Old Flu in the News 2008 - 2001:
Tracking Influenza's Every Movement
ScienceDaily (May 22, 2008) — It's the case of the missing flu virus. When the flu isn't making people sick, it seems to just vanish. Yet, every year, everywhere on Earth, it reappears in the appropriate season and starts its attack. So where does it go when it disappears? Does it hibernate, lying dormant in a few people and preparing for its next onslaught? Does it bounce around from the Northern hemisphere to the Southern hemisphere and back, following the seasons?
Neither, it turns out. The virus's breeding grounds are in Asia, a crew of virus-hunters has found, and it then teems out to take over the world anew each year. New varieties almost always evolve in Asia and then hitch a ride with travelers, spreading to Europe, Australia and North America and finally to South America, where they die away.
The work may make the flu vaccine even better than it already is. Because the flu virus is constantly evolving, scientists meet at the World Health Organization twice a year to decide whether to update the vaccine. Their job is made harder because they have to decide on a formulation a year in advance of when the flu will actually hit, to allow time for the vaccine to be manufactured and administered. So they have to predict which of the strains of flu virus are going to be causing the most disease a year down the line.
"In order to try to predict how flu viruses might evolve, we have to understand how they're moving around the world and where they're evolving," says Derek Smith, now of the University of Cambridge and formerly of the Santa Fe Institute, corresponding author of the research. Asia, the study suggests, is the best place to look for up-and-coming strains.
The team traced the virus's steps by studying 13,000 flu samples from around the world. The World Health Organization Global Influenza Surveillance Network collected this data between 2002 and 2007, keeping track of when and where different strains of the virus popped up. They analyzed the shape differences between the proteins each virus uses to bind to human cells, along with the genetic makeup of each virus.
The team used this information to create an "antigenic map" which visually shows the relationships between all the different viruses. This map allowed them to determine the migration patterns of the virus around the world.
"This work is highly multidisciplinary, with epidemiologists, computer scientists, computational biologists, mathematicians, virologists, immunologists, geneticists, veterinarians, and MDs," Smith says.
The work was funded by an NIH Director's Pioneer Award to Smith given for highly innovative research that has the potential for big impacts.
Bangladesh hit by bird flu outbreak
DHAKA, Bangladesh (AP) — Livestock officials slaughtered more than 27,000 chickens and ducks in northern Bangladesh after bird flu was confirmed at a poultry farm near the border with India, a report said Friday.
Officials in India's West Bengal state, which borders Bangladesh, have been struggling to contain that country's worst-ever outbreak of the virulent H5N1 bird flu virus.
Several hundred chickens died at the poultry farm in Dinajpur district, 170 miles north of Dhaka, and laboratory tests confirmed that the H5N1 virus was responsible, the United News of Bangladesh news agency reported.
Local livestock official Sydur Rahman said more than 27,000 chickens and ducks were killed and more than 60,000 eggs were destroyed on Thursday and Friday in an attempt to halt the spread of the virus, the agency said.
Local officials were not immediately available for comment Friday.
On Thursday, the government warned the Department of Livestock that more precautions were needed to prevent the disease from spreading.
Experts say any widespread outbreak could be disastrous for Bangladesh because of its dense population and poorly equipped public health care system.
Bird flu has been confirmed in at least 30 of Bangladesh's 64 districts and has struck more than 97 farms since it was first detected in February last year. More than 350,000 birds have been slaughtered, according to the Ministry of Fisheries and Livestock.
No cases of human infection have been reported.
Bangladesh recently tightened controls along its porous border with India, with authorities ordering officials to block all imports of poultry and eggs from that country.
In India, more than 129,000 poultry have died from bird flu in West Bengal state in recent weeks and nearly 2.5 million at-risk birds have been slaughtered, according to Animal Resource Development Minister Anisur Rahaman. Officials fear the disease could reach crowded Calcutta and its 14 million people.
The virus remains hard for people to catch, but experts worry it could mutate into a form that passes easily among people, igniting a flu pandemic. Most human cases have been traced to contact with infected birds. H5N1 has killed at least 224 people worldwide, according to the World Health Organization.
India, Bangladesh Try to Halt Bird Flu
CALCUTTA, India — India and Bangladesh searched for new cases of bird flu Thursday as authorities pressed ahead with plans to slaughter hundreds of thousands of birds in a bid to keep the outbreak from spreading, officials said.
No human cases have been reported since the latest outbreak of bird flu was first discovered earlier this week. But nearly 56,000 birds have died from the disease in eastern India, where authorities have begun slaughtering another 400,000 animals, most of them chickens. In Bangladesh, officials say about 20 birds have died and another 1,700 have been slaughtered.
Bangladeshi authorities say the outbreak in that country, which has so far been limited to a single poultry farm, is the H5N1 strain of the disease. In India, where the outbreak is more widespread, authorities say they are still conducting tests to determine what strain of bird flu killed the animals.
The outbreaks are in adjacent areas of the neighboring countries.
There was also uncertainty in India on Thursday about an undetermined number of new bird deaths in areas near the center of the outbreak in a rural region in the southwestern part of India's West Bengal state. Bangladeshi authorities were also searching for other cases of bird deaths.
While bird flu seemed to be the obvious culprit in the new deaths in West Bengal, the state's animal husbandry minister, Anisur Rahman, cautioned the symptoms indicated Newcastle disease, known locally as Ranikhet, a fatal respiratory virus that is not known to attack humans.
"But we are not taking chances and have sent samples to laboratories for testing for bird flu," he told The Associated Press.
Apart from slaughtering birds in areas where bird flu has been confirmed, health workers were also going door-to-door, looking for people with high fevers or breathing trouble, he said.
An outbreak of the H5N1 virus hit western India in 2006, but India declared the country bird flu-free after slaughtering hundreds of thousands of chickens. No human cases were reported. A smaller outbreak in northeastern India was contained last year.
Bird flu was first detected in Bangladesh in February 2007 at a poultry farm near the capital. Since then, authorities have slaughtered more than 300,000 chickens _ including 19,000 killed during another outbreak earlier this month _ at about 90 farms across the country. Nearly 360,000 eggs have been destroyed.
Bird flu has killed at least 217 people worldwide since it began ravaging Asian poultry stocks in late 2003. It remains hard for people to catch, but experts fear it will mutate into a form that spreads easily among humans, potentially sparking a pandemic. So far, most human cases have been linked to contact with infected birds.
Is yesterday's swine flu today's bird flu?
A newly mutated flu virus infects a man in New Jersey, and he dies within a day. Health officials fear that the general public has no immunity to this new strain and predict a severe pandemic on the order of the 1918 "Spanish flu." The president holds a news conference and recommends that all Americans be inoculated.
In 1976, a flu scare prompted a rash government response that was foolish, even dangerous, then. Now there are lessons.
This scenario reads like something from our near future. Experts predict that the bird flu virus might hit our shores within a year. In fact, it's a news flash from three decades ago. The events of the so-called swine flu in the USA seem hauntingly familiar to those of us who are focused on the current bird flu, and they can serve as a useful guide on what to do now and — perhaps as important — what not to do.
Despite the fact that H5N1 — the bird flu virus — remains essentially a bird disease, Anthony Fauci, esteemed director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, has spoken of the need to make more than 100 million doses of a vaccine for H5N1 available to Americans.
We've been here
The rush to make vaccines for a flu virus to which we have no immunity is not a new concept. This is what happened during the swine flu fiasco of 1976, when the fear of another killer outbreak provoked a national political response and a rushed vaccination program. More than 40 million people received the swine flu vaccine that year against a new pig virus that ultimately never took hold.
It was later determined that the swine flu wasn't as virulent or as deadly as originally thought. But more than 1,000 cases of Guillain-Barré syndrome, a life-threatening ascending paralysis, occurred in those who received the vaccine, which had been rushed into production. The public relations nightmare and lawsuits against the government helped to drive many drug companies away from making flu vaccine at all. (Of 27 companies that manufactured flu vaccines at the time, only three still do.)
