Academic journal article Social Alternatives

Flu Vaccination in Historical Perspective: Public Health for the Middle Class

Academic journal article Social Alternatives

Flu Vaccination in Historical Perspective: Public Health for the Middle Class

Article excerpt

The response to the outbreak of H1N1 swine flu in 2009-2010 exemplifies problems of disease management, but also highlights the nature of contemporary public health: an endeavour primarily geared toward protecting the current political economy of the developed world and promoting middle-class moral propriety. Understanding how today's flu response is shaped requires insight into the history of germ theory; the development of new ways of thinking about the role of immunisation in the public sector; the public health industry's turning away from earlier concerns with social structure, poverty, discrimination, and access to resources; and, the development of a focus on individual behaviour. Close inspection of two important events in immunisation history-the creation of the polio vaccine in the 1950s and the American swine-flu fiasco of 1976-yields new awareness of the contemporary collusion between public officials and wealthy corporations, and helps to reveal how public health serves existing power structures.


Almost everyone has taken some interest in epidemics of late. The noisy response to the epidemic of 2009, the H1N1 swine flu, made sure of that. Society certainly made too much of swine flu (many have blamed the media for that) (Brownstein 2009). Although some found people too complacent, or gratingly uncooperative with flu-control programs (Chan 2009; Shuchat 2009; Butler-Jones 2009), others thought too little attention was being paid to epidemics that seemed more important, like autism, obesity, attention-deficit/hyperactivity disorder (ADHD), or the auto-immune deficiency virus, AIDS (McKay 2009).

The debate crystallised around campaigns to immunise whole populations against H1N1 flu. That the swine flu outbreak was comparatively mild relative to outbreaks of common, seasonal flu intensified the attention (according to the World Health Organisation there were 12,799 confirmed HlNl flu deaths worldwide as of the beginning of January 2010 (WHO 2010)). Even if this number is a two to six-fold undercount, as some would argue,1 there were still far fewer HlNl flu deaths in 2009 than the 250,000 to 500,000 per year normally attributed to seasonal flu (WHO 2003). That the outbreak was negligible relative to the calamitous loss of millions of lives predicted by health professionals and officials (PCAST 2009; Syal 2009) made for still sharper scrutiny of the response to the socalled pandemic.

By late 2009, concerns were raised about conflicts of interest on the part of flu experts (Engdahl 2009). A resolution passed in December 2009 by the Assembly of the Council of Europe called for an enquiry into the influence of vaccine makers on the World Health Organisation's (WHO'S) flu policy, reflecting suspicions of arm-twisting or collusion (Silverman 2010). Accusations of hype came from both the democratic left (Chin 2009) and libertarian right (Daily Bell 2010); from vaccine supporters who feel that the overstatement of the swine-flu threat diminishes the public's faith in immunisation in general, and those who believe vaccines induce autism. What makes flu an epidemic? What makes any epidemic a threat? How much should the public be asked to sacrifice? How much money? How much liberty? In order to defend against the predicted catastrophe? Answering these questions requires delving into the history of vaccination.

Germ Theory and the 1918-1919 Flu

By the time the terrible influenza outbreak of 1918-19 had passed, the global toll was at least 20 million dead-although the true number of casualties is unknown, because so many died where disease surveillance was rudimentary, or simply died too suddenly to allow for official tallies (Johnson and Mueller 2002; Taubenberger and Morens 2006). The so-called Spanish Flu epidemic should have discredited the new germ theory, since its proponents were unable to do anything to ease the disaster (the influenza virus was not discovered until 1931). …

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