The Wrong Lessons - The Monster at Our Door: The Global Threat of Avian Flu - page 13

fuel. With some 500 million people estimated to have been infected, the pandemic was modern medicine's
greatest defeat.
But science does not celebrate defeat. Because the self-image of twentieth-century medicine is organ-
ized around a heroic mythology of progressive victory against disease, the 1918 catastrophe—that “great
shadow cast upon the medical profession”—was quickly repressed in popular memory. 52 After a final
flare-up of virulence in winter 1919, the pandemic died away, and influenza research then lost its glob-
al urgency. Unlike previous plagues that had laid siege to society for years or decades on end, the great
influenza—in essence, a viral atomic bomb—did most of its killing in a single season. Many at the time
thought (and some still think today) that it was an unrepeatable aberration, part of the larger nightmare
ecology of 1914-18. The pandemic's mystery persisted, however, and a small but committed cadre of mi-
crobiologists soldiered on in their laboratories. By the late 1920s they had discarded the once-orthodox
belief in a bacterial pathogen and had begun to look for an influenza virus. A swine variety was isolated in
1930 and, using ferrets as surrogates, its human counterpart was identified during a London flu epidemic
three years later; both were believed to be offspring of the 1918 killer, with today's opinion favoring the
idea that humans passed the virus to pigs, rather than vice-versa. 53
After Pearl Harbor, Washington again began to worry about influenza. The senior officers in the sur-
geon general's office had been young doctors on the frontlines of the 1918 pandemic, and they were
haunted by the threat of another pandemic in the barracks. A renowned University of Michigan research-
er, Dr. Thomas Francis, who had discovered influenza A's antigenic diversity in 1936 and isolated influ-
enza B in 1940, was appointed head of the Influenza Commission, and his young protégé, Jonas Salk, was
charged with carrying out vaccine field trials in 1943. Within a year, a safe and effective experimental
vaccine using inactivated viruses grown in fertile eggs was dispelling (forever, some thought) the specter
of 1918. 54 However, in the winter of 1946-47, the Francis/Salk vaccine (based on 1934 and 1943 strains)
totally failed to provide protection against a new flu. Although the 1947 outbreak (a “pseudo-pandemic”)
infected hundreds of millions across the globe, it fortunately lacked pandemic lethality; current opinion is
that the absence of any cross-immunity between earlier strains and the 1947 flu probably represented an
extreme case of mutation within a subtype (H1N1) which otherwise preserved the basic surface antigen
(HA and NA) characteristics of 1918. 55
The 1946-47 failure demonstrated the need to annually update vaccine composition based on careful
international screening for newly emergent strains. The new World Health Organization was spurred
to establish a world influenza center under the leadership of the famous flu researcher Sir Christopher
Andrewes at the British National Institute for Medical Research (NIMR) at Mill Hill, London; this became
the cornerstone of today's global influenza surveillance system. Affiliated national laboratories send un-
known influenza strains to London (or now, to Atlanta, Melbourne, or Tokyo) for rapid identification.
Based on worldwide reports, the WHO laboratories then provide drug manufacturers with candidate
strains for the next season's flu vaccine. This system faced its first great test in 1957 when a new flu
emerged in the southeastern Chinese province of Yunnan (also the likely origin of the 1894 plague pan-
demic). Because air travel was still a relatively uncommon mode of transportation, the virus spread by
traditional overland routes, via Russia to Europe, and by sea to the Western Hemisphere. Unlike the
1946-47 virus, this was not a mutation of the 1918 strain, but a genuine reassortant—probably arising in
pigs—with avian surface proteins (HA and NA) and human-flu internal proteins. H2N2—as it was later
classified—was, in other words, a new pandemic influenza.
In the United States, the Eisenhower administration rebuffed appeals from public-health experts for a
mass vaccination campaign. Although the surgeon general did appropriate small sums for influenza sur-
veillance, the Republicans in power relied upon free enterprise to develop and distribute the vaccine. “The
official national public policy at that time,” writes Gerald Pyle, “was that the private sector—[drug pro-