Influenza: A Century of Science and Public Health Response

Chapter 5: The Forecast Calls for Pandemics

93 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 advances. Beginning with Russian flu, influenza researchers have avidly tracked the relationship between transportation and the epicenters of outbreaks. Following the 1957 Asian flu pandemic, researchers began to identify a new pattern associated with the widely used new form of transportation: the jet airplane.1 Health officials of this era believed that the next influenza pandemic would move faster than had any others in human history. Because the 1957 and 1968 vaccination efforts had failed at many levels, preparation and organization for the next pandemic shift was undertaken at levels stretching from the local all the way up to the international . Any program that sought to protect against pandemic influenza would require close coordination among public health organizations. Building on efforts begun in the 1950s, these organizations sought to coordinate in terms of research, surveillance, manufacturing, and organization. A new influenza pandemic would brook no delays. Protecting against an influenza pandemic was seen as a technical problem, chapter 5 The Forecast Calls for Pandemics • 94 the forecast calls for pandemics one that could be solved. New predictive pandemic models and faster, more productive manufacturing processes were seen as crucial for blunting or even preventing pandemic spread in the nation. Public health officials anticipated that any successful new approaches to protecting against influenza epidemics would stem from increased research on the virus and its behavior. These advances in preventing the virus would be part of a global effort to control pandemic outbreaks. The increased knowledge about influenza achieved in the 1930s and 1940s, the ability to grow large quantities of virus cheaply, and the identification of an inexpensive animal model (laboratory mice) enabled many more researchers to study the influenza virus. Although other diseases, including polio, continued to attract more research funding, by the 1950s increasing numbers of people were working on the virus. This wider interest made it clear that some sort of coordination of effort was needed to prevent wasteful duplication in research. Again, such global coordination seemed a natural fit for the World Health Organization . By the early 1950s the expert committee on influenza—which already met regularly to decide on yearly vaccine recommendations—began the task of informally organizing research agendas on topics related to influenza. Expert committees have a curious relationship with the WHO. Consisting of individuals recognized as experts in the various fields in which the WHO is involved, they are called together to consult on a topic of interest to the organization. The reports or recommendations they issue are provided to the director general of the WHO but are neither binding on the organization nor necessarily accepted as its official policy. Only the directors of the WHO’s executive board or the amendments passed by the World Health Assembly officially speak for the organization. In practice, however, the expert committees ’ recommendations carry enormous clout with the WHO, especially in the case of influenza and the relevant committee’s twice-yearly vaccine recommendations . For committees working on matters of technical sophistication, senior WHO leaders are relatively unlikely to intervene in their recommendations . Significantly, the group of experts dealing with the influenza surveillance system has been—and remains—one of the more technically oriented of the WHO’s committees. In many ways the influenza committee’s role in the WHO mirrors the WHO’s role in global health. The WHO can craft reports and studies and issue proclamations and suggestions, but it cannot really compel acceptance of its goals. In fact, the WHO has few resources of its own, relying almost totally on national health programs to do its work and achieve its goals. The organization maintains a small staff at its headquarters in Geneva and in regional divisions, but it mostly uses people and resources “loaned” to it. Nonetheless, the forecast calls for pandemics 95 the WHO can bring enormous coercive public pressure to bear on individual nation-states, pushing them to adhere to its prescriptions and to work with the organization in various ways.2 The influenza expert committee meetings have tended to be informal affairs , with gatherings considered a meeting of equals. Although the number of researchers working...