Influenza: A Century of Science and Public Health Response (review)

Influenza is the only acute infectious disease that has swept the world in pandemics in recent centuries. Though it occurs in the United States each winter, as recently as 2009 it again assumed true pandemic strength, causing considerable mortality, particularly in pregnant women. In the first half of this book, Dehner has written an excellent, succinct accounting of the history of this disease, including its biology, nature of the virus, and epidemiology. The second half begins with a lengthy description of the “Swine Flu Epidemic,” thought to have originated in military recruits at Fort Dix, New Jersey, in January 1976. This is the transition to his analysis of governmental policies focused on the prevention and control of influenza in the United States and the world. He has studied primary source materials from a variety of government and archival sources and has interviewed important figures associated with epidemics from 1957 onward, among them, D. A. Henderson, Donald Millar, and the scapegoat of the 1976 epidemic, David Sencer, who was fired as the director of the CDC. In the background of each of the book’s eleven chapters is the memory of the 1918 pandemic which took over 500,000 lives in the United States and at least 50,000,000 lives throughout the world.

Dehner believes that world-wide cooperation in surveillance and containment of epidemics, for example, through the WHO, is the key to the prevention of future pandemics, particularly identifying epidemics early and containing them to prevent influenza crossing national borders to reach the world. He correctly identifies the inefficiencies of vaccine production and distribution, still largely relying on the use of fertilized chicken eggs for growth of viral strains. This book provides an interesting contrast between the botched handling of the 1976 Fort Dix outbreak of H1N1 influenza in a small group of military recruits—too much done too soon—and the 2009 H1N1 pandemic which apparently originated in Vera Cruz, Mexico—too little done too late. In both instances, the specter of H1N1 influenza in 1918 was ever in the minds of those U.S. government officials and experts charged with the initiation of effective measures to contain identified outbreaks and epidemics.

In March 1976, the small, contained outbreak of H1N1 influenza at Fort Dix, New Jersey, was escalated to a certain pandemic by Sencer and his public health colleagues and political figures in the Ford administration, the flames of the whole bureaucratic conflagration fanned by a hyperactive media looking for sensational stories. A univalent vaccine was hastily produced and a campaign to vaccinate all Americans undertaken. Meanwhile, the rest of the world watched and waited; only one other country, Canada, followed the lead of the United States. There was no pandemic, not even an epidemic. Subsequent to the needless vaccination of millions of Americans, the plaintiff ’s bar magnified the sporadic occurrence of cases of Guillain–Barré syndrome, a rare paralytic neurological disorder, into an epidemic consequent to the influenza vaccinations. The passage of thirty-three years did little to improve the government’s response to a small epidemic of H1N1 influenza just south of the United States border 2009 which was carried into California before it was properly identified by the influenza early warning systems of the CDC and WHO. Delays in identifying the antigenic structure of the new influenza virus, delays in contracting for and producing a univalent vaccine, and a poorly administrated system of distributing the vaccine, including rationing and establishing priorities for recipients, compromised the national response to a real pandemic, in distinction to the bureaucratic panic of 1976. Fortunately, for the United States and the world, the morbidity and mortality of the 1976 H1N1 scare was virtually nil and the morbidity and mortality of the 2009 H1N1 pandemic was not great, though substantial in younger patients, most particularly pregnant women.

Dehner concludes his book with a useful overview...