The Wrong Lessons - The Monster at Our Door: The Global Threat of Avian Flu - page 14

ducers], physicians and hospitals—could easily deal with the problem.” 56 But in the case of influenza,
without government coordination classical supply-and-demand relationships work mischievously. The
vaccine needs to be produced in quantity for immunization at least a month before the peak of an epi-
demic, but most of the market demand from individual consumers comes only after the epidemic is in
full course. Thus the pharmaceutical industry in fall 1957 was, according to J. Donald Miller and June
Osborne, “too little and too late. By mid-October of 1957, when the epidemic reached its peak, less than
30 million doses of influenza vaccine had been fully tested for release, and only 7 million persons had
actually received the benefit of immunization.” 57
Fortunately, the Asian flu seldom produced the viral pneumonia, cyanosis, and acute respiratory dis-
tress that so gruesomely killed off young adult victims in 1918. An arsenal of powerful new antibiotics,
moreover, gave doctors unprecedented control over secondary bacterial infections. Still, 2 million people
worldwide were later estimated to have perished in the pandemic, including 80,000 Americans, many of
whom might have been saved by timely vaccination. 58 In the opinion of public-health veterans, these
deaths were the dismal price of the failure of Eisenhower's reliance upon the invisible hand of private
enterprise to do the work of government. 59
Eleven years later a third pandemic strain was isolated in Hong Kong, although it likely had its origins
in neighboring Guangdong. This reassortant, again probably originating inside a pig, conserved the 1957
NA but added a new duck HA (thus becoming H3N2). It was fabulously contagious (500,000 cases in
Hong Kong in a few weeks), but unexpectedly mild-mannered, probably because of widespread cross-im-
munity to its familiar NA. Like an aging rock band on a revival tour, the Hong Kong flu (H3N2) carefully
retraced the itinerary of the 1957 Asian flu (H2N2), although its progress was now accelerated by air
travel—GIs returning from Vietnam promptly brought it back to California in September 1968. The drug
companies again failed to deliver the vaccine in time. “At the peak of the epidemic,” write Miller and Os-
borne, “only 10 million doses of vaccine had been distributed and no more than 6 million individuals had
been protected; again, a large store of unused vaccine remained after the epidemic had passed.” If H3N2
had been more virulent, a catastrophe might have resulted. About 34,000 Americans died in the event, as
did 700,000 others across the world. 60
The Hong Kong flu left an ambiguous legacy. For many politicians and nonspecialists in the medical
community, the relatively mild outcome relaxed apprehensions about pandemic influenza. “[M]any
health-policy makers,” writes Pyle, “felt no need for an inoculation program.” 61 Moreover, the generation
of doctors who had experienced the pandemic of 1918 were retiring from research, and new medical
school students inherited little more than folklore about hyperlethal influenza strains—and vaccines and
antibiotics seemed to be holding an old monster firmly in check. This false sense of security was rein-
forced by scientific ignorance: despite some important breakthroughs, such as the technique of negative
staining that allowed influenza viruses to be photographed under an electron microscope, surprisingly
little new ground had been gained in understanding the molecular chemistry of infection or the evolution
of the influenza genome. “It was unsuspected [for example] that influenza viruses from animals and birds
are involved in the origin of pandemic strains of influenza.” 62
Influenza specialists, however, took away different lessons from the 1957 and 1968 experiences. They
were appalled by the unnecessary loss of life and the inefficiency of the profit-driven vaccine market-
place. Pharmaceutical corporations manufactured too little vaccine, and most of it failed to reach such key
vulnerable groups like elderly people, pregnant women, and asthmatics. “In 1975, for example,” Miller
and Osborne write, “less than 20 percent of the group for whom the vaccine was recommended were actu-
ally immunized; much of the remaining vaccine had gone to corporations which purchased flu vaccine in
bulk and administered it to their young, healthy employees to reduce wintertime attrition due to the flu.”
The influenza fighters, in contrast, argued for a federally-supported vaccination program for the country's