Pandemic Disease and Public Response
Your initial response should be at least 250 words.
For this week’s discussion, first write a brief overview of the history of pandemic influenza in the world, including the ways in which governments responded to the health crisis throughout history.
Then, how has the human understanding of the cause of the disease changed, and how have these changes affected government response and public policy?
What have been the consequences of calling a pandemic flu a national security threat?
Considering the information you acquired in the reading this week, do you think that governments should enforce the flu vaccine each year?
Changing Perceptions: of Pandemic Influenza and Public Health Responses � PUBLIC HEALTH THEN AND NOW � American Journal of Public Health | January 2012, Vol 102, No. 190 | Public Health Then and Now | Peer Reviewed | Kamradt-Scott | Adam Kamradt-Scott, PhD, MAIS OF ALL COMMUNICABLE diseases, pandemic influenza probably remains the most feared by politicians, policymakers, and health practitioners alike, and with good cause. Unlike a variety of other infectious diseases such as HIV/AIDS, West Nile virus, and severe acute respiratory syn- drome (SARS), influenza has infected and affected humanity for centuries. Although seasonal variations of this pathogen tend to cause serious illness only in the old, infirm, or very young, periodically a new strain emerges to which humans have little to no immunity. These latter strains have, on occasion, demonstrated that even those in the prime of life are vulnerable. There is no better example than the 1918– 1919 Spanish Influenza pan- demic, which spread around the world approximately 3 times in 18 months and killed an esti- mated 40 million people. Over time, however, the magnitude of the 1918 pandemic faded from memory. The 1958 and 1967 pandemics revealed that the menace remained, yet for much According to the latest World Bank estimates, over the past decade some US $4.3 billion has been pledged by governments to combat the threat of pandemic influenza. Presidents, prime ministers, and even dictators the world over have been keen to demonstrate their commit- ment to tackling this disease, but this has not always been the case. Indeed, government-led intervention in responding to the threat of pandemic influenza is a relatively recent phenomenon. I explore how human understandings of influenza have altered over the past 500 years and how public policy responses have shifted accordingly. I trace the progress in human understanding of causation from meteoro- logical conditions to the microscopic, and how this has prompted changes in public policy to mitigate the disease’s impact. I also exam- ine the latest trend of viewing pandemic influenza as a security threat and how this has changed contemporary governance structures and power dynamics. (Am J Public Health. 2012;102:90–98. doi:10.2105/ AJPH.2011.300330) of Pandemic Influenza and Public Health Responses Perceptions Changing of the 20th century pandemic influenza was generally viewed as inconsequential in the face of other potential threats such as nuclear annihilation. In more recent years, the inter- national community has wit- nessed a lot of activity (often accompanied by dire warnings) directed against the threat of pandemic influenza. Literally bil- lions of dollars have been spent on procuring and securing access to pharmaceuticals, in drawing up contingency plans and then exercising them, in training criti- cal personnel and first-line responders, and in encouraging the private sector to develop business continuity plans, all to better prepare societies for dealing with the next pandemic. Although the 2009 H1N1 pandemic was less severe than originally feared, medical pro- fessionals and scientists con- tinue to warn that another pandemic of similar severity to the 1918 pandemic remains a distinct probability. The only question that remains is not if, but when. January 2012, Vol 102, No. 1 | American Journal of Public Health Kamradt-Scott | Peer Reviewed | Public Health Then and Now | 91 ⏐ PUBLIC HEALTH THEN AND NOW ⏐ ” I examine how understandings of influenza and attempts to miti- gate its effects have developed and evolved over the past 500 years and how the recent shift toward framing the virus as a threat to national and interna- tional security has shaped con- temporary public health policy. A BRIEF HISTORICAL OVERVIEW According to the Oxford Eng- lish Dictionary, “influenza” is from the Italian influenza, which literally means “influence,” although its origins can also be traced to the medieval Latin influere meaning “to flow in.”1 The official adoption in 1782 of the term “influenza” by the Brit- ish College of Physicians firmly established its place in medical parlance2 and displaced several of the alternative names the dis- ease was known by, such as the French “la grippe,” the English “catarrh,” and the Scottish “rant.”3 Yet, although the name may have changed over time, his- torical accounts of the symptoms experienced by victims display a striking commonality that leaves little doubt that the disease has been a persistent element of the human condition for millennia. Indeed, from the historical accounts that have survived to the present day, it is now gener- ally held that the first truly world- wide influenza pandemic occurred in the year 1510. Before this, although evidence of local- ized