A healthy partnership against flu

CHAPEL HILL -- People express frustration about not immediately getting the pandemic H1N1 vaccine for high-risk relatives, and some suggest that this temporary delay is another example of governmental inefficiency and a foretaste of what will happen if health care reform legislation is passed.

As a physician, I believe that a historical perspective provides a more accurate view of our nation's remarkable response to the H1N1 flu pandemic.

The second wave of the 1918 flu, which killed tens of millions around the world at the end of World War I, hit Camp Devens near Boston in September of that year. The army hospital was overflowing with some 8,000 critically ill soldiers, and dedicated doctors and nurses hopelessly witnessed some 100 deaths a day. When respected physician and medical researcher Dr. William Henry Welch visited and examined the lungs of a young man who had died from the flu, he was shaken by the sight and exclaimed, "This must be some new kind of infection or plague."

Welch and the physicians of his day were well acquainted with bacteria and suspected that there were much smaller infectious agents known as viruses. No one at that time, however, had seen a virus and no one had any idea about their composition and action in the human body.

My first exposure to epidemic flu came when I was a resident in a New York hospital during the 1957 Asian flu epidemic. A previously healthy 35-year-old man was admitted with flu and acute respiratory distress. Antibiotics were available to treat his secondary bacterial pneumonia but there were no antiviral medicines and no intensive care units with respirators. Despite treatment in one of the nation's best hospitals he died.

It was not until the late 1990s that the 1918 flu virus was isolated and its genetic code determined, but it took the federal Centers for Disease Control only weeks this year to determine the genetic code of the new H1N1 virus after illnesses with this virus were identified in Mexico.

This knowledge permitted the difficult decision by the U.S. and other major governments to fund the preparation of the new H1N1 vaccine by the foremost vaccine companies. Time did not permit raising the necessary funds from other sources and the companies would have been fiscally irresponsible to undertake such an effort on their own.

Knowing the genetic structure of this H1N1 flu virus also made possible prompt and specific genetic-based diagnostic testing by the CDC, which then provided the test materials to other laboratories. These tests allow physicians to provide optimal patient care and the public health community to follow this pandemic in real time as it spread around the globe.

The local, national and global approach to the H1N1 pandemic is truly unprecedented in medical history. To a large measure this success represents an extraordinary return on a half-century of investment by American taxpayers in federal programs such as the National Institutes of Health's biomedical research and training grants. It is also a tribute to the vision and political courage of many presidents and members of Congress - both Republicans and Democrats - who appropriated funds for these programs.

The knowledge, technologies, space-age materials and educated scientists and physicians resulting from these and other government programs have been utilized by for-profit entrepreneurial companies to provide us with today's diagnostic tests, vaccines, antivirals, antibiotics and equipment such as monitors and ventilators for the care of patients in sophisticated intensive care units.

Fortunately this pandemic to date has had a much lower mortality than the 1918 pandemic. But all the funding and effort is well spent, since it better prepares us to deal with a more deadly flu epidemic or bioterrorist attack in the future.

Rather than lamenting the inevitable temporary imperfections of a massive effort to respond to the flu pandemic, we should be celebrating that we live in a nation where the government takes bold steps to address threats to our health and where the business community uses the government-funded new knowledge and technology to provide us with the tools we need to meet these threats.

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