In the wake of the great pandemic of 1918-19, the twentieth century witnessed additional (and relatively minor) pandemics during 195782 and 19 6 8.83 The processes of emergence of pandemic influenza are cyclical and thus, contain a degree of periodicity.84 However, the Swine flu affair of 1976, which emanated from initial cases of flu-induced mortality in Fort Dix, New Jersey, generated problems in US domestic response to contagion that persist to this day. Despite dire warnings regarding the emergence of a novel strain of highly pathogenic influenza, the 1976 flu failed to generate the high levels of morbidity and mortality that had been predicted. However, profoundly negative repercussions did result from the vaccination program that was authorized by the US government, which rushed though a prototype vaccine without adequate testing before mass dissemination.85 Owing to the faulty production and insufficient testing of that vaccine, the provision of such vaccinations to the American people resulted in a significant number of people becoming afflicted with Guillain-Barre paralysis.86 The result was a storm of litigation against the manufacturers, which ultimately resulted in the courts' awarding huge damage settlements to plaintiffs. Ultimately, owing to the litigation, the major US-based developers of vaccines were forced to relocate to Canada and to Europe. This situation persists in the twenty-first century, greatly complicating domestic US ability to respond to a future influenza pandemic. As a result, the US is now almost completely dependent on vaccines produced abroad, and on the honoring of contractual obligations in the face of a global health emergency.
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