So what happened to ignite this overreaction? It all started when David Lewis, a military recruit at Fort Dix, N.J., became ill in February of that year and died within a day, apparently of a mysterious new flu virus. Over the next two weeks, more than 200 other recruits were found to have antibodies to this swine flu, meaning they had caught it and survived. At least one recruit became ill. Public health officials jumped to the conclusion that this was the first wave of flu, and that it would return with a vengeance in the fall. They feared millions of deaths.
What is bird flu? The avian flu strain that some fear could mutate into a virulent human disease is a virus called H5N1. The strain is deadly to domestic chickens and some wild bird species.
How is it spread? Most human cases have come from direct contact with infected poultry; so far, the virus does not spread easily from person to person.
Where has it been detected? It surfaced in China in 1996 and killed six people in Hong Kong in 1997. In 2003, it began its deadly spread throughout Asia, and cases have since been confirmed in Europe, Africa and the Middle East. It has yet to be detected in the Western Hemisphere.
How many people have been infected? Nearly 200 human cases have been confirmed; about half of the victims have died. By comparison, the 1918 flu pandemic killed 2.5% of those it infected.
When is it expected to reach the USA? Three Cabinet secretaries said Monday that it will reach the USA within the next year, via Arctic bird migrations. (Compiled by Debra McCown)
In 1976, health experts believed that history gave them plenty of reasons to be afraid. It was thought, incorrectly, as it turns out, that the Spanish flu had jumped from birds to pigs before mutating into a massive killer of humans. Nevertheless, there is a disturbing similarity between 1976 and today: A worst-case scenario, just a prevailing theory, is used to justify a massive public reaction.
'Forecasts of doom'
David Sencer, then the head of the Centers for Disease Control, began to make proclamations and forecasts of doom, just as current agency head Julie Gerberding has done recently. In a memo March 18, 1976, Sencer wrote, "The entire U.S. population under the age of 50 is probably susceptible to this new strain." Sencer still maintained, in a CDC publication earlier this year, that "when lives are at stake, it is better to err on the side of overreaction than underreaction."
Sencer's recent statement shows a continuing lack of insight because it assumes that the only choices available to a public health official are either protecting all of civilization or not protecting it at all. In fact, decisions on potential health threats are never so clear-cut.
Thirty years ago, Sencer headed a group of distinguished scientists (including the polio vaccine inventors Jonas Salk and Albert Sabin) who met in Washington with President Ford for the purpose of persuading the federal government to take action. Ford, with flagging public support and in the midst of a presidential election campaign, attached himself to the issue and held a national TV news conference announcing a plan to vaccinate every American by the fall.
A similar scene played out late last year. President Bush, supported by several of today's greatest scientists and public health experts, responded to the risk of the bird flu virus by announcing a $7.1 billion plan for pandemic preparedness. At the time, Bush was reeling in the aftermath of Hurricane Katrina and found that linking the bird flu with the historical precedent of the 1918 "blue death" gave him an issue in which he could be perceived as our protector.
Lessons for today
The president can't be faulted for leading an aggressive public reaction to the global fears, but he and his administration would be wise to revisit the errors of 1976 while mapping out a strategy for today.
What are some of the rational lessons our government can take from the swine flu scare?
• A rushed production of vaccines could lead to premature use. That could mean significant side effects, or perhaps worse, for any American who is inoculated.
• Currently, $3.8 billion of Bush's plan has been approved for this year and $2.6 billion budgeted for 2007. But the majority of the money is set aside for emergency stockpiles of vaccines and anti-virals. More money should be budgeted for upgrading how vaccines are made.
• Even if the worst-case scenario occurs and the bird virus mutates into a form that can pass easily from human to human, it might still not signal the next pandemic. As science advances, predictions are still often wrong. There is much about flu genetics that we don't know, such as whether the virus will cause the human population significant harm.
Three decades ago, there was no course correction when the supposed "first wave" of the outbreak never made it out of Fort Dix. Today, while the United States is helping to create a global health net in response to bird virus fears, we can ill afford swine-flu type scare messages that put the public prematurely on alert while compromising scientific complexity.
Marc Siegel is an associate professor of medicine at New York University School of Medicine and author of Bird Flu: Everything You Need To Know About the Next Pandemic.
Remember the swine flu pandemic?
Lessons the U.S. can learn from how it reacted to the 1970s threat
While Tuesday’s meeting between President Bush and World Health Organization Director Dr. Lee Jong-wook dramatized the international threat of bird flu, the president is struggling with House Republican budget cutters over his $7.1 billion request to fight bird flu.
He is not the first president to pay so much attention to a pandemic influenza threat.
It was 1976. The threat was swine flu.
“No one knows exactly how serious this threat could be,” President Ford said then, adding, “Nevertheless, we cannot afford to take a chance with the health of our nation.”
Ford ordered enough vaccine to protect the entire country after one Army recruit died and some scientists predicted a pandemic. Some say Ford acted so quickly partly because of politics — the way some say Mr. Bush focused on bird flu after hurricane Katrina.
"The issue was, was he going to be decisive?" recalls Joseph Califano, who served as secretary of Health, Education and Welfare in the Carter administration. "What was he going to do?"
In early 1977, Califano faced the issue himself. Swine flu never reappeared, but 40 million Americans got shots and a few developed a rare paralytic disease called Guillain Barre syndrome. The vaccination program was ended. But then regular flu broke out and the only vaccine available was mixed with swine flu.
“I was required to make this decision as to whether to release this vaccine,” Califano remembers.
Califano gathered experts, released the vaccine and fired the head of the Centers for Disease Control who had urged President Ford to undertake the aggressive campaign.
Is sauerkraut a new weapon against bird flu?
MILWAUKEE — While President Bush scrambles to ward off an avian-flu pandemic, the world's largest sauerkraut producer, tucked amid the glacial lakebeds of rural Wisconsin, is sitting atop a bumper crop of one possible preventative.
That's right: sauerkraut.
An international buzz is surrounding the unassuming fermented cabbage. Scientists at Seoul National University in South Korea fed an extract of kimchi, a spicy Korean variant of sauerkraut, to 13 chickens infected with avian flu, and a week later, 11 of the birds started to recover, according to a report by the BBC Network.
"Unlike the government, we've got the preventative, and 115,000 tons of it in Wisconsin alone," said Ryan Downs, owner and general manager of Great Lakes Kraut Co., which has sauerkraut factories in Bear Creek and Shiocton, Wis., and in Shortsville, N.Y.
Downs said more extensive scientific research is needed to prove any curative link to avian flu, but he's more than happy to tout kraut as a healthful part of any diet.
"People are starting to realize kraut is a pretty doggone good food," Downs said when contacted about the South Korean study. "We're ready to help keep the world healthy."
Several television and radio stations across the United States have picked up the BBC story, said Steve Lundin, spokesman for Frank's Sauerkraut, based in Fremont, Ohio.
After a Minneapolis CBS affiliate did its own story on sauerkraut's potential in the battle against avian flu, Frank's checked 54 Twin City area stores it supplies, and found an 850 percent spike in overall sauerkraut sales, Lundin said.
"People will do whatever they can if they can't rely on the government to provide them with a vaccine or other preventative," Lundin said.
South Koreans reportedly are eating more kimchi since news of the study came out. But Korean researchers acknowledged that if kimchi actually caused the effects they observed, it was unclear why.
Men's Health magazine fed the sauerkraut buzz in its November issue, suggesting Americans put together pandemic kits containing a few cans of sauerkraut, among other nonperishable foods, because — like kimchi — it is packed with lactic-acid bacteria "shown by Korean researchers to speed recovery of chickens infected with avian flu."
Another recently released study at the University of New Mexico indicates that sauerkraut may reduce the risk of breast cancer by up to 74 percent. That study set out to determine why the risk of breast cancer nearly triples in Polish women who immigrate to the United States.
