In 1976, 13 soldiers at Fort Dix in New Jersey were sickened by swine flu and one died. Fearful of a pandemic similar to one in 1918 that killed 40 million people, President Gerald Ford ordered vaccinations for every American.
But the government was not prepared for what happened next.
Mixed messages from health officials and politicians created hysteria, and serious illnesses and deaths potentially related to the inoculations left the public deeply critical of the government's ability to handle a crisis, public health experts later said.
The government did little better after the anthrax scare following the terrorist attacks of Sept. 11, 2001, they said.
"We realized we didn't have the basics like all the state health officials' phone numbers in one place, and it took a whole day to get everyone on a conference call," said Dr. Georges Benjamin, a former Maryland health secretary who helped develop the state's bioterrorism plan.
"There wasn't a clear message, or even a full accounting of where all of the Cipro was located to treat anthrax," said Benjamin, now executive director of the American Public Health Association, a group of health workers.
That experience, as well as those with SARS and avian influenza during the next few years, were a wake-up call, he said. Officials used them to build the government's modern plan for dealing with pandemic influenza and other public health crises - a plan in use for the current outbreak of swine flu.
The swift and clear response to the outbreak, which has yet to be declared a full-blown pandemic, is being praised by officials such as Benjamin.
Efforts to develop a specific plan began in the 1990s during the Clinton administration, but President George W. Bush solidified the move in 2005 with a National Strategy for Pandemic Influenza and $7.1 billion in funding.
The plan coordinated federal, state and local health workers, as well as border surveillance and hospital preparedness. It also led to creation of an infrastructure to allow for speedy dissemination of antiviral medications that are generally effective only a day or two after infection, and development of vaccines that could be needed in the event of a deadly outbreak, according to Jeff Levi, executive director of the Trust for America's Health, a nonprofit group that works for disease prevention.
"It raised the level of attention throughout the government by creating an almost forced march for the agencies to come up with a preparedness plan," he said. "Now we are in a much better place than five years ago. ... There is one science-backed message from everyone, no hysteria."
That doesn't mean the government is fully prepared, however, Levi said. Diminished numbers of health care workers due to cuts and retirements, and funding to replenish vaccine and antiviral stockpiles, among other things, remain problems, Levi said.
The recession is only making the shortfalls worse, he said. For example, funding was added and then removed from last year's congressional appropriations and the recent economic stimulus package.
That could jeopardize the government's effort to expand vaccine production capacity, Levi said. The goal is to produce enough for every American within six months of a pandemic virus being identified. And more immediately, it could jeopardize supplies of antiviral medications, such as Tamiflu, for the most vulnerable Americans.
Such medicine is used throughout the normal flu season to lessen the symptoms and duration of the ailment. On average, 36,000 people die from seasonal flu every year, according to the Centers for Disease Control and Prevention.
Local officials say the government has a tendency to let down its guard in between crises. The last appropriation for state and local planning came in 2006, said Dr. Paul E. Jarris, executive director of the Association of State and Territorial Health Officials.
If lessons of the past go unheeded and more funding isn't forthcoming, he said, "this could be the worst possible time to see a novel virus that could become a pandemic."