Influenza

Influenza: A Century of Science and Public Health Response

GEORGE DEHNER
Copyright Date: 2012
Pages: 352
https://www.jstor.org/stable/j.ctt6wrdfm
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    Influenza
    Book Description:

    In 1976, the outbreak of a new strain of swine flu at the Fort Dix, New Jersey, army base prompted an unprecedented inoculation campaign. Some forty-two million Americans were vaccinated as the National Influenza Immunization Program hastened to prevent a pandemic, while the World Health Organization (WHO) took a wait-and-see approach. Fortunately, the virus did not spread, and only one death occurred. But instead of being lauded, American actions were subsequently denounced as a "fiasco" and instigator of mass panic.InInfluenza,George Dehner examines the wide disparity in national and international responses to influenza pandemics, from the Russian flu of 1889 to the swine flu outbreak in 2009. He chronicles the technological and institutional progress made along the way and shows how these developments can shape an effective future policy.Early pandemic response relied on methods of quarantine and individual scientific research. In the aftermath of World War II, a consensus for cooperation and shared resources led to the creation of the WHO, under the auspices of the United Nations. Today, the WHO maintains a large and proactive role in responding to influenza outbreaks. International pandemic response, however, is only as strong as its weakest national link-most recently evidenced in the failed early detection of the 2009 swine flu in Mexico and the delayed reporting of the 2002 SARS outbreak in China.As Dehner's study contends, the hard lessons of the past highlight the need for a coordinated early warning system with full disclosure, shared technologies, and robust manufacturing capabilities. Until the "national" aspect can be removed from the international equation, responses will be hampered, and a threat to an individual remains a threat to all.

    eISBN: 978-0-8229-7785-8
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. ACKNOWLEDGEMENTS
    (pp. vii-x)
  4. INTRODUCTION. Wagers and Unexpected Outcomes
    (pp. 1-20)

    It all started with a bet.¹

    On 5 January 1976, the U.S. Army base at Fort Dix, in south-central New Jersey, rapidly filled with a mixture of new recruits, advanced recruits, and military and civilian personnel and dependents. The camp barracks and quarters—which had been nearly deserted over the Christmas and New Year’s break—quickly crowded with about 19,000 people. Quarters were tight, and none more so than those for the approximately 6,000 basic trainees. These new recruits were grouped into units of fifty and assigned to eight-person rooms. In addition to sharing a common mess hall and repeated...

  5. CHAPTER 1 Influenza: Virus and History
    (pp. 21-41)

    By any measure, the scientific and medical breakthroughs of the late nineteenth and twentieth centuries are truly astounding. For millennia, human societies attributed their sickness and afflictions to angry gods, misaligned cosmological events, evil witches, or any number of other supernatural causes. It is stunning to consider that the knowledge that most diseases are caused by discrete, invasive microscopic agents (or “germs”) is only about 150 years old. Not until the early twentieth century did people finally abandon the idea that diseases can be caused by malodorous vapors, or miasmas. Medical knowledge about illnesses and the organisms that cause them...

  6. CHAPTER 2 The Forgotten Pandemic Remembered
    (pp. 42-57)

    One of the small bright spots amid the horrors of warfare is its propensity to stimulate rapid medical advances. Commanders of the imperial armies locked in the ferocious combat of World War I sought to keep their soldiers fit to fight, taking steps that included inducting vast numbers of physicians, nurses, and volunteers to provide medical support for the troops. Of course, the related medical research and experts involved focused primarily on the horrific injuries soldiers sustained in battle or on the fields where the next crop of casualties were being trained. This focus on protecting a nation’s armed forces...

  7. CHAPTER 3 Breakthroughs
    (pp. 58-73)

    Spanish flu was arguably the worst pandemic in human history, but as the catastrophe receded from memory, few medical researchers worked on the agent responsible for the disaster. In the interwar years, the study of influenza was largely an individual pursuit rather than an organized research field. During World War II, however, and in the years following it, organizations for systematically tracking and studying the influenza virus began to emerge. One such organization, the World Health Organization, developed a surveillance system that both drew on previous health systems, such as the League of Nations Health Organization, and maintained a narrow...

  8. CHAPTER 4 Setbacks
    (pp. 74-92)

    Based on Christopher Andrewes’s observations of influenza B in 1946 and the vaccine failure in 1947, influenza researchers had determined that a new influenza virus arises in one location and then rapidly circulates into the wider world. The scientists did not yet understand the mechanisms of new strain formation—what we now call antigenic drift and antigenic shift—but they recognized that new strains had a competitive advantage in serial human transfer over older strains. This observation about the behavior of the influenza virus provided the logical underpinning for the World Influenza Centre and its role in surveillance. But the...

