The Coming Plague

by Laurie Garrett

  5 Beveridge (1991), op. cit., note 1.

  6 It may well be the case that the AIDS epidemic will by 1999 surpass the horrible toll taken by influenza in 1918–19, making AIDS the worst pandemic of the twentieth century. In early 1993, the World Health Organization forecast a cumulative total of 40 million HIV infections by the end of 1999, and 8 million cumulative AIDS deaths. A more frightening projection from the Harvard-based Global AIDS Policy Coalition predicts up to 120 million cumulative HIV infections by that time and 20.4 million deaths. Regardless of the horrible eventual toll of AIDS, however, it will undoubtedly remain the case that the influenza pandemic merits the gruesome ranking of the number one global killer in this century, as the bulk of the planet’s HIV-infected population will not die until after the millennium.

  7 Beveridge (1977), op. cit.

  8 D. Scott, Epidemic Disease in Ghana 1901–1960 (London: Oxford University Press, 1965).

  9 A. W. Crosby, “The Influenza Pandemic of 1918,” in Osborn (1977), op. cit., pp. 5–13.

  10 Excellent anecdotal accounts of the 1918 epidemic can be found in A. A. Hoehling, The Great Epidemic (Boston: Little, Brown, 1961); and A. W. Crosby, Epidemic and Peace, 1918 (London: Greenwood Press, 1976).

  11 R. E. Shope, “Swine Influenza,” Harvey Lectures 31 (1936): 183–213.

  12 The CDC’s Morbidity and Mortality Weekly Report chronicles the spread of A/Victoria/75 week after week. The week Private Lewis fell ill at Fort Dix, for example, there were A/Victoria/75 outbreaks in Johannesburg, the United Kingdom, and the American states of Arizona, Washington, Iowa, Minnesota, Massachusetts, New York, and New Jersey. See MMWR 25 (January 24, 1976): 23–24.

  13 H. M. Rose, “Influenza: The Agent,” Hospital Practice, August 1971: 49–56.

  14 A. D. Langmuir, “Influenza: Its Epidemiology,” Hospital Practice, September 1971: 103–8.

  15 E. D. Kilbourne, “An Explanation of the Interpandemic Antigenic Mutability of Influenza Viruses,” Journal of Infectious Diseases 128 (1973): 668–70. For an excellent detailing of widely accepted influenza theories of the day, see Edwin Kilbourne’s Influenza (New York: Plenum, 1987).

  16 E. D. Kilbourne, New York Times, February 13, 1976: A33.

  17 N. Masurel and W. M. Marine, “Recycling of Asian and Hong Kong Influenza A Virus Hemagglutinins in Man,” Scientific American 97 (1973): 48–49.

  18 Rose (1971), op. cit.

  19 Beveridge (1977), op. cit.

  20 The proceedings of the Rougemont gathering were later published by the Sandoz Institute for Health and Socio-Economic Studies, Influenza: Virus Vaccines and Strategy, ed. Philip Selby (New York: Academic Press, 1976).

  21 In 1980 over 100 wild seals washed ashore around Boston and Cape Cod, victims of influenza. Webster and his colleagues studied the viral RNA, matching it to influenza strains then common among ducks and sea gulls. Three years later, influenza, apparently spread by migratory bird droppings, broke out in Pennsylvania in a massive commercial chicken house. Every single chicken died. From “Influenza,” in S. S. Morse, ed., Emerging Viruses (Oxford, Eng.: Oxford University Press, 1993, R. G. Webster, 37–45.

  22 During a 1993 interview, Sencer took a deep breath when the subject of Swine Flu was broached, smiled, and discussed an old Peanuts cartoon strip in which the pooch is sitting atop his doghouse typing a manuscript entitled “Swine Flu.” The first words of the manuscript read, “It was a dark and stormy night …”

  23 Centers for Disease Control, “Current Trends: Influenza—United States,” Morbidity and Mortality Weekly Report 25 (1976): 47–48.

  24 Ibid., 55–56.

  25 Ibid., 124.

  26 Dowdle and LaPatra (1983), op. cit.

  27 A. S. Beare and J. W. Craig, “Virulence for Man of a Human Influenza-A Virus Antigenically Similar to ‘Classical’ Swine Viruses,” Lancet, July 3, 1976, 4–5.

  28 C. Stuart-Harris, “Swine Influenza Virus in Man—Zoonosis or Human Pandemic?” Lancet, July 3, 1976: 31–32.

  29 “Planning for Pandemics,” Lancet, July 3, 1976: 25–26.