Of the hundreds of Polish women and Polish-born U.S. immigrants observed in the study, those who ate four or more servings of sauerkraut and cabbage per week during adolescence were 74 percent less likely to develop breast cancer than those who ate 1.5 or fewer servings per week.
Copyright © 2005 The Seattle Times Company
Swine flu outbreak kills 34 people
CHINA was battling a deadly outbreak of swine flu on several fronts yesterday, rushing vaccine to a southwestern province where 34 people have died, starting a campaign to teach illiterate farmers not to slaughter and eat sick animals and banning journalists from the area.
Vaccine for 350,000 pigs has been flown to Chengdu, the capital of Sichuan province, where the infection has spread to about 100 villages, state media said.
Vaccine for 10 million pigs was being produced to combat the disease, which is contracted from slaughtering, handling or eating infected pigs.
The Health Ministry said that Sichuan had 181 confirmed or suspected cases of Streptococcus suis bacteria, or swine flu, the symptoms of which include nausea, fever, vomiting, and bleeding under the skin.
Details of the conditions of patients in Sichuan were not available after the Chinese Government banned journalists from the area, where 31 people were reported to be in a critical condition.
About 50,000 health workers and officials have been sent to the area to inspect and register every pig and authorities have set up 39 temporary quarantine stations to stop dead pigs from reaching markets.
An official at the China Centre for Disease Control and Prevention blamed the outbreak on unsanitary conditions at Sichuan’s small-scale pig farms combined with a heat wave.
Beijing has banned pig and pork imports from Sichuan and set up checkpoints around the capital to block diseased pork and avert a health threat to its 15 million residents.
Report: China bans media from 'swine flu' sites
Death toll hits 34; number of confirmed cases jumps to 174
HONG KONG - Chinese authorities have banned local reporters from visiting areas where an outbreak of a pig-borne disease has killed 34 farmers, ordering newspapers to use dispatches from the state news agency, a Hong Kong newspaper reported Sunday.
A total of 174 confirmed or suspected cases have been linked to the bacteria streptococcus suis in China’s southwestern Sichuan province, where farmers who handled or butchered infected pigs have been sickened in dozens of villages and towns. Symptoms include nausea, fever, vomiting, and bleeding under the skin.
Sichuan authorities have ordered local journalists to stay away from locations where the disease surfaced, and told newspapers to instead carry stories as issued by the official Xinhua News Agency, including the headline, Hong Kong’s Ming Pao Daily News reported.
Calls to Sichuan’s provincial government headquarters in Chengdu seeking confirmation of the media ban went unanswered.
Beijing was heavily criticized during its SARS outbreak for its reluctance to release information. A Sichuan journalist, quoted by the Ming Pao newspaper, said Hong Kong reporters were better informed than they were about the pig disease.
Former British colony Hong Kong, which returned to Chinese rule in 1997, isn’t subject to China’s media controls under a special autonomy arrangement. Much of the information about the disease has been filtering out through Hong Kong, which is briefed by China about health threats.
Hong Kong is wary about diseases spreading here from China, especially after severe acute respiratory syndrome killed 299 people in the territory in 2003 and devastated the economy.
The first cases of the pig-borne disease outbreak appeared in the city of Ziyang and elsewhere in Sichuan. The first case outside the province was reported Saturday in Guangdong, a southern Chinese province neighboring Hong Kong. Hong Kong has also reported 11 cases of the disease since May 2004, but it wasn’t clear if they were related to the Sichuan outbreak.
© 2009 The Associated Press. All rights reserved.
THE COMING WAR AGAINST BIRD FLU
No one doubts that the world will eventually face a deadly influenza outbreak. Here's where we'd stand if one starts soon.
(FORTUNE Magazine) – TALK ABOUT GUARDING THE HENHOUSE. TO REACH ONE OF the secluded chicken farms of Charles River Laboratories, a Wilmington, Mass., biomedical products and services company, you wind along a New England back road until you come to a gate with a cryptic command: THINK BIOSECURITY. A few hundred feet beyond is a clutch of long, white buildings that house chickens--not just any chickens, but thousands of birds that have been immaculately conceived, hatched, and raised. The hens live in ultraclean inner sanctums, breathe purified air, eat sterilized food, and lay eggs in disinfected plastic nests. To enter their domain, you must first shower and then don a biosafety suit with hat and booties. The worry is that you might infect the birds, not vice versa.
The chickens are a key line of defense in a war that each year kills about ten times as many Americans, on average, as 9/11 did. The foe is influenza. Scientists use the hens' eggs, nearly as pristine as autoclaved glassware, as living chambers for growing influenza seed viruses, the seminal stuff of flu vaccines.
At the farm's main office, a closed-circuit TV shows a vast klatch of the milling hens. "They're very calm today," says Russ Larson, a stocky Iowa transplant with prematurely white hair who is the farm's, well, mother hen. Having grown up on a poultry farm, Larson can tell whether the birds are stressed or ill just by watching them on a monitor, like a mom picking up subtle signs that her toddler is about to have a meltdown.
Larson calls the high-tech chicken coops the "Marriotts of the poultry system." The U.S. has precious few facilities that supply eggs to make flu shots, and details about them "have been identified as a security issue," says a spokesman for Sanofi Pasteur, the vaccine-making unit of France's Sanofi-Aventis. The protectiveness isn't surprising. Flu experts have long warned about a potential replay of the Spanish flu pandemic of 1918, which killed an estimated 20 million to 40 million people around the world. In 1997 a possible forerunner of another such virus appeared: An avian flu strain, known as H5N1, was found to infect humans. At this point it's rarely transmitted between people. But it's very deadly, killing some 70% of those infected, vs. an estimated 2.5% of Spanish-flu sufferers in 1918, and 0.1% of those hit by the typical strains of recent years.
Six people died in the initial H5N1 outbreak in Hong Kong, and now the virus has spread widely in birds across Southeast Asia. Since early 2003 more than three dozen H5N1 victims have died in Thailand and Vietnam. Reports of H5N1's ability to spread among cats and possibly to infect pigs suggest that the fast-mutating virus is feeling its way toward a form that might spread like wildfire in mammals, including humans.
If a pandemic starts, we could face a desperate lack of our main defense against flu--vaccines. That risk was brought home last fall when bacterial contamination at a British flu-vaccine plant owned by Chiron, an Emeryville, Calif., biotech, put the facility out of action, instantly halving America's supply of flu shots and leaving Sanofi as the sole major supplier to the U.S. The vaccine shortage has eased, but Sanofi's plant in Swiftwater, Pa., remains the only American-based source of vaccine for flu shots.
To hear some experts tell it, if there were a flu-catastrophe clock like the one for nuclear doomsday, it would now read two minutes to midnight. At a press conference last November, a World Health Organization official spun out a lurid estimate that if the bird-flu virus evolves into a form that spreads easily among people, perhaps 100 million would die worldwide. That dismaying scenario would resemble the 1918 Spanish flu pandemic, which turned the "old man's friend"--pneumonia--into the young person's horror, striking down mainly people under 50. Victims' lungs filled with bloody fluid, and their faces often turned dark blue from a bodywide lack of oxygen, as if their skin were scorched by inner flames. Blood sometimes flowed from their noses, ears, and eyes. Some fell ill in the morning and were dead by nightfall. Awaiting burial, bodies of flu victims had to be stacked like cordwood at some military camps.
Others counter that if history is any indication, the next flu pandemic won't be as horrific as 1918's--there have been three less severe ones since 1890. (See box, "Is the Risk Overblown?") Yet even a relatively mild pandemic today would likely dwarf disasters such as December's tsunami.
Where would we stand if one started soon?
