HARVARD GAZETTE ARCHIVES
Past, present of flu pandemics examined
Experts seek lessons from broad range of disciplines
By By Alvin Powell
Harvard News Office
The global response to bioterrorism and AIDS is increasing health system capacity in a way also useful if avian flu strikes, according to experts attending an interdisciplinary conference on Asian flus.
The bad news, however, is that vast disparities in health care systems still persist and, despite the expanding capacity in recent years, bird flu could still have a devastating impact.
"I think of what happens if avian flu comes to Lesotho. The mortality and morbidity would just be devastating," said Jim Kim, who heads Harvard Medical School's Department of Social Medicine and serves as the Francois-Xavier Bagnoud Professor of Health and Human Rights in the Harvard School of Public Health.
Kim used Lesotho as an example of a nation hard-hit by AIDS where the response to the disease includes building health system capacity in a rural area.
Worldwide, Kim said, there's been an enormous investment in recent years in fighting AIDS, tuberculosis, and malaria.
Kim was just one speaker at the "Asian Flus and Avian Influenza Workshop," held at the American Academy of Arts and Sciences in Cambridge Dec. 8-10.
The workshop attracted an international group of scholars on all aspects of the flu, including, among others, its history, bird and pig biology, public health, and anthropology. The workshop was organized around the central theme of Asian flus and brought together a number of fields that do not traditionally work together.
Arthur Kleinman, chairman of the Anthropology Department in the Faculty of Arts and Sciences and medical anthropology professor in the Medical School, said pandemic flus touch society far more deeply than simply the experience of a single person in a hospital. They encompass the experiences of people raising animals in intensive settings where the flus sometimes arise. They encompass the biology of the virus, the public health response of those seeking to understand its broader course through society, the actions society takes to fight the flu, and, when large numbers of people become incapacitated, how society recovers.
Harvard School of Public Health Dean Barry Bloom said the workshop provided a chance for universities to contemplate all these many factors at length in advance of a crisis.
"We're doing what a university does best," Bloom said. "Not putting out fires, but sitting back and reflecting."
The conference kicked off with a discussion of the history of pandemics and their relation to global security and health. Subsequent sessions looked at flu biology and epidemiology, animal husbandry and the anthropology of the flu, public health concerns, institutional responses to the flu, and global issues with respect to avian flu.
"The purpose of this is a fuller comprehension by the individual, the health care system, the research apparatus, and society as a whole of a pandemic like this," Kleinman said.
In the early sessions, Charles Rosenberg, Ernest E. Monrad Professor of the Social Sciences, spoke of the history of disease epidemics. Disease was a fact of life in Colonial America, he said, with everyday occurrences of diseases marked by diarrhea and fevers that took an enormous toll. Several diseases that were deadly, such as tuberculosis, were part of everyday life.
Perhaps the most frightening epidemic in Colonial history, Rosenberg said, was a diphtheria epidemic that tore through western Massachusetts and New Hampshire in the 1730s. The epidemic targeted children and killed as many as half of children in isolated villages throughout the region.
During the 20th century, Rosenberg said, epidemic disease began to look very different. With the advent of modern medical science and public health improvements, many of the diseases that ravaged populations in centuries past ceased to be a threat.
Still, he said, the 20th century was bookended by two large pandemics: the 1918-19 flu pandemic, and the ongoing AIDS pandemic.
The 1918 flu likely originated in the American Midwest and swept around the world in five months before changing and becoming more lethal. It was notable because it struck vast numbers of people and killed between 50 million and 100 million, notably adults in their productive years, striking those between age 15 and 34 more than any other age group.
Ford Foundation Professor of Science and International Affairs Ashton Carter, director of the Center for Science and International Affairs, said a flu outbreak has potential national security ramifications. Many of the steps being taken today to combat possible bioterror strikes would be effective against a flu outbreak.
Fighting a bioterror attack, Carter said, depends more on rapid response than prevention, given that the raw materials for a biological terror attack are widespread and fairly easily attainable. The best way to combat bioterror, he said, is to ensure the public health system is robust enough that any attack is rapidly responded to.
"The goal is not prevention; it is to make an attack fizzle," Carter said. "The perpetrators are out there. They're always going to be out there as long as there are aberrant human beings. And there will always be aberrant human beings."
With China rapidly growing on the international stage, Carter said epidemics that originate there could potentially worsen tensions between the United States and China, particularly if such epidemics hurt the U.S. economy and the United States felt the Chinese government were mismanaging the crisis. Further, he said, as China rapidly industrializes, its impact on the global environment has the potential to grow rapidly - and negatively.
"It can't be good when something that affects us adversely originates elsewhere," Carter said.