Influenza

Title Page

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Copyright

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Contents

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Acknowledgements

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pp. vii-viii

Introduction: Wagers and Unexpected Outcomes

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pp. 1-10

It all started with a bet.¹
On 5 January 1976, the U.S. Army base at Fort Dix, in south-central New Jersey, rapidly filled with a mixture of new recruits, advanced recruits, and military and civilian personnel and dependents. The camp barracks and quarters—which had been nearly deserted over the Christmas and New Year’s...

Chapter 1: Influenza: Virus and History

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pp. 21-41

By any measure, the scientific and medical breakthroughs of the late nineteenth and twentieth centuries are truly astounding. For millennia, human societies attributed their sickness and afflictions to angry gods, misaligned cosmological events, evil witches, or any number of other supernatural causes....

Chapter 2: The Forgotten Pandemic Remembered

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pp. 42-57

One of the small bright spots amid the horrors of warfare is its propensity to stimulate rapid medical advances. Commanders of the imperial armies locked in the ferocious combat of World War I sought to keep their soldiers fit to fight, taking steps that included inducting vast numbers of physicians, nurses,...

Chapter 3:Breakthroughs

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pp. 58-73

Spanish flu was arguably the worst pandemic in human history, but as the catastrophe receded from memory, few medical researchers worked on the agent responsible for the disaster. In the interwar years, the study of influenza was largely an individual pursuit rather than an organized research field. During...

Chapter 4: Setbacks

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pp. 74-92

Based on Christopher Andrewes’s observations of influenza B in 1946 and the vaccine failure in 1947, influenza researchers had determined that a new influenza virus arises in one location and then rapidly circulates into the wider world. The scientists did not yet understand the mechanisms of new strain formation...

Chapter 5: The Forecast Calls for Pandemics

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pp. 93-109

Influenza and other pandemic diseases are by definition border-defying agents. The highly transmissive nature of this respiratory disease and the world’s tight interconnections ensure that every nation has been susceptible to new strains of influenza. Moreover, the speed with which the virus circulates has accelerated with the pace of transportation...

Chapter 6:"Chance Favors the Prepared Mind"

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pp. 110-127

In January 1976 influenza researchers and public health officials around the globe coordinated their efforts to speed up their responses to pandemic influenza. At Rougemont, Switzerland, public health experts met to evaluate the current status of influenza surveillance and vaccine manufacturing and...

Chapter 7: An Act of Will

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pp. 128-144

In the world of a bureaucratic organization, any action that seeks to change the usual course of affairs must overcome a high level of inertia, not only because the new option counteracts established and entrenched protocols, but also because the proposed activity must be considered and accepted at a number of levels. Making a decision outside the norm is not a onetime event; rather, it is...

Chapter 8: A Different Interpretation Emerges

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pp. 145-157

The World Health Organization is forced to straddle a sometimes uncomfortable divide between the global and the local. The organization is resolutely broad in outlook, an attitude exemplified by the first principle of its constitution, which states, “Health is a state of complete physical, mental, and social...

Chapter 9: WHO Decides

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pp. 158-173

In the morning session of the 7–8 April 1976 influenza experts meeting at Geneva, the two representatives from the United States, Walter Dowdle and J. Donald Millar, had carefully laid out the epidemiological evidence uncovered at Fort Dix and the rationale behind and method of the U.S. vaccination campaign. None of the influenza scientists challenged the science behind...

Chapter 10: A Program Begins and Ends and Epidemic Appears

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pp. 174-192

The United States and Canada were alone in planning large-scale vaccination programs, and the two nations would each have to overcome a host of challenges if the campaigns were to succeed. With respect to logistics, they confronted similar problems, but each nation also faced unique obstacles. In the United States, some of these challenges were anticipated, some were anticipated but not properly communicated, and some were completely unexpected...

Chapter 11: The Continuing Lessons of Influenza's History

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pp. 193-206

Pandemic influenza remains a threat to human health in the twenty-first century, just as it was in preceding centuries. Combating or mitigating the impact of influenza epidemics continues to rely on the procedures whose value lay behind the establishment of the World Influenza Centre in 1947: detecting a novel strain of influenza in order to manufacture...

Notes

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pp. 207-260

Bibliography

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pp. 261-278

Index

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pp. 279-286