I’ve been thinking about the only other time a pandemic vaccine was rolled out during a US Presidential election year: the 1976 “swine flu” campaign. What warnings and lessons might that experience hold?
In brief, a new influenza virus was detected in January 1976 in NJ. Public health officials at the time thought the US (and the world) faced an imminent pandemic from this virus, to which no one under 50 had pre-existing immunity.
In March President Ford, following strong recommendations from CDC experts and other health officials, announced the US would develop and distribute enough vaccines to immunize every man, woman, and child in the country to prevent a pandemic.
I don’t want to rehash the whole timeline; many other sources go into more detail on the interesting series of events:
huffpost.com/entry/ford-swi…
en.wikipedia.org/wiki/1976_swin…
history.com/news/swine-flu…
huffpost.com/entry/ford-swi…
en.wikipedia.org/wiki/1976_swin…
history.com/news/swine-flu…
Suffice it to say immunizations began in October (a few short weeks before the election) and ran through December. A pandemic never materialized. Even so, by the end of the program about 25% of the US population had been vaccinated.
[Aside: interesting to note that in August 1976, before immunizations began, polls indicated 53% of Americans intended to get shots - remarkably similar to the 50-60% of Americans saying they would choose to get a coronavirus vaccine when available].
Here are four takeaways from the vaccine roll-out in 1976, drawing on the many subsequent reflections and post-mortems published.
1) Even the perception of political motives driving a public health effort can be highly damaging. When vaccines are politicized, public health is the victim.
Non-experts (political figures) were the ones leading public messaging around the vaccine roll out, which in the end actually undermined public confidence (and also didn’t help politicians’ political fortunes, either, when things went poorly).
Health experts (at CDC and elsewhere) were NOT giving regular press conferences and were not visible to the public. Instead, politicians and political appointees controlled the message, and fashioned messages with an eye to politics, not necessarily public health.
As a NYT op-ed in Dec 1976 said, there was a “scarcity in the White House and in Congress of officials with sufficient sophistication in medical problems to be able to put biological reality before political expediency.” 32/ nytimes.com/1976/12/21/arc…
2) Public perceptions about adverse events– even when NOT actually caused by a vaccine– can severely damage public confidence. The media [and, these days, social media] are likely to amplify rumors about vaccine adverse events, with negative effect on confidence.
Where there is insufficient surveillance and/or a lack of public communication and transparency about vaccine safety and adverse events, conjecture and rumor about safety is likely.
Particularly relevant may be rumors about vaccine safety in older persons. In 1976 several deaths in individuals >70 years occurred after receiving a shot. The vaccines were NOT the cause but the media jumped on the story and the perception of a link stuck. 
The head of the 1976 immunization program said afterward that he wished “he had earlier and more strongly outlined possible events surrounding the program including deaths that might appear to be associated with the shots.” ncbi.nlm.nih.gov/books/NBK21960…
[Given older individuals are likely a priority group for Covid-19 vaccines, care in assessing the safety in these individuals is needed to ensure spurious links are not made between vaccinations and adverse health events in this group].
3) Divergent levels of success in distributing vaccine can be expected in a decentralized US system, where state/local officials handle much of the implementation of vaccine programs. In 1976 health departments had different levels of commitment and capacity.
In the end, vaccine coverage was highly unequal across jurisdictions. Some states/localities immunized 80% of adults, while others barely reached 10% (Delaware was at the top of the list, New York City at the bottom). There was difficulty in reaching minority populations.
4) The implications for failure, even the perception of failure, can extend beyond the specific vaccine roll out effort – to vaccines, public health, prevention, and trust in government more generally.
It may be hard to believe right now, but in early 1976 there was a huge amount of public trust in the CDC. But, the swine flu affair severely dented public respect and the agency’s reputation for a time.
While we can see some lessons from this history, we should also note there are important differences between our current coronavirus situation and what happened in 1976.
Most importantly: what we are facing now is an real, serious pandemic that has upended daily life as we know it - it's not just the specter of one. So, if anything, the current stakes for a vaccine roll-out are in fact much, much higher than in 1976.
I should say that only after I wrote these tweets did I realize @marynmck had written much of this months ago, in a more compelling and complete way:
