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The history of flu pandemics: Learning from past crises

Since 1918, there have been four flu pandemics, each one with different characteristics.
by Jaclyn Cosgrove Published: January 7, 2013

“At that time when you received a flu vaccine, you typically got sick for a few days, so there was not a whole lot of enthusiasm about the flu vaccine because it was almost as bad as having the flu,” Shook said.

This is not the case for the present-day flu shot. Because of how the current flu shot is made, it is not possible to contract the virus from the shot.

“The side effects of the vaccine have been virtually eliminated,” Shook said. “They really have a very, very pure vaccine that's extremely safe, and even though you might feel a little bit draggy the day you get your shot, you usually don't feel anything. The concept that you can get the flu from this vaccine clearly is not true any more.”


It goes against everything you're taught in public health to turn people away who want to get their flu shot, said Joyce Lopez, program administrator for immunizations at the Oklahoma City-County Health Department.

But that's exactly the predicament many health departments experienced in 2009. In the spring of 2009, a new flu virus spread quickly throughout the United States and the world, according to the Centers for Disease Control and Prevention.

The first U.S. case of H1N1, or swine flu, was diagnosed was diagnosed on April 15, 2009, according to the CDC. About a week later, the CDC was working to develop a vaccine for the new virus. Soon, the U.S. government declared H1N1 a public health emergency.

The flu shot that year did not cover H1N1. This meant government agencies and vaccine companies had to work quickly to find another vaccine.

The flu virus is constantly mutating — the reason a new flu shot is needed each year. Scientists typically base what strains to include in the flu shot on what strains are found in places such as Australia, which experiences its flu season opposite of the U.S.

The flu vaccine is made using eggs in laboratories, and it can take several months to create. Thankfully, by November 2009, 61 million vaccine doses were ready, according to CDC.

But at first, Lopez and other public health workers were limited in what they could dole out during flu clinics at local high schools and colleges.

“You would think that we were Buy For Less giving away iPads or something because people would be literally camped out waiting for a shot,” Lopez said. “And you hated to tell them, ‘I'm sorry, but you don't have a pre-existing medical condition, and we have to see all these people that have pre-existing medical conditions, that are pregnant, before we can give you a flu shot.”

Turning healthy people away from getting their flu shots is not typically what county health departments do. Rather, public health entities are generally the biggest proponents of vaccinations and immunizations.

That flu season in 2009 was the only time Lopez has worked a flu pandemic.

“It didn't make sense,” Lopez said. “It was totally against everything that public health is, especially in a pandemic, that's our job to cover everybody.”