Influenza: A Century of Science and Public Health Response

Chapter 8: A Different Interpretation Emerges

145 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 well-being and not merely the absence of disease or infirmity.”1 To achieve the lofty goal of ensuring such health globally, however, the WHO must rely almost entirely on national health organizations in implementing its various tasks, and these national health organizations differ enormously in terms of resources and capabilities. Quite simply, many nation-states are in such desperate economic straits that they lack either the resources to contribute to global health issues or the equipment and training to implement the technologically driven programs the WHO has tended to favor. Those nations able to help fund the organization and to provide equipment and personnel to global health programs have an outsized role in driving the WHO’s agenda. In 1976, by far the loudest voice in the WHO was the United States, which was the largest contributor both of funds ($40 million in fiscal year 1977, a full 25 percent of the WHO’s budget) and of scientific experts to run WHO projects, most notably the effort to eradicate smallpox.2 This benefactor had just initiated an expedited immunization program to safeguard its citizens from a possible swine chapter 8 A Different Interpretation Emerges • 146 a different interpretation emerges flu pandemic; what would the WHO recommend to its other member states? The United States played a similarly outsized role in shaping the WHO’s technical focus. Scientists from that country predominated on a number of expert advisory boards. Moreover, U.S. money often underlay U.S.-style technical programs for disease control or health improvement. The scientific experts from the United States were part of a technical elite largely drawn from a small number of “developed” nations. Although increasing numbers of WHO member states were arguing for new approaches to health, these new demands had little impact on the more technical programs in the 1970s. The WHO surveillance system is a prime example of the technical elite approach to health. By 1976 the WHO’s expanding influenza surveillance system encompassed ninety-seven centers in sixty-seven countries, all actively engaged in shipping influenza samples to WHO collaborating centers.3 As in 1947, the collected influenza samples were sent either to the United Kingdom (Mill Hill, in London) or to the United States (Atlanta), where the sophisticated work of strain identification was carried out. The CDC served a dual role, acting as the expert source for influenza virus identification for both the United States Public Health Service and the WHO. In practical terms, the WHO thus received precisely the same information that the USPHS did. Walter Dowdle, the director of the CDC’s virology division, quickly passed along relevant information about the Fort Dix outbreak to Charles Cockburn, the director of the WHO’s division of communicable diseases. Cockburn and Dowdle worked closely on responses to the new influenza strain, agreeing on the official name for the reference strain (A/NJ/8/76) and, with D. A. Henderson, coordinating simultaneous press conferences to publicize the discovery of the virus.4 The structure of the WHO influenza surveillance system called for close coordination between the two collaborating reference centers. As was mentioned earlier, tensions between the heads of these two centers had hindered efficient cooperation in the late 1940s and early 1950s. By 1976, however, the tensions had long since dissipated, and the two laboratories worked in a close harmony facilitated by the fact that their longtime heads, Geoffrey Schild and Walter Dowdle, were good friends. In fact, the scientists at the highest levels of influenza research were all well acquainted with one another, often visiting each other’s laboratories to observe techniques and research.5 The tightness of communication among WHO headquarters in Geneva, London, and Atlanta, however, did not extend throughout the entire WHO influenza surveillance system, and communication problems would become public after President Ford’s 24 March 1976 announcement of the U.S. vaccination program. a different interpretation emerges 147 The discovery of a new influenza virus at Fort Dix provoked trepidation among scientists at the top levels of the WHO. These scientists had been looking out for just such an event since 1968. Like the USPHS...