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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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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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