Fear, Flight, Frustration and Dedicated Service: A Brief History of International Disease Control Activities, 1918-2008

Article excerpt

Introduction

What role does studying the history of epidemics play in enhancing our understanding of nations and empires? Similarly, how do health threats fit in traditional diplomatic history or policy making? Is health security a national or an international priority? And in the 21st century with its opportunities for the rapid transmission of communicable diseases will the agencies and approaches that were so slowly crafted during preceding centuries continue to suffice? Will nation states willingly participate in supranational efforts to stem the tide of disease? And even if they do, does humanity have the capacity to meet the challenge posed by ever-mutating microorganisms?

To answer these questions, a comparative review of the 1918-1919 flu pandemic and the 2003 SARS epidemic will be used to demonstrate the many factors which influence nations as they grapple with severe outbreaks of infectious disease. In general as many historians have argued, local and national responses to epidemics from the Black Death to the present reflect existing scientific knowledge, cultural beliefs and practices and the power of the state to impose preventive or curative measures such as quarantine or isolation. (1) But were influenza and SARS imported or endemic? Should nations regard them with the same fear that was felt for cholera, plague and yellow fever in preceding centuries? What best practices would ensure that limited human and institutional resources were used to greatest effect since the 1918-19 pandemic coincided with the final months of the First World War while SARS was coterminous with the war in Iraq?

The similarities and difference between the two outbreaks reveal the importance of historical understanding of local, national and regional approaches to controlling communicable disease in a global context. Although efforts to establish international regulations had occurred prior to 1914, the First World War effectively prevented cooperation among the combatants. As a result, each nation or colony had to rely on local laws and existing health personnel for action to contain the outbreak and care for sufferers and their families. In contrast, the SARS epidemic occurred in a world linked through air travel and the Internet which enabled the World Health Organization (WHO) to take a leadership role on behalf of its 193 members to assist those countries who were suffering disease outbreaks. What changes in international diplomacy, biomedical knowledge and public attitudes had occurred to legitimize global action against a communicable disease? Does this portend a new definition of global health as a public good that must be available to all? By comparing and contrasting the international dimensions of the 19181919 influenza pandemic with the SARS outbreak in 2003, we will see how various nations and their peoples responded to the challenge of controlling communicable disease and the impact of these experiences on biomedical science, national health systems and international order. Starting first with the influenza pandemic, we will then examine the contested interwar attempts to create effective disease monitoring and control efforts, the discovery of the flu virus and its frightening ability to mutate, the creation and disease fighting function of the World Health Organization, and end with a discussion of the SARS outbreak and the way that it has affected global health.

Pandemic Influenza, 1918-1919

The historiography of the 1918-19 pandemic focuses on national, regional and local responses to the disease, the scientific challenges which it posed, the difficulty of determining the worldwide death toll and the surprising absence of discussions of the outbreak's impact on the peace talks in 1919, and in long term collective memory. (2) To date little attention has been paid to its role as a catalyst for the expansion of international sanitary regulations during the 1920s beyond the limited group of European and American nations who had formed organizations such as the Pan American Sanitary Bureau (1902) and the Office international d'hygiene publique (1907). …