The Wrong Lessons - The Monster at Our Door: The Global Threat of Avian Flu - page 16

species barrier. Some believed that only a few HAs were endowed with the ability to successfully reassort
with human flu genes, while others conjectured that all avian HAs were potential new human influenzas.
There was broad agreement, however, that medicine needed to heed influenza's unpredictable evolution-
ary potential. The revelation of an unexpectedly diverse wild gene pool implied that 1918 might not have
been such an aberration after all.
On 13 February 1976, the New York Times carried an op-ed piece by Dr. Edwin Kilbourne, a leader
of the younger generation of influenza researchers. Kilbourne warned that a new pandemic might be
close at hand: “Worldwide epidemics, or pandemics, of influenza have marked the end of every decade
since the 1940s—at intervals of exactly eleven years—1946, 1957, 1968. A perhaps simplistic reading of
this immediate past tells us that 11 plus 1968 is 1979, and urgently suggests that those concerned with
public health had best plan without further delay for an imminent natural disaster.” The very same day,
communicable-disease officials at the Centers for Disease Control (CDC) in Atlanta were discussing dis-
turbing laboratory findings. New Jersey public health officials had sent the CDC cultures of an unidenti-
fied flu that had killed one Army recruit and hospitalized several others at Fort Dix; Dr. Walter Dowdle,
the director of CDC's lab, now reported that the mysterious virus was swine flu, a variant of H1N1 that
was believed to be genetically closer to the original pandemic strain than the attenuated human genotypes
that had circulated from 1920 until they were replaced by H2N2 in 1957. In the worst-case scenario, the
great killer of 1918 had been resurrected and posed acute danger to anyone born after 1956 (who thus
lacked H1N1 immune memory). 65
CDC Director David Sencer canvassed the opinions of other experts, but the crucial responsibility
for characterizing a pandemic crisis was his. In an emergency meeting with David Mathews, secretary
of Health, Education, and Welfare (HEW), Sencer—supported by his boss, Dr. Theodore Cooper—made
the case for universal immunization. Any decision had to be made punctually, for Washington had only
a brief window of opportunity to order the vast quantity of fertile eggs required to manufacture a vac-
cine for the next flu season. Mathews, it turned out, had just finished reading Alfred Crosby's new topic,
Epidemic and Peace: 1918, and he was thus vividly aware of the carnage wrought by the 1918 pandemic.
On 15 March, the secretary sent a note to the director of the budget, warning that “the indication is that we
will see a return of the 1918 flu virus.” Of course, 1976 was an election year, and the White House was
stunned when it learned of Mathews's memo. President Gerald Ford, already being pressured by Ronald
Reagan's succcess in the early Republican primaries, hardly wanted voters dropping dead of influenza on
the way to polling stations in November. Accordingly, he tried to turn the swine flu threat into a political
asset by dramatically announcing a crash program to vaccinate more than 100 million Americans. 66
The administration, however, quickly discovered the vagaries of relying upon the marketplace to sup-
ply the emergency vaccine, as well as the difficulties inherent in fragmented local governments supervis-
ing mass immunization. Since a 1974 court decision that found drugmaker Wyeth liable for the calamit-
ous side effects of its polio vaccine, the big pharmaceutical companies had been rushing to drop vaccines
from their product lines. To induce the companies to start up fertile egg production lines, Ford had to bribe
them with $135 million appropriated from Congress for the purchase of vaccines. He then had to submit
to blatant extortion by the casualty insurance industry, which refused to provide coverage to the manufac-
turers unless the federal government agreed to indemnify any claims against the insurers. (An incredulous
California congressman, Henry Waxman, asked Theodore Cooper: “Dr. Cooper, are you in effect saying
that the insurance industry is using the possibility of a swine flu pandemic as an excuse to blackmail
the American people into paying higher insurance rates?”) The manufacturing processes, moreover, were
proprietary secrets: although the Food and Drug Administration (FDA) had to approve the final vaccines,
the government could exert little direct quality control over their production. As a result, Parke-Davis