Honigsbaum, Mark

RERO DOC Digital Library

Focus on EpidemicsGeorge Dehner, Influenza: A Century of Science and Public Health Response,Pittsburgh, PA: University of Pittsburgh Press, 2012. Pp. vii+ 285. $27.95. ISBN978 0 8229 6189 5.In the past 40 years, technically driven responses to flu pandemics have twice calledscience and public health into disrepute. The most recent occasion was in 2009 whenthe unexpected emergence of a quadruple reassortment swine flu virus in Mexico trig-gered contracts for the distribution of billions of dollars worth of antiviral drugs and vac-cines—the political fallout from which, in light of the mild nature of the pandemic, is stillthe subject of controversy today. The other occasion was in 1976 when the emergence atFort Dix, New Jersey, of another strain of swine flu prompted the United States PublicHealth Service to wage an unprecedented nation-wide inoculation campaign. Approvedat the highest levels of the Ford government, the programme resulted in the vaccinationof 42 million Americans but was soon labelled a costly ‘fiasco’ when people began suffer-ing adverse reactions and the pandemic proved far milder than experts had anticipated.The story of the 1976 swine flu has been told many times before, most notably byRichard Neustadt and Harvey Fineberg in their 1982 book, The Epidemic That NeverWas.1 Although George Dehner’s new book relies heavily on their account of events atFort Dix, he has supplemented it with interviews with many of the key bureaucraticplayers, including David Sencer, the then head of the Centers for Disease Control (CDC);Walter Dowdle, the CDC’s chief virologist; and Donald A. Henderson, whom the CDChad loaned to the World Health Organization (WHO) and who was privy to key discussionswith European vaccine manufacturers. However, as should be clear from Dehner’s subtitle,his ambition extends far beyond 1976 as he seeks to document ‘a century of scientific andpublic health response’ to flu—a project that has him trawling the archive all the way backto the 1889 ‘Russian’ influenza pandemic.While Dehner’s approach is empirical, his book is peppered with insights into how gen-erational responses to flu pandemics are shaped by prevailing scientific theories and tech-nologies, as well as by institutional and folk memories of previous pandemics. Time andagain he shows how pandemic planners have sought to apply the ‘lessons’ of previouspandemics (p. 199), only to find themselves outwitted by the ‘wily’ influenza virus(p. 190). While Dehner’s tendency to anthropomorphise flu and his reluctance to stepoutside of ‘globalising’ health narratives may not be to all readers’ tastes, his book con-tains much valuable new material. He also has some perceptive things to say about theWHO’s tendency to see flu as a ‘technical problem’ to be overcome by ‘functionalist’approaches to health (pp. 12–13, 72–3, 93). In particular, Dehner shows how theWHO’s ‘template for a truly global health system’ (p. 16) was laid way back in 1947with the establishment of the World Influenza Centre in London—the model for thenetwork of sentinel flu laboratories that encircle the globe today. Perhaps the most© The Author 2013. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.All rights reserved.1Richard Neustadt and Harvey Fineberg, The EpidemicThat Never Was: Policy Making and the Swine FluAffair (New York: Vintage Books, 1982).Social History of Medicine Vol. 26, No. 4 pp. 779–788important passages, however, are Dehner’s analysis of the differences between the USA’sand the WHO’s response to the 1976 swine flu outbreak. Thus though Dehner acknowl-edges that 1976 was a presidential election year and that politics played its part in therush to vaccination, he argues that the more important reason was the experience ofthe previous 1957 and 1968 pandemics. The other key factor was the way that the emer-gence of the A/New Jersey strain of swine flu seemed to fit then predictive theories aboutthe ‘recyling’ of influenza viruses and the correspondence of pandemics with 10-yearcycles. For all that these supposed scientific facts were marshalled by Sencer and othersto force the administration’s hand, however, in Europe WHO officials working with thesame facts reached a very different conclusion: namely, that the pandemic was likely tobe mild and it was better to adopt what Dehner characterises as a policy of ‘watchfulwaiting’ (p. 200). The irony today is that although modern genomic technology meanswe can detect pandemic strains far earlier than in the past, our dependence on old-stylechicken–egg vaccine production methods and the concentration of manufacturingcapacity in global corporations, means that national vaccination campaigns are simplyno longer an option. In this respect, if in no other, Dehner concludes the 1976 swineflu debacle ‘was and probably will remain unique’ (p. 198).doi:10.1093/shm/hkt049Advance Access published 16 August 2013Mark HonigsbaumInstitute and Museum of theHistory of Medicine, Zurich Universitymhonigsbaum@mhiz.uzh.chNancy K. Bristow, American Pandemic: The Lost World of the 1918 InfluenzaEpidemic, New York: Oxford University Press, 2012. Pp. ix+ 280. $34.95. ISBN978 0 19 981134 2.Since the republication of Alfred Crosby’s landmark work on Spanish Flu in 1989, and therecovery of fragments of the causative virus in 1997, there has been a tsunami of scholarlyand popular works examining the cataclysmic Spanish Flu.1 Nancy Bristow, Professor ofHistory at Puget Sound University in Tacoma, Washington, seeks to carve out a spacefor her own work in this expanding canon by both ‘piec[ing] together fragmentarysources to hear voices previously unheard’ (p. 6) and to explore the ‘preferred narrativesthat emerged both during and following the epidemic, seeking to illuminate the publicamnesia about the pandemic that contrasted starkly with its profound private impact’(p. 8).To achieve her aim of giving voice to those previously unheard, Bristow mined a remark-able collection of archival and published sources ranging from the institutional responsesof government and private organisations like the Red Cross, to contemporary newspaperand medical literature reports, to personal recollections of those swept up in the pan-demic recorded both immediately following the epidemic and from retrospectivesources. Bristow privileges race, class and gender in interrogating this material. In thisanalysis, it must be said, Bristow is only partly successful. The sections discussing the differ-ing gender responses to the catastrophe, especially as the professional medical1Alfred Crosby, Epidemic and Peace, 1918 (Westport,CT: Greenwood Press, 1976) subsequently reissuedas America’s Forgotten Pandemic (Cambridge: Cam-bridge University Press, 1989); JeffreyK. Taubenberger, Ann H. Reid, Amy E. Krafft, KarenE. Bijwaard and Thomas G. Fanning, ‘Initial GeneticCharacterization of the 1918 “Spanish” InfluenzaVirus’, Science, 21 March 1997, 275, 1793–6.780 Focus on Epidemics

George Dehner, Influenza: A Century of Science and Public Health Response

Abstract

Similar works

Full text

Available Versions

RERO DOC Digital Library