Fortunately, the threat hasn't been lost on policymakers. Flu-related spending by the U.S. Department of Health and Human Services has risen almost sevenfold over the past five years, to a proposed $283 million for the fiscal year ending Sept. 30. Meanwhile, the flu research budget at the National Institute of Allergy and Infectious Diseases has tripled, to a proposed $61 million for fiscal 2005. The NIAID money has accelerated development of an arsenal to fight flu: handheld biochip devices that in minutes can precisely identify a flu strain from a throat swab, drugs to jam flu viruses' molecular machinery, and bioengineered vaccines churned out by cells cultured in vats called bioreactors, eliminating the complex logistics of supplying millions of eggs for the purpose.
The egg issue is bigger than you'd think. Federal health officials have long fretted that a shortage of eggs might impede emergency vaccine production. Suppliers of fertilized eggs for making vaccines are a rare breed, a cross between farmers and microbiologists. A tour of Charles River's facility gives a glimpse of what it takes: The sequestered hens' freshly laid eggs roll onto conveyor belts and are carried through a kind of air lock to a disinfecting system that looks like a miniature car wash, with sprayers and rotating brushes. Post-washing, the eggs are gingerly placed on plastic flats and conveyed to a processing facility resembling a gym-sized walk-in refrigerator. There machines sort them by weight, and technicians wearing gloves and lab coats inspect them one by one for defects. Nearby, thousands of eggs are stacked on eight-foot-high racks inside a room-sized incubator that warms them for several days until the chick embryos inside are precisely at the right development stage for use in making vaccine. To tell when they're ready, specialists laboriously candle each egg, shining a bright light through its translucent shell to examine the developing embryo. The eggs are then shipped to Sanofi and other makers of human and animal vaccines.
This tricky process won't go away anytime soon. In fact, the federally funded updating of our anti-flu arsenal is still years from full deployment. Meanwhile, we'll be counting on existing defenses, such as isolation of infected patients and restrictions on travel to places with serious flu outbreaks. Mounting a fast, effective response if a pandemic starts may sound like mission impossible after last fall's Chiron debacle. Not necessarily. A crash program to immunize Americans against swine flu in 1976--which at the time seemed about to bring on another 1918 pandemic--shows how a terrible threat can focus the national mind. Despite policy stumbles and technical glitches, it took less than seven months to produce, test, and deploy a novel swine-flu vaccine across the U.S. As it happened, the feared pandemic didn't occur--swine flu turned out to be much less virulent than expected--and the program was branded a fiasco after rare neurological side effects were linked to the vaccine. "But technically it was a phenomenal success," says NIAID director Dr. Anthony Fauci. "I think [such speed] could be repeated." Indeed, the rapid response to SARS in 2003 suggests that health authorities are, if anything, more vigilant than in the days of swine flu.
Several nations, including the U.S., China, Britain, and France, have initiated development of H5N1 vaccines. NIAID expects within weeks to begin a clinical trial with one made by Sanofi-Aventis. And last fall the U.S. government awarded a $13 million contract to Sanofi to produce two million doses of the vaccine, an emergency stockpile that is expected to be at least partly ready by year-end. The U.S. has also stockpiled 2.3 million doses of Tamiflu, an antiviral medicine that could help curtail H5N1's spread. Made by Swiss drug company Roche Group, Tamiflu can speed recovery if taken within 48 hours of the first flu symptoms. It also can lower the risk of infection when taken before exposure--health-care workers near an outbreak would probably get the medicine first.
In order to buy time with such defenses, we'd need to spot a virulent new flu strain before it spreads much. The World Health Organization's flu-surveillance network, which includes 112 labs in 83 countries, serves as the planet's influenza radar. Set up in 1952, it's a well-tuned machine. In 1997 the system played a key role in identifying and stopping the spread of the H5N1 strain in Hong Kong. In 2003 it helped arrest another novel bird flu, H7N7, in Europe. (Like H5N1, the H7N7 strain can sicken humans who are in close contact with infected poultry--it is thought to have killed one of 83 infected people.)
But here's the worry: Flu pandemics are most likely to originate in Southeast Asia, where vast rural populations of people live in close contact with poultry, pigs, and other animal reservoirs of flu viruses that can jump to humans. The surveillance system there is spread thin, and local officials are sometimes reluctant to report possible cases of a disease because publicity can cause devastating economic losses and social upheaval. The Asian surveillance problem was highlighted last year by a probable case of human-to-human transmission of H5N1--an 11-year-old Thai girl, after apparently passing the virus to her mother and aunt while she lay dying, was cremated before specimens could be obtained to test for the virus's presence. Says Scott Harper, an influenza expert at the Centers for Disease Control and Prevention in Atlanta: "Whenever we hear of one case of avian flu [in Asia], we worry that it's just the tip of an iceberg."
Flu's ability to be transmitted before symptoms appear adds to the risk of insidious spread. "If a [newly infected] businessman got on a plane in Hong Kong and came here, his virus could be widespread before we turned around," says Richard Webby, a virologist at Memphis's St. Jude Children's Research Hospital, a major node in the global flu network.
Unless, that is, the bug didn't quite have its killer act together. Let's unfold that. Animal flu viruses that have newly jumped to humans pose high pandemic risk because we lack resistance to them. This is largely because our immune systems aren't familiar with the H and N molecules on their surfaces (whence strains get their names), so we aren't protected by antibodies left over from earlier bouts with human-adapted influenza strains--or from flu shots. It takes the body days to weeks after infection with a novel virus to generate new antibodies and other immune defenses. That gives the bug a good chance to merrily multiply in the lungs, sometimes leading to fatal pneumonia.
Novelty can also work against a flu virus: After first jumping to humans, its molecular tool kit, having evolved to help the virus invade and multiply in animal cells, may still be somewhat ill suited for deftly hijacking human cells. Thus the disease may begin its pandemic career with limited virulence. Something like that apparently happened in 1918: A relatively mild herald wave of influenza preceded the deadly pandemic by several months. The herald virus was probably Spanish flu at an early stage of its evolution into a monster. If that pattern recurs, we would have advance warning of a bad bird flu coming at us.
To scientists at places like St. Jude, H5N1 already seems monstrous--they're not waiting for a herald wave before taking action. Two years ago the Memphis team, led by veteran flu researcher Robert Webster, extracted H5N1 virus from the mucus of an infected Asian patient who had died. Then they isolated each of the virus's eight genes and, with a technique called reverse genetics, employed two of them to fashion a nonvirulent H5N1-like virus to use in making a vaccine. Last spring they learned that the dominant H5N1 strain in Asia had mutated. (Influenza viruses are notoriously changeable, hence the need to update flu vaccines every year.) No problem: Within two weeks they had created a new seed virus based on the altered strain. Packed in a dozen thumb-sized vials, the highly concentrated stuff was shipped to Sanofi, where it was injected into fertilized eggs like those supplied by Charles River. After multiplying in the embryos, the virus was extracted, neutralized, and processed into the vaccine that the NIAID is about to test in the clinic. The trial, expected to be completed near the end of the year, will determine whether the vaccine is safe and what dosage is needed to generate am- ple antibodies targeting H5N1. (The trial's hu- man subjects, by the way, won't be exposed to the deadly virus to see if the vaccine works.)
Even if the H5N1 virus changes again, as it doubtless will, this vaccine should afford some immunity--inoculated people exposed to H5N1 may get ill, but not gravely so. And scaling up production of the vaccine to manufacture the two-million-dose stockpile will give Sanofi's crew invaluable experience. "We have a lot of momentum for making the H5N1 vaccine now and could move to full production fairly quickly," says Sanofi executive James Matthews.
So there's a reasonable chance we could initiate mass vaccinations before an unfolding bird-flu pandemic takes a huge toll. But it probably won't be possible to churn out enough vaccine to quickly cover the entire U.S. population, says David Fedson, a former executive at a Merck/Sanofi-Aventis joint venture in Europe. One reason is that it typically takes at least two doses to engender immunity to a novel virus like H5N1. Sanofi's Pennsylvania plant is geared to make about 150 million doses of H5N1 vaccine over several months. Assuming two doses per person, that would cover 75 million Americans, or about one in four. Several million more might be covered if MedImmune, a Gaithersburg, Md., biotech that makes a nasal- spray flu vaccine, pitched in to fight H5N1.
Could we get more vaccine overseas? Forget it, says Fedson, now a consultant on vaccine issues. "When we have a pandemic, authorities in each country will want to vaccinate their own populations first," he explains. "Given that imperative, vaccine companies will be nationalized," cutting off cross-border sales. No wonder Charles River's special egg operation has the aura of a homeland-defense asset--it is one.
Most other countries will be in a far worse plight than the U.S. if a pandemic hits sometime soon, notes Fedson. A crash program using the world's entire flu-vaccine-making capacity probably could immunize only about 450 million people against H5N1, or 7% of the world population. Further, just nine countries, mostly in Europe, produce over 95% of the flu vaccine made today. That could make for very ugly politics during a mad scramble for vaccine.
New dose-sparing strategies may help, though. Becton Dickinson, a Franklin Lakes, N.J., medical-technology concern, recently introduced syringes that, by minimizing inner waste space, can get up to 25% more shots from a multidose vial than older ones do. Injecting flu vaccine into the skin instead of muscle (the current practice) may conserve vaccine too--relatively low intradermal doses are needed since the skin is especially rich with immune cells that trigger antibody production. A recent study sponsored by Iomai Corp., a biotech in Gaithersburg, indicated that intradermal flu shots would require only a fifth of the standard dose. Dramatic savings are also promised by adjuvants, immune stimulants sometimes added to vaccines to boost efficacy. A study by British drugmaker GlaxoSmithKline suggests that an adjuvant called alum could extend flu-vaccine supplies by a factor of eight. The NIAID plans to test adjuvants, including alum, to stretch experimental bird-flu vaccines that are now in development, says the agency's Fauci.
In an emergency, strategies such as intradermal vaccine injection could come into play quickly, potentially averting shortages, says Benjamin Schwartz, senior science advisor at the CDC's National Immunization Program. That still leaves some burning issues to be addressed, such as who will first get vaccines and antiviral drugs if a pandemic starts. "But we're certainly far more ready today than we were a couple of years ago" to fight bird flu, says Schwartz.
Let's hope he's right. A lull in bird-flu cases in Southeast Asia ended in December, and since then half-a-dozen people with H5N1 infections have died in Vietnam. Recently Cambodia recorded its first known H5N1 fatality, a 25-year-old woman who sought treatment in a Vietnamese hospital and died there. Her 14-year-old brother died before she did, after showing flu-like symptoms. As in several other cases of possible human-to-human transmission, he was cremated before samples could be taken for testing.
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Recent flu outbreak mild compared to past pandemics
ATLANTA, Georgia (CNN) -- While U.S. health officials are taking the recent deadly influenza outbreak seriously, its scope is modest compared with flu pandemics of the 20th century that killed tens of millions of people.
The worst flu pandemic on record -- the infamous Spanish flu of 1918 and 1919 -- killed an estimated 20 million to 50 million people worldwide and some 500,000 in the United States alone, according to the Atlanta-based Centers for Disease Control and Prevention.
Within just two years, 20 percent to 40 percent of the human race was thought to have fallen ill from the virus.
Almost half of those who died in the plague -- which occurred before the development of virus-fighting vaccines -- were young and otherwise-healthy adults, according to the CDC.
A flu epidemic happens when a virus spreads rapidly through a population. This happens nearly every year. A pandemic occurs when a virus spreads across the world.
It wasn't until 1934 that scientists were able to isolate the influenza type A virus, and eventually develop vaccines in the 1940s.
Vaccinations may have prevented the 1957 Asian flu from being worse than it was. It was blamed for the deaths of about 70,000 people in the United States -- most of them elderly.
According to the CDC, the 1957 pandemic was identified quickly because of scientific advances -- also helping to prevent more deaths. Cases multiplied a great deal shortly after the original U.S. outbreak in August of that year because children spread the disease when they returned to school in the fall. The highest infection rates were among school children, young adults and pregnant women.
Flu fatalities diminished greatly by 1968, when the Hong Kong flu raced around the globe. The number of people killed in the United States in this pandemic was about 34,000, according to CDC records, making it the mildest flu pandemic of the century, according to CDC records.
Together, the Hong Kong and Asian flus caused an estimated 1.5 million worldwide deaths, according to the World Heath Organization, and cost $32 billion in health care and lost productivity.
Flu fears
The 1918 Spanish flu outbreak led to a so-called "pandemic scare" in 1976, when a unique virus called the Swine flu was identified in Fort Dix, New Jersey. Scientists thought the Swine flu was related to the Spanish strain, which had killed so many millions of people 60 years earlier.
The resulting flu fears in the United States prompted President Gerald Ford to authorize a $135 million national immunization program to fight the latest strain, dubbed Swine flu.
The funds paid for about 200 million doses of vaccine manufactured by private pharmaceutical firms and local officials were given $26 million for mass inoculations.
All the fears and preparations turned out to be unnecessary. Although 40 million people in the United States were vaccinated, the virus failed to spread, and neither an epidemic nor a full-blown pandemic of Swine flu ever developed.
More recently, flu scares in the 1990s also failed to erupt into major health threats. A 1997 outbreak of Avian flu -- a virus previously seen only in birds -- killed six people in Hong Kong and prompted Chinese officials to order the slaughter of all chickens in the region.
Hong Kong also was the focal point of a 1999 flu scare which also was linked to birds. Although no one was known to have died from the strain, two children identified with the virus were hospitalized and later recovered.
Ruminating on the Notorious Swine Flu Fiasco
As public health officials debate whether to offer smallpox vaccine to every American who wants it, they would do well to recall what happened a quarter-century ago when a mass vaccination campaign ended in disaster. That experience -- in the ill-fated swine flu immunizations of 1976 -- does not mean that health officials should shrink from offering smallpox vaccinations today. But it does suggest there are lessons to be learned on how best to do it.
In 1976, concern was ignited by an outbreak of illness at Fort Dix, N.J., that included both a normal strain of influenza and a strain that seemed related to the swine flu of 1918 that killed anywhere from 20 million to 100 million people around the world. Although the swine strain at Fort Dix mysteriously disappeared after infecting some 500 soldiers, no one could say whether it would re-emerge or how lethal it might be if it did.
Some experts who had nervously been awaiting the return of a killer flu could hardly wait to spring into action to stop it. Brushing aside all qualms, health officials at the Centers for Disease Control in Atlanta and officials in Washington pushed through a presidential decision to vaccinate every man, woman and child in the country -- more than 200 million Americans in all. Brief thought was given to simply making and stockpiling the vaccine so that it would be available should the swine flu reappear. But that was rejected on the theory that influenza moves too fast for a vaccination campaign to keep up with it.
Unfortunately, pretty much everything that could go wrong did go wrong. Manufacturing the vaccine took far longer than expected. The vaccine didn't work well in children. Bitter arguments over who should accept liability for side effects almost derailed the effort until the government assumed responsibility. And the states differed greatly in their enthusiasm and competence, resulting in extensive vaccination in some areas and very little in others.
Meanwhile, three coincidental deaths among elderly vaccinees at a Pittsburgh clinic forced a suspension in 10 states. Then, in the blow that killed the campaign for good, a rare side effect -- a paralytic disease known as Guillain-Barre syndrome -- appeared unexpectedly. This was a devastating shock to health officials who had considered influenza vaccines extremely safe. In all, some 532 people contracted Guillain-Barre after being vaccinated, and 32 of them died.
Many of these cases would have occurred anyway, but the vaccine itself was blamed for causing roughly 1 case of Guillain-Barre for every 100,000 people vaccinated. That seems like a small risk, but when the swine flu failed to reappear and the media zoomed in to record every disastrous side effect, the damage looked very big indeed. The campaign was halted after reaching only 45 million people. It was widely condemned as a fiasco, a debacle, a ghastly mistake, a medical Vietnam.