influenza epidemics and even regional epidemics dating back to 1173 survives, none of the accounts proffer sufficient information to suggest that these epidemics were worldwide in scope. It is in this regard that Dr Thomas Short’s account in his work A General Chronological History of the Air, Weather, Sea- sons, Meteors Etc., published in 1749, is unique. It describes an epidemic that hit Britain in 1510, while also noting its wider impact: The disease called Coccoluche, or Coccolucio, (because the sick wore a cap or covering close all over their heads) came from the island of Melite in Africa, into Sicily; so into Spain and Italy, from that over the Alps into Por- tugal, Hungary, and a great part of Germany, even to the Baltic Sea; every month shifting its sit- uation with the wind from East to West, so into France, Britain. It attacked at once, and raged all over Europe, not missing a fam- ily, and scarce a person.4 Yet, although additional writ- ings have contributed to our overall understanding of the dis- ease at this time,5 the intrinsic flaw in both the early and con- temporary accounts has been their overreliance on a limited pool of literature, as David Patterson acknowledges that [e]ighteenth- and nineteenth- century information is geo- graphically uneven, with data most abundant by far for West- ern Europe, notably Britain, Germany, France, and northern Italy. Scandinavia, Russia, the Iberian Peninsula, and espe- cially the Balkans are more sparsely documented in the contemporary medical litera- ture, but we can usually con- struct a fairly satisfactory pic- ture of influenza activity in Europe. Reports on Asia, the Middle East, Africa, and South America are sketchy at best and usually supplied by European observers. North American data are better, but often quite dis- appointing.6 As a consequence, contempo- rary knowledge about influenza epidemics and pandemics through- out earlier centuries tends to be heavily skewed toward European worldviews and those of a few specific countries in particular. Moreover, little progress was made in determining the nature of the disease in large part because of competing ideas over causation. In fact, as Margaret DeLacy relates, the depiction of influenza as a distinct genus of disease only first became common during the eighteenth century. During that period, physicians devel- oped competing theories about its etiology (causation) and transmission, including the the- ory that influenza was conta- gious. Theories of contagion were held by an increasing number of physicians during the course of the eighteenth century, although the issue re- mained a contested one, as symbolized by the publication of two separate reports on the epidemic of 1782 by the Royal College of Physicians and the Society for Promoting Medical Knowledge: reports that dif- fered on the question of trans- mission.7 The debate over causation continued into the early 20th century, with some physicians robustly defending the notion that influenza was linked to mete- orological conditions such as high winds, sunshine, and relative “Of all communicable diseases, pandemic influenza probably remains the most feared by politicians, policymakers, and health practitioners alike, and with good cause. humidity.8 Generally speaking, however, influenza did not rate particularly high on medical and political agendas even at the beginning of the 20th century. As late as 1837, there was a strong view that governments had little to no role in ensuring public health9; although this sentiment progressively began to change, government intervention in the form of large-scale public health campaigns was rare, particularly American Journal of Public Health | January 2012, Vol 102, No. 192 | Public Health Then and Now | Peer Reviewed | Kamradt-Scott ⏐ PUBLIC HEALTH THEN AND NOW ⏐ the virus’s isolation and identifi- cation by Richard Shope and his colleague Paul Lewis. Following closely behind this discovery, three scientists—Wilson Smith, Christopher Andrewes, and Pat- rick Laidlaw—isolated and identi- fied the virus from human tissue samples in 1933,16 naming this first virus influenza A. These dis- coveries and the subsequent development of a viable influ- enza vaccine in 1940s altered considerably the response of individuals and governments toward influenza, serving to usher in a new age of human interaction with the disease. The 1918 pandemic had another interesting (albeit tempo- rary) outcome: it instilled the notion that influenza was closely associated with war, with some scientists even explicitly referring to it as a “war disease.”17 Govern- ments had been cognizant of influenza’s ability to decimate mil- itary forces since at least 1782,18 but the 1918 pandemic cemented military interest in the disease because of the considerable impact it had on armed services personnel.19 So convinced were some officials that influenza would appear with the outbreak of World War II that in 1941 the United States established the Commission on Influenza of the United States Army Epidemiologi- cal Board to provide technical advice and commence work on an effective vaccine. The preoccu- pation, though, was short-lived,20 and with the advent and mass production of antibiotics and new vaccines, many began to believe that the war against infectious diseases would soon be over.21 Two subsequent pandemics revealed that such optimism was misplaced. The first pandemic, which