Defeating ‘the American Plague’

Yellow fever doesn’t have the cachet of the Black Death or the Asian flu, but the mosquito-borne disease nicknamed “the American Plague” has tormented the world for centuries.

The U.S. Centers for Disease Control and Prevention estimates the virus causes 200,000 cases and 30,000 deaths each year, and not just in the tropics. The disease first struck New York City in 1668, followed by at least 25 major outbreaks in the Americas, including an 1878 epidemic in the Mississippi River Valley that killed 20,000 people.

There is a vaccine, developed after the opening of the Panama Canal in 1912 by scientists throughout the world. However, historically it needed to be freeze-dried, a process prone to mechanical issues until it was refined in the early 1950s by National Drug in the small hamlet of Swiftwater, Pennsylvania.

You can read the story of this and other vaccine innovations in The Spirit of Swiftwater, a chronicle of the pioneers of immunization who fought to revolutionize healthcare in America.

An outbreak of innovation

The Spanish flu outbreak of 1918 wasn’t the first pandemic to sweep America.

In the late 1800s, smallpox ravaged the nation. In New York City, the mid-century death rate from the disease hit 21.9 people per 100,000. In nearby Pennsylvania, by 1900 the disease had killed thousands.

There was a vaccine. And it worked. Some of the time. And there were side-effects.

The solution? A cross-cultural effort that combined French ingenuity with American innovation.

You can read the full story in my first book, The Spirit of Swiftwater, a chronicle of the pioneers of immunization who fought the odds to revolutionize healthcare in America.

 

 

You bet your life

The measles are back with a vengeance, and so are the protests.

So far this year, the Centers for Disease Control and Prevention is tracking six outbreaks affecting more than 100 people, with 68 cases in the Pacific Northwest alone, according to the CDC, Associated Press and Washington Post.

Yet despite the demonstrable success of vaccines—the near worldwide eradication of polio a case in point—anti-vaccination fervor is spreading like a virus. Some lawmakers are pushing legislation that would allow parents to opt out of childhood vaccinations, a move that could jeopardize not only the health of their children but others with whom they come into contact.

None of this is new. In 1897, Dr. Richard Slee, founder of the firm that would evolve into the U.S. operations of biologics company Sanofi Pasteur, faced a similar backlash when he introduced to the United States a vaccine to prevent smallpox.

The story of his struggle is told in The Spirit of Swiftwater, a chronicle of the fight to eradicate vaccine-preventable disease in the 20th Century. The story is a timely reminder of the efficacy and controversy of this form of medicine:

The new science of immunology had proven vaccines could save lives. It had progressed quickly from the late 1700s, when British physician Dr. Edward Jenner discovered that smallpox could be prevented by inoculating people with the substance from cowpox lesions. The vaccine worked. According to the New York City Health Department, the death rate from smallpox in 1869 was 21.9 per 100,000 people. In 1876, New York’s Vaccination Corps fanned out to inoculate the city. The following year, the death rate per 100,000 people had dropped to 0.18.

That did little to convince parents who’d heard reports that bacteria from the lesions had caused serious infections in some children.

Even with a tacit endorsement from the federal government, the fledgling biologicals industry still faced a daunting problem not related to finance — a public backlash against vaccination. Despite the reduction in mortality that immunization had brought to the nation, not all of its citizens were convinced this was good public policy, or even effective health care.

In 1908, a medical doctor from Niagara Falls, New York, J. W. Hodge, wrote that compulsory vaccination was “the crime of the century,” citing evidence that the process not only violated an American’s freedom but that it was ineffective. “The accumulated experience of more than one hundred years has conclusively demonstrated that vaccinia neither prevents smallpox nor mitigates that disease when it attacks the vaccinated.”

Slee countered those attacks and others in a letter to the Bergen County, New Jersey, Medical Society in 1910:

The growth of the anti-vaccination societies in this country is largely due to the undeniable fact that the protection by vaccination was sometimes followed by results that were more serious than would be a mild attack of smallpox. We are now passing through the transition state, so to speak, and in a short time physicians will begin to realize that the regulations of the government are wise and that the failures from time to time are more than offset by the undeniable elimination of many severe and unpleasant sequelae [an abnormality following a disease, like paralysis following polio].

Unless lawmakers take the decision out of the hands of the experts.

[Measles vaccine doesn’t cause autism, says a decade-long study of half a million people.]

 

The infectious prediction of thrillers

Some writers land in the right place at the right time. Others anticipate, showing us what life might look like in a few years if things go horribly wrong. Many of the near-futurists build their plots on epidemics. Bob Reiss (Black Monday) did it with oil. Patricia Gussin (Weapon of Choice) does it with biologics.

In Gussin’s novel, published in 2012 but set in 1985, thoracic surgeon Dr. Laura Nelson gets caught in a medical and bureaucratic firestorm when a fast-moving staph infection spreads through her hospital at the same time the facility receives its first AIDS patient. Aside from delivering a decent thriller, the author shows what happens when antibiotic-resistant infections spread, and how hospitals and agencies such as the CDC must work quickly to contain the disease.

Weapon-of-Choice-3DSince Gussin is not only a physician but the former vice president of consumer pharmaceuticals at healthcare giant Johnson & Johnson, she writes with great detail . . . and frightening authority. Frightening because people can use these microbes as weapons.

All of which leads us to the latest crisis in healthcare, the threat of an Ebola pandemic. People worry about travel and transmission. Writers evoke images of the plague. Institutions scramble to contain, treat and reassure.

In Gussin’s book, she details CDC protocols for isolation and decontamination. Have they improved since 1985? Do they work as well in airports as they do in books?

When you look into the near future, what do you see?