Now, once again there is a threat that could be dire but may not materialize. Nobody knows if terrorists or rogue states have access to the smallpox virus or a means to deliver it. The smallpox vaccine is considered one of the most toxic, causing life-threatening complications in 15 of every million vaccinees, of whom one or two might die. Health officials worry that in the absence of a smallpox attack, the vaccine damage will look just as awful in a media spotlight as Guillain-Barre did in 1976.
Still, the very existence of a vaccinated population should lessen the likelihood of smallpox being used as a weapon. When swine flu failed to appear, it was deemed evidence that the vaccination campaign was misguided. If no smallpox attack occurs, it could very well be due to a successful vaccination campaign.
Virtually all analyses of the 1976 failure suggest that the government must plan more carefully and prepare for the worst in such a huge undertaking. In some respects, the government is off to a better start this time. It separated the production of vaccine (already under way) from the decision over whether to stockpile it or administer it (yet to be made). It has adopted a phased approach, offering vaccine to health personnel first and only later, if at all, to the public. It has issued guidelines for states to follow in the event of attack. Officials are already pondering liability issues to iron out problems before the vaccinations start. And they are openly discussing the risks of the vaccine, ensuring that the downside of any campaign is recognized before it is launched. One big difference from 1976 is that the virus used in the smallpox vaccine has the potential to spread from those vaccinated to their close contacts, possibly endangering vulnerable people. That problem will have to be addressed with great care.
Most of the mistakes in the swine flu campaign were driven by the perceived urgency of acting quickly before a new flu strain could flash through the population. This time around, with no smallpox attack in immediate sight and vaccine stockpiles ready just in case, the deadlines for distribution are less tight. There is plenty of time for President Bush to get it right.
A Shot in the Dark: Swine Flu's Vaccine Lessons
Twenty-six years ago, the United States government got word that a deadly virus nobody had seen for years -- and which experts thought was gone forever -- was possibly circulating again.
There wasn't any proof it was back, just a few worrisome hints. However, the microbe had killed millions of people earlier in the century, so even a small amount of evidence had to be taken seriously. So, at great effort and expense, the government launched a plan to vaccinate the American population against the virus.
It seemed like a good idea at the time. But it turned into one of the biggest public health debacles in memory.
The disease was swine flu, whose appearance in 1976 was believed to be a reincarnation of the infection that killed tens of millions of people in 1918 and 1919. Today, the U.S. government is engaged in similar deliberations about smallpox, a disease officially eradicated in 1980 but whose virus some experts believe may be possessed by terrorists.
Over the next month, a panel of scientific experts convened by the Centers for Disease Control and Prevention (CDC) will debate the value -- and hazards -- of making the smallpox vaccine available in the United States for the first time in 30 years. Universal vaccination is out of the question, but widespread distribution is possible. By the end of June, the experts will recommend a course of action to the Bush administration.
Influenza and smallpox -- and their vaccines -- differ in innumerable ways, making comparisons tricky. Influenza occurs naturally and spreads quickly. Smallpox hasn't existed outside of laboratory freezers since 1978, but might be in terrorist arsenals. The flu vaccine has few serious side effects, while the smallpox vaccine has many.
Nevertheless, the swine flu campaign is the one recent example of a large, government-sponsored emergency immunization program, and as such may offer lessons for today.
Events began with the death, on Feb. 4, 1976, of an Army recruit at Fort Dix, N.J., during an outbreak of respiratory infections following the holidays. Throat washings were taken from 19 ill soldiers, and a majority tested positive for that winter's dominant strain of the influenza virus, which was called A/Victoria. But four samples were different, and New Jersey public health officials sent them to the CDC to be identified.
On Feb. 12, the CDC delivered a chilling report. The four samples -- which included one from the dead soldier -- were swine flu. As the name suggests, swine flu was endemic to pigs. However, the devastating pandemic of the Spanish flu in 1918 and 1919 is believed to have been caused by a strain of swine flu that, through mutation, gained the ability to infect people.
In 1927, a scholar put the Spanish flu's global mortality at 21.5 million. In 1991, a systematic recalculation raised it to 30 million. The latest estimate, published in the current Bulletin of the History of Medicine, sets the minimum mortality at 50 million, with an upper limit of 100 million.
The possibility that the Spanish flu had reemerged was a matter whose importance is hard to overstate -- and wasn't missed by anyone in 1976. Within days of identifying the strain, federal health officials were meeting at the CDC to discuss what to do.
According to various accounts, the idea that a swine flu epidemic was quite unlikely never received a full airing or a fair hearing, although numerous experts apparently held that view. Instead, the notion that an epidemic was likely enough to warrant population-wide vaccination grew from dominant opinion to unquestioned gospel.
At the same time, the rhetoric of risk suffered steady inflation as the topic moved from the mouths of scientists to the mouths of government officials. In a memo prepared for his superiors at the Department of Health, Education and Welfare (HEW), David Sencer, head of the CDC, talked about the "strong possibility" of a swine flu epidemic. Later, HEW's general counsel commented that "the chances seem to be 1 in 2." A memo from the HEW secretary to the head of the Office of Management and Budget noted that "the projections are that this virus will kill one million Americans in 1976."
A few experts suggested the vaccine be made and stockpiled but used only if there was more evidence of an epidemic. This was considered but rejected early on. The argument was that the influenza vaccine had few, if any, serious side effects, and that it would be far easier (and more defensible) to get it into people's bodies before people started dying.
On March 24, President Gerald Ford announced on television that he was asking Congress for $135 million "to inoculate every man, woman and child in the United States" against swine flu.
Over the next nine months, very little went right -- or as planned.
Pharmaceutical companies undertook crash programs to make enough of the vaccine by the start of flu season in October. But it turned out the Fort Dix bug grew poorly in chicken eggs, the growth medium for the influenza virus. This meant that yields were going to be about half of what was planned. In addition, one company used the wrong virus and had to start over.
The insurance industry announced it wouldn't insure manufacturers against liability arising from the vaccine. An act of Congress shifted most of the liability to the government.
Studies of Fort Dix's soldiers showed that about 500 had been infected with swine flu. But with only one death, this called into question the deadliness of the strain. In addition, swine flu didn't appear that summer in the Southern Hemisphere, as would be expected if a pandemic were starting.
Tests showed that single injections of some vaccine formulations didn't protect children. This required time-consuming studies of a two-shot regimen.
Albert Sabin, the father of the oral polio vaccine and a high-profile advocate, broke with the party line and called for stockpiling, but not immediate use, of the vaccine.
Three elderly people in Pittsburgh died on the same day within hours of getting swine flu shots. It was a chance event, but just the sort of guilt by association that arises whenever a public health intervention is done on a mass scale.
What killed the program, though, was the observation in early December that people given the swine flu vaccine had an increased risk of developing Guillain-Barre syndrome, a rare, usually reversible but occasionally fatal form of paralysis. Research showed that while the actual risk for Guillain-Barre was only about 1 in 1,000 among people who had received the vaccine, that was about seven times higher than for people who didn't get the shot.
On Dec. 16, the swine flu vaccine campaign was halted. About 45 million people had been immunized. The federal government eventually paid out $90 million in damages to people who developed Guillain-Barre. The total bill for the program was more than $400 million.
There are a lot of lessons to draw, said Harvey Fineberg, a former dean of Harvard's School of Public Health, who co-authored an analysis of the "swine flu affair" for Joseph A. Califano, HEW secretary under President Jimmy Carter, who succeeded Ford in January 1977.
Among them: Don't over-promise; think carefully about what needs to be decided when; don't expect the consensus of experts to hold in the face of changing events. The biggest, he said recently, was perhaps the most obvious: Expect the unexpected at all times.
Tiny change in flu virus can be deadly
WASHINGTON (AP) — A tiny change in a virus that causes flu can turn it from an unpleasant annoyance to a killer, a team of researchers has found.
A change in just one of the virus' 10 genes switched a form of flu in chickens to a strain deadly to humans four years ago in Hong Kong, they discovered.
Authorities were forced to kill more than a million chickens in that city to block spread of the flu, which killed six of the 18 humans that it infected.
"What this tells you is that the avian influenza virus can become the virus that causes the disease in humans at any moment," said Yoshihiro Kawaoka, one of the research team at the University of Wisconsin-Madison.
The findings are published in Friday's issue of the journal Science.
"We have found that a limited number of very tiny genetic changes in a specific gene, one called PB2, can have a big effect on how potent the influenza virus is," said Kawaoka.
"Because the influenza virus constantly mutates, and because only a few changes can make a nonpathogenic virus highly pathogenic, we should assume that an outbreak of any new strain or subtype is potentially dangerous to humans," he said.
Robert Lamb, professor of biochemistry at Northwestern University, called the report intriguing.
"In many ways it tells us just how complicated understanding the influenza virus is, that a point mutation in one gene can confer virulence," he said. "It also tells us just how dangerous a virus influenza is."
The disease reappeared in Hong King this summer and more than a million chickens again were slaughtered.
It has long been known that animals such as swine can harbor viruses, with major epidemics occurring when it jumps from the usual host to humans. The Hong Kong case was the first documented instance of a flu virus jumping directly from chickens to humans, according to the National Institutes of Health.
The jump from fowl to humans raises particular worries because of the many live poultry markets common around the world, including parts of Florida and New York, Kawaoka said.
Viruses need to enter the cells of their hosts to reproduce and spread. Their surfaces are key to this ability, and the surface proteins of flu viruses change readily to escape detection by the human immune system. That is why new flu vaccines have to be developed each year.
The Wisconsin team's report also indicates that small changes can transform a disease generally confined to the respiratory system to one that infects the vital organs including the heart and brain.
The team tested various forms of the Hong Kong virus, known as H5N1 influenza A, in mice.
They obtained samples of the viruses that had infected Hong Kong humans during the 1997 outbreak and divided them into two types, one that merely made mice sick and another that was deadly.
Then the researchers were able to study the viruses by swapping genes between them and testing how they affected mice. Through that process they discovered that the gene called PB2 from the harmful group gives the virus its potency.
Further testing allowed them to identify the changes in the gene that had the effect.
While not all the effects of the PB2 gene are known, scientists think it directs the production of an enzyme that helps force the host cell to make more viruses.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, which supported the research, said the study "provides insight into the emergence of virulent viruses and can help us develop better strategies for detecting future outbreaks."
Copyright 2001 The Associated Press. All rights reserved.
Medicine: The Swine Flu Dilemma
Fearing a repetition of the worldwide 1918-19 influenza pandemic that cost 548,000 lives in the U.S. alone, President Ford last March called for the inoculation of virtually all Americans against swine flu. His announcement had all the fervor of a declaration of "war, and Congress promptly authorized funds for the largest public health measure in U.S. history. But the flu campaign has run into one roadblock after another. Last week it appeared close to total collapse.
The threat was an impasse over who would protect the vaccine manufacturers against a possible onslaught of lawsuits. Few medical authorities believe the vaccine itself is dangerous, but they point out that with so many shots being given, some reactions are inevitable. That would be true, as one drug spokesman put it, "even if we vaccinated the whole population with tap water." Worried about defending against many frivolous suits, insurance companies have refused to provide coverage for the manufacturers. So has Congress, although at week's end some compromise was being sought—perhaps legislation that would limit damages anyone could collect from drug companies.
The legal hassle was not the only problem. From the start, manufacturers have found meeting Ford's original goal of providing 200 million shots for the winter's flu season a staggering task; the quantities required are up to ten times the usual production run. In addition, local officials have complained that the cost of inoculations will greatly exceed the money available in the $135 million package appropriated by Congress.
Seed Viruses. The doubts have been magnified by the fact that not a single new case of swine flu has been found since the strain (ominously similar to the 1918-19 virus) was identified in several hundred G.I.s at Fort Dix, N.J., earlier this year. Even Dr. Edwin D. Kilbourne of New York's Mount Sinai School of Medicine, a leading proponent of the Ford program, concedes that the Fort Dix outbreak could have been a "freak occurrence." Complicating matters further, the vaccine, grown in fertilized eggs from "seed" viruses developed in Kilbourne's lab, has been only partially successful in clinical trials.
Injected into some 5,000 volunteers, the vaccine appeared to offer good protection with minimum side effects to people over the age of 23. But it caused high fever in a significant number of youngsters. Concerned by these results, Dr. Albert Sabin, developer of oral polio vaccine and originally a supporter of Ford's program, reversed himself and said that unless there is an actual outbreak, the vaccinations should be limited to "high-risk" people, notably the aged and chronically ill. A rival polio-vaccine pioneer, Dr. Jonas Salk, disagrees. Describing the vaccine as safe, he pointed out that even a partial immunization program reduces the spread of the virus by closing what he calls the immunity gap. Said he: "Vaccine is the most useful tool we have for preventing viral disease."
Government health officials clearly agree. They note that the last major new flu strain—Hong Kong A—caused some 30,000 deaths when it appeared in the U.S. in 1968-69, and they hope to start giving swine-flu shots Sept. 1.
Influenza Navigation:
“When in doubt, tell the truth.”
- Mark Twain
“Falsehood is easy, truth so difficult.”
- George Eliot
“Who is more foolish, the child afraid of the dark or the adult afraid of the light?”
- Maurice Freehill
“I know God will not give me anything I can't handle. I just wish He didn't trust me so much.”
- Mother Teresa
“A popular government without popular information, or the means of acquiring it, is but a prologue to a farce or a tragedy, or perhaps both.”
- James Madison
“The United States is unusual among the industrial democracies in the rigidity of the system of ideological control — 'indoctrination,' we might say — 'exercised through the mass media.'”
- Noam Chomsky
“Truth, like gold, is to be obtained not by its growth, but by washing away from it all that is not gold. ”
- Leo Tolstoy
“A newspaper, as I'm sure you know, is a collection of supposedly true stories written down by writers who either saw them happen or talked to people who did. These writers are called journalists, and like telephone operators, butchers, ballerinas, and people who clean up after horses, journalists can sometimes make mistakes.”
- Lemony Snicket
“Knowledge is the antidote to fear.”
- Ralph Waldo Emerson
“What the caterpillar calls the end of the world, the master calls a butterfly.”
- Richard Bach
“Fear is not in the habit of speaking truth; when perfect sincerity is expected, perfect freedom must be allowed; nor has anyone who is apt to be angry when he hears the truth any cause to wonder that he does not hear it.”
- Publius Cornelius Tacitus
“The man who fears no truth has nothing to fear from lies.”
- Thomas Jefferson
“Truthfulness has never been counted among the political virtues, and lies have always been regarded as justifiable tools in political dealings.”
- Hannah Arendt
“If Thomas Edison invented electric light today, Dan Rather would report it on CBS News as: 'Candle making industry threatened.'”
- Newt Gingrich
“Truth has no fear; Untruth shivers at every shadow.”
- Sri Sathya Sai Baba
“In spite of your fear, do what you have to do.”
- Chin-Ning Chu
“Fear grows in darkness; if you think there's a bogeyman around, turn on the light.”
- Dorothy Thompson
“Whenever the people are well-informed, they can be trusted with their own government.”
- Thomas Jefferson
“The man who fears no truths has nothing to fear from lies.”
- Francis Bacon
“A man goes to knowledge as he goes to war, wide awake, with fear, with respect, and with absolute assurance. Going to knowledge or going to war in any other manner is a mistake, and whoever makes it will live to regret his steps.”
- Carlos Castaneda
“Get your facts first, and then you can distort 'em as much as you please.”
- Mark Twain
“Don't waste life in doubts and fears; spend yourself on the work before you, well assured that the right performance of this hour's duties will be the best preparation for the hours and ages that will follow it.”
