administered, and we have the second-highest per capita rate of vaccinations completed among any of the provinces. “Unfortunately, today we are virtually out of vaccines. And with no new shipments coming this week, our vaccination program will be stalled for the next number of days.” Next week, the province is expecting 12,000 additional doses, of which 5,850 will be Pfizer doses heading to Saskatoon, Regina, North Battleford, Yorkton and Swift Current to allow continued vaccination of long-term care residents and staff, as well as those over 70. A further 6,500 Moderna doses will be going to the far northeast, far northwest, and northeast regions of the province for a second doses. In the central-west region, first shots will be administered, Moe said. The province will continue to push the federal government for more vaccines, and to also look at approving additional types of vaccines for use. He referenced the vaccines that AstraZeneca and Johnson & Johnson have been working on. Shahab said, “I think it’s really important that we are seeing a steady decline in our case numbers; all the indicators are moving in the right direction is slow and steady.” Daily case numbers have come down from 24 per 100,000 population to 20 per 100,000. Test positivity is down under 10 per cent, and is doing so throughout the province. When vaccination starts picking up in March and April, “then we hope to see significant impact on hospitalization and deaths,” he said. Until then, we really have to stay the course. “The other thing is that, with our public health measures, some people say it’s too little, some people say it’s too much. But, you know, they try to strike a fine balance between minimizing cases, as long as the guidelines are followed, and letting people work, (and) enjoy other amenities as much as possible.” He added, “But the downward trend does show, that if all of us abide by public health principles, it has a significant impact on our case numbers.” On the same day, Manitoba implemented 14-day quarantines for nearly all travellers to that province. Asked about doing something similar for Saskatchewan, Shahab said it have been looked at, but found to be impractical, given our long borders, and people in border communities who work and shop across the border. But he did recommend minimizing travel. Regarding variants of the COVID-19 virus, Shahab said sampling is done with relation to travel, and some sampling with age groups and geography as well. “I would not be surprised if we saw a variant in Saskatchewan, but again, what we’re doing, is exactly the same. We really have to follow all these public health measures.” Asked about adverse reactions to the vaccines in Saskatchewan, Shahab said there have been around 10 to 15 allergic reactions, some tingling on the face, and one anaphylaxis that was managed safely. They were well-described in the product monograph and have been managed, he said. “Most of them have presented in individuals who may have had a history of allergies, and they have managed well, so at this point the signal is not of any concern, compared to what is known about these vaccines what we were expecting, with what’s know about other vaccines.” He noted the importance of watching those vaccinated for 15 minutes after the shot, and if you have any allergies, make it known and you will be monitored some more. Brian Zinchuk, Local Journalism Initiative reporter, Estevan Mercury

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Vaughn Palmer: Henry reduced to pleading for people to 'do more' in face of COVID-19 – Vancouver Sun

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Article content continued

There were. But not a lot more answers.

Was he in contact with anyone else on his return? “There’s a small number of family contacts … they’re being monitored for symptoms.”

Where had he travelled? “We don’t have a map of where he went.”

Was he Chinese Canadian? “The person is resident here in Vancouver.”

After a few more questions along those lines, Henry put a stop to it: “So I’m not going to talk anymore about that person. I’ve told you what we know. Anything else is rumour.”

Rumours being one of her main concerns of the day.

“I think we need to be very careful about listening to rumours and third- and fourth-hand information,” she cautioned reporters. “What’s concerning to me, having been in the city of Toronto during the SARS outbreak, is how easily those rumours can lead to discrimination, inappropriate discrimination, against people.”

She expressed the hope that “the fact that we’re being open about this, that you know the details that you need to know, that we are on top of this, that people can be reassured the risk still is extremely low here.”

But as would prove to be the case throughout the year, the provincial health officer would be the judge of “the details that you need to know.”

Far from B.C. being unprepared, B.C. was ready for the arrival of the first case from China, according to Henry.

“This first case is not unexpected to us. We know that we have quite a lot of travel between areas in China and particularly Vancouver and the Lower Mainland, but other parts of B.C. as well. We have been on high alert for a number of weeks now.”

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