  30 Centers for Disease Control, “Influenza Vaccine—Supplemental Statement,” Morbidity and Mortality Weekly Report 25 (1976): 221–27: and Boffey, “Swine Flu Vaccination Campaign” (1976), op. cit.

  31 There are several sources for valuable insights into the 1976–77 Legionnaires’ Disease investigation. Particularly useful are Annals of Internal Medicine 90, No. 4 (1979) (special issue devoted to Legionnaires’ Disease); Centers for Disease Control, Legionnaires’: The Disease, the Bacterium and Methodology, (Atlanta: U.S. Department of Health, Education, and Welfare, 1979); F. W. Chandler, M. D. Hicklin, and J. A. Blackmon, “Demonstration of the Agent of Legionnaires’ Disease in Tissue,” New England Journal of Medicine 297 (1977): 1218–20; D. W. Fraser et al., “Legionnaires’ Disease: Description of an Epidemic of Pneumonia,” New England Journal of Medicine 297 (1977): 1189–97; G. L. Lattimer and R. A. Ormsbee, Legionnaires’ Disease (New York: Marcel Dekker, 1981); J. E. McDade et al., “Legionnaires’ Disease: Isolation of a Bacterium and Demonstration of Its Role in Other Respiratory Disease,” New England Journal of Medicine 297 (1977): 1197–1203; and Silverstein (1981), op. cit., Chapter 10.

  32 Some of the most important features of Public Law 94–380 are as follows:

  Informed Consent. The law required that the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research draft “a written informed consent form and procedures for assuring that the risks and benefits from the swine flu vaccine are fully explained to each individual to whom such vaccine is to be administered. Such consultation shall be completed within two weeks after enactment of this Act, or by September 1, 1976, whichever is sooner. Such procedures shall include the information necessary to advise individuals with respect to their rights and remedies arising out of the administration of such vaccine.”

  Pharmaceutical Industry Profiteering. “Any contract for procurement by the United States of swine flu vaccine from a manufacturer of such vaccine shall … be subject to renegotiation to eliminate any profit realized from such procurement … as determined pursuant to criteria prescribed … and the contract shall expressly so provide.”

  Litigation. “ … in order to be prepared to meet the potential emergency of a swine flu epidemic, it is necessary that a procedure be instituted for the handling of claims by persons alleging such injury or death until Congress develops a permanent approach for handling claims arising under programs of the Public Health Service Act.”

  “The Attorney General shall defend any civil action or proceeding brought in any court against any employee of the Government … or program participant … based upon a claim alleging personal injury or death arising out of the administration of vaccine under the swine flu program.”

  Timing. The bill did not take effect until September 30, 1976. Prior to that date, pharmaceutical manufacturers, or their insurers, carried full liability.

  33 For details, see the CDC’s Morbidity and Mortality Weekly Report (September 3, 1976): 270–76.

  34 Crosby (1976), op. cit.

  35 Eighteen months later, a medical journal, when referring to the Philadelphia outbreak, opened with the following florid language: “The explosive outbreak of acute respiratory disease that occurred in Philadelphia during the summer of 1976 was both mysterious and terrifying. Now, after a year and one half of painstaking investigation, much of the mystery and some of the terror are beginning to be dispelled.” (From “Legionnaires’ Disease: An Unfolding Riddle,” Hospital Practice, February 29 [sic], 1978: 24–25.) The above article was followed
by an editorial comment that noted: “Along with those of Lassa fever and Ebola-virus disease, the organism of Legionnaires’ disease takes its place as one of the newly recognized infectious agents capable of causing severe, life-threatening illness in man.”

  36 Committee on Interstate and Foreign Commerce, House of Representatives Proceedings, hearing before the Subcommittee on Consumer Protection and Finance, 94th Congress, November 23–24 (Serial No. 94–159) (Washington, D.C.: U.S. Government Printing Office).

  37 “U.S. Center Assailed on ‘Legion’ Disease,” New York Times, October 29, 1976: Al.

  38 Silverstein (1981), op. cit.

  39 An excellent analysis of press coverage during October 1976 can be found in D. M. Rubin and V. Hendy, “Swine Influenza and the News Media,” Annals of Internal Medicine 87 (1977): 769–74.

  40 H. F. Retailliau et al., “Illness After Influenza Vaccination Reported Through a Nationwide Surveillance System, 1976–1977,” American Journal of Epidemiology 111 (1980): 270–78.

