Porcine Memories

In its response to the swine-flu epidemic, the government would do well to remember a similar crisis in 1976—and its attendant overreaction.

These are challenging days for the nation's public-health experts. Just as the financial crisis thrust economic forecasters or Wall Street analysts into the Washington limelight, the swine-flu epidemic will force health officials into the hot seat. History will prove the nation's judgment either appropriate or overblown.

However, despite the urgency that our current swine-flu epidemic appears to be engendering, our public-health experts need some contextual reference when making decisions. The best advice for today's policy makers and the president is to examine America's instructive history of reaction to this disease.

The swine-flu scare of 1976 led to America's most extraordinary public-health response, including the inoculation of 40 million people before the vaccine's side effects-and the failure of the pandemic to materialize-shut down the program. Today's epidemic-and its risk of becoming a full-blown pandemic spanning the globe-has so far resulted in few deaths, but produced growing hysteria. Our best way forward is to educate the public about the potential outcomes of this epidemic, and the approaches and ramifications inherent in them. That's a particularly challenging agenda for a nation that rarely thinks about public health above the health of individuals.

In 1976, the government sought to immunize every American with an effective vaccine. The result of these massive inoculations included more than fifty cases of Guillain-Barré Syndrome, a frightening condition in which nerves are rapidly stripped of their myelin sheath-which produces results akin to an acute and rapid case of multiple sclerosis.

These cases stoked sufficient press coverage and fear to shut down the program. It's not the first time that the public has rebelled against the best knowledge at hand. Hard-core epidemiologists, along with family practitioners across the country, register annual consternation at the fact that only about 20 percent of the population chooses inoculation for the annual flu season that puts two hundred thousand people in hospital and kills thirty thousand Americans.

The current restrictions being imposed, such as limitations on travel, are unlikely to thwart the disease. We simply know too little at this point. Further, through the lens of the current global economic downturn, measures which further limit productivity and exports are likely to have unanticipated public-health consequences. When poor urban factory workers lose their jobs or work fewer hours, they invariably have less money to spend on food and health care, which in turn results in the deterioration of public health.

In an intricately connected global economy, it's vital to recognize that health and wealth go together. Had SARS hit poor sub-Saharan countries, where respirators are few and public-health infrastructure often abominable, the death rates would have been much higher. Thus, it's important today to look at the poorest and most vulnerable at home and abroad, and come up with plans for them, should this pandemic materialize.

Meanwhile, the governments and public-health leaders in richer countries should commence programs to inform the public that pursuing programs to prevent massive death and morbidity may have unintended and undesirable consequences. The fear and hysteria of an anticipated pandemic is miniscule in impact compared with the reality of an actual pandemic.


Josh N. Ruxin is an assistant clinical professor of public health at Columbia University's Mailman School of Public Health. He resides in Rwanda where he directs the Access Project and the Millennium Villages Project Rwanda, and advises Rwanda Community Works.