The Big Influenza Gamble

On Sept. 27, 1918, the Andover Board of Health closed all schools, the library, and the movie theater. Church services were voluntarily discontinued. These actions were taken because of the Great Influenza Epidemic of 1918-19. The Board of Heath reported 1,503 cases of influenza in 1918 and 25 people died. The Andover Townsman reported 341 new cases in one week. In 1919, there were 274 more cases, but the Board of Health was too busy dealing with the epidemic to file a report and no deaths were stated. (The town's population was 8,000.) In Lawrence, open air hospitals were set up in tent villages. In Massachusetts, 45,000 people died.

The Great Influenza was one of the worst events in human history. Twenty million Americans were infected, 20 percent of the population. It killed 675,000 of those people, 10 times more Americans than died in World War I. Half the American troops who died in the war died of the influenza. Worldwide, between 20 million and 100 million died, with 50 million being a widely quoted number. More people died from the Great Influenza in one year than died from the "Black Death" (Bubonic Plague) during the Middle Ages.

The mortality rate for the annual "flu" is 0.1 percent. Last year, the flu killed about 34,000 worldwide. That was a normal year. The mortality rate during the Great Influenza was 2.5 to 5 percent. Not only was that influenza much more contagious than ever, it killed a high percent of the people infected. The 1918-19 Influenza came in three waves. The first wave was relatively benign; the second wave was deadly; and the third wave was benign.

Virus mutation rate calculations are for scientists, but rapid mutation is what makes viruses so dangerous. Simply stated, viruses go through countless generations and mutations during the time it takes humans to go through a single generation.

"(H1N1) Influenza A," formerly called the "Swine Flu" is now causing concern. The 1918-19 was an H1N1 virus, but within the designation H1N1 are large numbers of variations. Some variations are harmless, some will make you sick, and some will kill you.

We had a Swine Flu scare in 1976, and it affected a presidential election. That year, a small number of soldiers at Fort Dix were diagnosed with Swine Flu. One died. Acting with the recommendation of the Centers for Disease Control and with Congressional approval, President Gerald Ford implemented a Swine Flu program that included the vaccination of 40 million Americans. Three elderly people died shortly after being vaccinated and the media assumed a connection. Public outcry stopped the vaccination program. Today we know that there was no scientific connection between those deaths and the vaccinations. However, after the vaccinations were stopped, as many as 500 people developed Guillain-Barre syndrome (GBS), a serious neurological disorder. Up to 25 of these people died. GBS is rare and can be caused as a response to a vaccination.

Before large scale vaccination programs are begun, experts predict the number of health issues that will be caused by the vaccine. It is a risk/reward analysis: how many people will be hurt as compared to how many will be helped by the vaccine. With flu vaccinations, it is predicted that one person in a million will get GBS. The 1976 Swine Flu Vaccine had an abnormally high 500. (That may have been a statistical anomaly, or something unique in the vaccine, or a heightened awareness of the side effects caused by media attention, or a combination of all of these.)

President Ford was criticized for overreacting to the Swine Flu. This "overreaction" may have played a role in his defeat by Jimmy Carter. In 1979, I was at the Kennedy School, and we studied the 1976 "Swine Flu Crises." The important part of the discussion was not about whether Ford had overreacted but whether the perception that he'd overreacted might cause future Presidents to underreact in similar situations.

The predictable cries that the government, the media, and "we" are overreacting began several days ago. Part of my full-time job involves risk management. Besides insurance (which is really shifting risk rather than managing it), risk management means that you do things that cost time and money to prevent people from getting hurt and assets from being destroyed. The trouble with risk management is that you can't always quantify whether you had the desired results. In other words, you don't know what problems you prevented.

This is a high stakes game, folks. If I were betting money, I'd bet that this will all blow over, and maybe laugh about it. However, I'm in favor of overreaction as opposed to underreaction when the stakes are so high.

Postscript. As the paper goes to press, it appears more than likely that the latest flu is no more dangerous than an ordinary flu. However, the government will have to make a decision as to whether it manufactures a vaccine for this new strain of influenza or whether it keeps on with its plans to manufacture a vaccine for the routine annual flu. There may not be enough capability to manufacture both, but that could change. Remembering that this H1N1 may be able to remake itself into a deadly second wave in time for the colder weather and flu season, like the H1N1 of 1918-19 remade itself, the stakes remain very high.