  41 Centers for Disease Control, “Innuenza—Worldwide,” Morbidity and Mortality Weekly Report 25 (1976): 331.

  42 Centers for Disease Control, “Influenza Surveillance—United States,” Morbidity and Mortality Weekly Report 25 (1976): 391–92.

  43 Rubin and Hendy (1977), op. cit.

  44 Centers for Disease Control, “Guillain-Barré Syndrome—United States,” Morbidity and Mortality Weekly Report 25 (1976): 401–2.

  45 J. L. Reismann and B. Singh, “Conversion Reactions Simulating Guillain-Barré Paralysis Following Suspension of the Swine Flu Vaccination Program in the U.S.A.,” Australian and New Zealand Journal of Psychiatry 12 (1978): 127–32.

  46 L. B. Schonberger et al., “Guillain-Barré Syndrome Following Vaccination in the National Influenza Immunization Program, United States, 1976–1977,” American Journal of Epidemiology 110 (1979): 105–23.

  Fifteen years later, CDC researchers not directly involved in the events of 1976 reexamined all Guillain-Barré-associated medical records for 1976–77 in Minnesota and Michigan, submitting patient data to panels of neurologists for reanalysis. This was done because doubts still lingered—doubts fueled by the fact that 1.7 million military personnel were vaccinated in 1976 without a single resulting case of the syndrome. They concluded that some cases had been misdiagnosed in 1976, but Guillain-Barre was still clearly linked to the vaccine. Vaccine recipients in those two states were more than seven times more likely to suffer the syndrome. The study can be found in T. J. Safranek et al., “Reassessment of the Association Between Guillain-Barré Syndrome and Receipt of Swine Influenza Vaccine in 1976–1977: Results of a Two-State Study,” American Journal of Epidemiology 133 (1991): 940–51.

  47 J. Axelrod, personal communication, 1993. A total of $2.4 billion was sought in lawsuits, but less than $48 million was paid out as a result of litigation; a track record of which Axelrod is quite proud. The precise settlement payout was $92,833,020.

  48 For details on the lasting impact of Swine Flu and other vaccine litigation upon research and development, see Institute of Medicine, The Children’s Vaccine Initiative, V. S. Mitchell, N. M. Philipose, and J. P. Sanford, eds., (Washington, D.C.: National Academy Press, 1993).

  49 Communicable Disease Center, “Institutional Outbreak of Pneumonia,” Morbidity and Mortality Weekly Report 14 (1965): 265–66. S. B. Thacker et al., “An Outbreak in 1965 of Severe Respiratory Illness Caused by the Legionnaires’ Disease Bacterium,” Journal of Infectious Diseases 138 (1978): 512–19.

  50 Centers for Disease Control, “Follow-up on Respiratory Illness—Philadelphia,” Morbidity and Mortality Weekly Report 26 (1977): 9–11.

  51 Osborn (1977), op. cit.

  52 Neustadt and Fineberg (1982), op. cit.

  53 M. Goldfield et al., “Influenza in New Jersey in 1976: Isolations of Influenza A/New Jersey/ 76 Virus at Fort Dix,” Journal of Infectious Diseases 136 (1977): S347–S355.

  54 H. F. Top, Jr., and P. K. Russell, “Swine Influenza A at Fort Dix, New Jersey (January-February 1976). IV: Summary and Speculation,” Journal of Infectious Diseases 136 (1977): S376–S380.

  55 Dowdle and LaPatra (1985), op. cit., 88–89.

  56 Centers for Disease Control, Laboratory Manual: “Legionnaires’,” the Disease, the Bacterium and Methodology (Washington, D.C.: Department of Health, Education, and Welfare, 1979).

  57 Centers for Disease Control, “Legionnaires’ Disease—United States,” Morbidity and Mortality Weekly Report 26 (1977): 300.

  58 Centers for Disease Control, “Follow-up on Legionnaires’ Disease—Ohio,” Morbidity and Mortality Weekly Report 26 (1977): 308; and J. S. Marks et al., “Nosocomial Legionnaires’ Disease in Columbus, Ohio,” Annals of Internal Medicine 90 (1979): 565–69.

  59 Centers for Disease Control, “Follow-up on Legionnaires’ Disease—Vermont,” Morbidity and Mortality Weekly Report 26 (1977): 328.