  9. CHAPTER 5 The Forecast Calls for Pandemics
    (pp. 93-109)

    Influenza and other pandemic diseases are by definition border-defying agents. The highly transmissive nature of this respiratory disease and the world’s tight interconnections ensure that every nation has been susceptible to new strains of influenza. Moreover, the speed with which the virus circulates has accelerated with the pace of transportation advances. Beginning with Russian flu, influenza researchers have avidly tracked the relationship between transportation and the epicenters of outbreaks. Following the 1957 Asian flu pandemic, researchers began to identify a new pattern associated with the widely used new form of transportation: the jet airplane.¹ Health officials of this era believed...

  10. CHAPTER 6 “Chance Favors the Prepared Mind”
    (pp. 110-127)

    In January 1976 influenza researchers and public health officials around the globe coordinated their efforts to speed up their responses to pandemic influenza. At Rougemont, Switzerland, public health experts met to evaluate the current status of influenza surveillance and vaccine manufacturing and to discuss methods of improving both. The predictive eleven-year-cycle and recycling theories added impetus to influenza research, providing an almost audible ticking sound to preparations for the next pandemic. When Martin Goldfield, an epidemiologist for New Jersey, sent his unidentified influenza samples to the CDC headquarters in Atlanta, he had no idea that he was initiating the first...

  11. CHAPTER 7 An Act of Will
    (pp. 128-144)

    In the world of a bureaucratic organization, any action that seeks to change the usual course of affairs must overcome a high level of inertia, not only because the new option counteracts established and entrenched protocols, but also because the proposed activity must be considered and accepted at a number of levels. Making a decision outside the norm is not a onetime event; rather, it is something that must be reargued and carefully stewarded through the various levels of the organization. Successfully navigating this process requires an influential person to champion the cause and continue to promote it as it...

  12. CHAPTER 8 A Different Interpretation Emerges
    (pp. 145-157)

    The World Health Organization is forced to straddle a sometimes uncomfortable divide between the global and the local. The organization is resolutely broad in outlook, an attitude exemplified by the first principle of its constitution, which states, “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”¹ To achieve the lofty goal of ensuring such health globally, however, the WHO must rely almost entirely on national health organizations in implementing its various tasks, and these national health organizations differ enormously in terms of resources and capabilities. Quite simply, many nation-states...

  13. CHAPTER 9 WHO Decides
    (pp. 158-173)

    In the morning session of the 7–8 April 1976 influenza experts meeting at Geneva, the two representatives from the United States, Walter Dowdle and J. Donald Millar, had carefully laid out the epidemiological evidence uncovered at Fort Dix and the rationale behind and method of the U.S. vaccination campaign. None of the influenza scientists challenged the science behind the vaccination decision or directly disputed the logic of the U.S. program. As the afternoon session of the meeting began, however, it became clear that representatives from other national health programs did not draw the same alarming conclusions from the epidemiological...

  14. CHAPTER 10 A Program Begins and Ends and an Epidemic Appears
    (pp. 174-192)

    The United States and Canada were alone in planning large-scale vaccination programs, and the two nations would each have to overcome a host of challenges if the campaigns were to succeed. With respect to logistics, they confronted similar problems, but each nation also faced unique obstacles. In the United States, some of these challenges were anticipated, some were anticipated but not properly communicated, and some were completely unexpected. In Canada, obtaining vaccine for the program presented an overwhelming difficulty. Finally, the influenza virus itself remained a wild card. The anticipated influenza epidemic did not arrive in 1976. An unanticipated epidemic...

  15. CHAPTER 11 The Continuing Lessons of Influenza’s History
    (pp. 193-206)

    Pandemic influenza remains a threat to human health in the twenty-first century, just as it was in preceding centuries. Combating or mitigating the impact of influenza epidemics continues to rely on the procedures whose value lay behind the establishment of the World Influenza Centre in 1947: detecting a novel strain of influenza in order to manufacture and distribute a protective vaccine against it. But for decades following the events in 1976 and 1977, the effectiveness of these twin elements traveled in opposite directions. Nothing illustrates this divergence better than pointing out that manufacturers still use fertilized egg production methods developed...

  16. NOTES
    (pp. 207-260)
  17. BIBLIOGRAPHY
    (pp. 261-278)
  18. INDEX
    (pp. 279-285)