- Ralph Waldo Emerson
“The world is for thousands a freak show; the images flicker past and vanish; the impressions remain flat and unconnected in the soul. Thus they are easily led by the opinions of others, are content to let their impressions be shuffled and rearranged and evaluated differently.”
- Johann Wolfgang Von Goethe
“I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.”
- Nelson Mandela
“We are taught to understand, correctly, that courage is not the absence of fear, but the capacity for action despite our fears.”
- John McCain
“You can conquer almost any fear if you will only make up your mind to do so. For remember, fear doesn't exist anywhere except in the mind.”
- Dale Carnegie
“Courage is a special kind of knowledge: the knowledge of how to fear what ought to be feared and how not to fear what ought no to be feared.”
- David Ben-Gurion
“Fear is the path to the dark side. Fear leads to anger. Anger leads to hate. Hate leads to suffering.”
- Yoda
“The only sure bulwark of continuing liberty is a government strong enough to protect the interests of the people, and a people strong enough and well enough informed to maintain its sovereign control over the government.”
- Franklin D. Roosevelt
“How very little can be done under the spirit of fear. ”
- Florence Nightingale
“Listen to what you know instead of what you fear. ”
- Richard Bach
“To fear to face an issue is to believe the worst is true.”
- Ayn Rand
“A nation that is afraid to let its people judge the truth and falsehood in an open market is a nation that is afraid of its people.”
- John F. Kennedy
“It may well be that our means are fairly limited and our possibilities restricted when it comes to applying pressure on our government. But is this a reason to do nothing? Despair is nor an answer. Neither is resignation. Resignation only leads to indifference, which is not merely a sin but a punishment.”
- Elie Wiesel
“It would be difficult to dispel ignorance unless there is freedom to pursue the truth unfettered by fear. With so close a relationship between fear and corruption it is little wonder that in any society where fear is rife corruption in all forms becomes deeply entrenched.”
- Aung San Suu Kyi
“Fear is the main source of superstition, and one of the main sources of cruelty. To conquer fear is the beginning of wisdom, in the pursuit of truth as in the endeavour after a worthy manner of life.”
- Bertrand Russell
“If it's called the USA Today, why is all the news from yesterday? BAM. Busted!”
- Stephen Colbert
“Nothing in life is to be feared. It is only to be understood.”
- Marie Curie
“When even one American - who has done nothing wrong -- is forced by fear to shut his mind and close his mouth, then all of Americans are in peril.”
- Harry S. Truman
“A lie gets halfway around the world before the truth has a chance to get its pants on.”
- Winston Churchill
“When the people fear their government, there is tyranny; when the government fears the people, there is liberty.”
- Thomas Jefferson
“I do not mean to be the slightest bit critical of TV newspeople, who do a superb job, considering that they operate under severe time constraints and have the intellectual depth of hamsters. But TV news can only present the 'bare bones' of a story; it takes a newspaper, with its capability to present vast amounts of information, to render the story truly boring.”
- Dave Barry
“The truth is more important than the facts.”
- Frank Lloyd Wright
“Truth is tough. It will not break, like a bubble, at a touch, nay, you may kick it all about all day like a football, and it will be round and full at evening.”
- Oliver Wendell Holmes
“For my part, whatever anguish of spirit it may cost, I am willing to know the whole truth; to know the worst and provide for it.”
- Patrick Henry
“It is a puzzling thing. The truth knocks on the door and you say, 'Go away, I'm looking for the truth,' and so it goes away. Puzzling.”
- Robert M. Pirsig
“It is error alone which needs the support of government. Truth can stand by itself.”
- Thomas Jefferson
“When I tell any truth, it is not for the sake of convincing those who do not know it, but for the sake of defending those that do.”
- William Blake
“If I had my choice I would kill every reporter in the world, but I am sure we would be getting reports from Hell before breakfast.”
- William Tecumseh Sherman
“A nation of sheep will beget a government of wolves.”
- Edward R. Murrow
“If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.”
- Joseph Goebbels
“Newspapers are unable, seemingly, to discriminate between a bicycle accident and the collapse of civilisation.”
- George Bernard Shaw
“The truth is found when men are free to pursue it.”
- Franklin D. Roosevelt
“Hastiness and superficiality are the psychic diseases of the twentieth century, and more than anywhere else this disease is reflected in the press.”
- Alexander Solzhenitsyn
“I am a firm believer in the people. If given the truth, they can be depended upon to meet any national crisis. The great point is to bring them the real facts.”
- Abraham Lincoln
“A wave of panic passed over the vessel, and these rough and hardy men, who feared no mortal foe, shook with terror at the shadows of their own minds.”
- Arthur Conan Doyle
“Fear cannot be banished, but it can be calm and without panic; it can be mitigated by reason and evaluation.”
- Vannevar Bush
“Cowardice, as distinguished from panic, is almost always simply a lack of ability to suspend the functioning of the imagination.”
- Ernest Hemingway
“Courage is not the absence of fear but the ability to carry on with dignity in spite of it.”
- Scott Turow
“The media's the most powerful entity on earth. They have the power to make the innocent guilty and to make the guilty innocent, and that's power. Because they control the minds of the masses.”
- Malcom X
“If you once forfeit the confidence of your fellow citizens, you can never regain their respect and esteem. It is true that you may fool all of the people some of the time; you can even fool some of the people all of the time; but you can't fool all of the people all of the time.”
- Abraham Lincoln
“We hang the petty thieves and appoint the great ones to public office.”
- Aesop
“Media is just a word that has come to mean bad journalism.”
- Graham Greene
“By definition, a government has no conscience. Sometimes it has a policy, but nothing more.”
- Albert Camus
“Those who seek absolute power, even though they seek it to do what they regard as good, are simply demanding the right to enforce their own version of heaven on earth. And let me remind you, they are the very ones who always create the most hellish tyrannies. Absolute power does corrupt, and those who seek it must be suspect and must be opposed.”
- Barry Goldwater
“We are not afraid to entrust the American people with unpleasant facts, foreign ideas, alien philosophies, and competitive values. For a nation that is afraid to let its people judge the truth and falsehood in an open market is a nation that is afraid of its people.”
- John F. Kennedy
“I know of no safe repository of the ultimate power of society but people. And if we think them not enlightened enough, the remedy is not to take the power from them, but to inform them by education.”
- Thomas Jefferson
“Where large sums of money are concerned, it is advisable to trust nobody.”
- Agatha Christie
“Love all, trust a few.”
- William Shakespeare
“One of the saddest lessons of history is this: If we've been bamboozled long enough, we tend to reject any evidence of the bamboozle. The bamboozle has captured us. Once you give a charlatan power over you, you almost never get it back.”
- Carl Sagan
“All of us who professionally use the mass media are the shapers of society. We can vulgerize that society. We can brutalize it. Or we can help lift it onto a higher level.”
- William Bernbach
“I'm not upset that you lied to me, I'm upset that from now on I can't believe you.”
- Friedrich Nietzsche
“If one morning I walked on top of the water across the Potomac River, the headline that afternoon would read: 'President Can't Swim.'”
- Lyndon B. Johnson
“Lies are often much more plausible, more appealing to reason, than reality, since the liar has the great advantage of knowing beforehand what the audience wishes or expects to hear.”
- Hannah Arendt
“The public have an insatiable curiosity to know everything. Except what is worth knowing. Journalism, conscious of this, and having tradesman-like habits, supplies their demands.”
- Oscar Wilde
“When in doubt, tell the truth.”
- Mark Twain
“When distant and unfamiliar and complex things are communicated to great masses of people, the truth suffers a considerable and often a radical distortion. The complex is made over into the simple, the hypothetical into the dogmatic, and the relative into an absolute.”
- Walter Lippmann
“If such a plague came today, killing a similar fraction of the U.S. population, 1.5 million Americans would die, which is more than the number felled in a single year by heart disease, cancers, strokes, chronic pulmonary disease, AIDS, and Alzheimer’s disease combined.”
- Gina Kolata
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