  60 Centers for Disease Control, “Legionnaires’ Disease—Tennessee, Vermont,” Morbidity and Mortality Weekly Report 26 (1977): 336; and C. V. Broome et al., “The Vermont Epidemic of Legionnaires’ Disease,” Annals of Internal Medicine 90 (1979): 573–77.

  61 Centers for Disease Control, “Sporadic Cases of Legionnaires’ Disease—United States,” Morbidity and Mortality Weekly Report 26 (1977): 388; and Centers for Disease Control, “Follow-up on Legionnaires’ Disease—United States,” Morbidity and Mortality Weekly Report 26 (1977): 443.

  62 Centers for Disease Control, “Legionnaires’ Disease—England,” Morbidity and Mortality Weekly Report 26 (1977): 391.

  63 “Hospital Haunted by Legionnaires’ Disease,” New York Times, November 13, 1978: Al; and C. E. Haley et al., “Nosocomial Legionnaires’ Disease: A Continuing Common-Source Epidemic in Wadsworth Medical Center,” Annals of Internal Medicine 90 (1979): 583–86.

  64 W. L. L. Wang et al., “Growth, Survival, and Resistance of the Legionnaires’ Disease Bacterium,” Annals of Internal Medicine 90 (1978): 614–18.

  65 R. P. Hudson, “Lessons from Legionnaires’ Disease,” Annals of Internal Medicine 90 (1978): 704–7.

  7. N’zara

  1 After the fall of the Soviet communist state, documents pertaining to the former regime’s biological weapons practices slowly came to light, revealing that McCormick and the CDC were justified in suspecting the intentions of some Soviet Lassa researchers, as well as the efforts of their counterparts working on other infectious diseases. Well after 1972 treaty agreements between the U.S.S.R. and the U.S.A. allegedly suspended all such research and development, the Soviets continued trying to develop weapons based on Legionnaires’ Disease, anthrax, bubonic plague, tularemia, Lassa fever, and a variety of other diseases. The effort continued into the 1980s, despite an accidental leakage of anthrax from the government’s Sverdlovsk laboratory in 1979, and involved over 25,000 scientists toiling in eighteen laboratories dispersed throughout the U.S.S.R. A summary of the findings revealed in newly released Soviet documents appeared in Newsweek, February 1, 1993: 40–41.

  2 The biological weapons treaty between the United States and the U.S.S.R. was signed by the two parties on April 10, 1972, in London, ratified by the U.S. Congress on December 16, 1974, and proclaimed as law by President Gerald Ford on March 26, 1975. Formally titled the “Convention on the Prohibition of the Development, Production, and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction,” the treaty had been signed by 125 nations as of January 1993. Article X of the Convention states that
all parties to the treaty shall facilitate “the fullest possible exchange of equipment, materials, and scientific and technological information for the use of bacteriological (biological) agents and toxins for peaceful purposes.”

  3 Throughout the late 1970s and early 1980s Guido van der Gröen followed the Biological Weapons Convention quite literally, personally working inside the top security laboratories on both sides of the Iron Curtain and freely distributing samples of dangerous viruses—including Ebola and Lassa—to scientists in Moscow, Leningrad, Paris, London, Porton Down, Fort Detrick, Atlanta, and anywhere else he went. The Belgian reasoned that “science knows no politics,” and told curious intelligence officers from the CIA, Sûreté, Interpol, KGB, and MI5 who repeatedly grilled him that, as a scientist, he simply refused to acknowledge the Cold War.

  4 J. B. McCormick, Lassa Fever Update, SME/80.5 (Geneva: World Health Organization, 1980).

  5 “For a three-year study in Sierra Leone, it became evident that in many villages a substantial portion of the population was infected with Lassa during their lifetime, beginning at a young age. It appears that people in many of these villages live surrounded by virus-infected rodents which are excreting large amounts of virus in the houses both day and night, since many of the houses are closed during the day, creating a nearly twenty-four-hour nocturnal environment. This allows rodents to move around depositing urine at will in many places such as beds, floors, food supplies, etc. Transmission to humans did occur throughout the year. There is a general correlation between antibody prevalence in humans and percent of Mastomys found in the village and the proportion excreting virus. Infection may be frequent in both susceptible persons as well as persons with antibody titers who appeared to be boosted by these infections. Human-to-human infection also occurs and some evidence suggests that it may constitute an important source of human cases.” G. van der Gröen and J. B. McCormick, Expert Committee on Viral Haemorrhagic Fevers, Agenda Item 2.3, VIR/VHF/EC/84.13 (Geneva: World Health Organization, 1984).