Chapter 6: A Litigation Nightmare

Despite having the support of prominent experts such as Dr. Jonas Salk and Dr. Albert Sabin, the vaccine announcement of 1976 invited criticism almost immediately. CBS journalists John Cochran and Robert Pierpoint began to investigate if the vaccine campaign was politically motivated or intended to “bolster Ford’s popularity.” Cochran and Pierpoint discovered that many CDC scientists privately disagreed with the mass vaccination plan.

Yet preparations for the vaccination program continued. Since all vaccinations carry a tiny risk, critics feared that mass vaccination could cause adverse reactions in many people. On CBS Evening News, Dr. Goldfield of Fort Dix went as far as to say that the government could expect “approximately fifteen percent” of the population to suffer a “disability reaction.”

These concerns around safety put a temporary hold on the vaccination plans, but a swine flu scare in August spurred the US government into action. A group of people fell ill at an American Legion convention in Philadelphia, and twenty-six people died. Immediately, some experts began to ascribe the deaths to swine flu and questioned Congress’s decision to delay the vaccine. Although data showed that the respiratory sickness was not swine flu, the message was not lost on the government. If swine flu were to crop up, the criticisms in the absence of a vaccine would be “withering.”

The vaccine program was restarted, and the first round of immunizations took place on October 1. Ten days later, three elderly vaccinated patients died in Pittsburgh. Many counties suspended the vaccination program, fearing adverse effects. Though Dr. Sencer held a press conference stating that there was no known correlation between the deaths and the vaccine, the panic around vaccination had already become full-blown. In November, a Minnesota doctor reported increased cases of Guillain-Barré syndrome, a nerve disorder, among vaccinated patients in his practice. The rare disease leads to a tingling of the limbs in the mildest cases, but in more severe instances, it can impair nerves that control swallowing and breathing, sometimes leading to death. More cases of Guillain-Barré syndrome began to show up all over the US.

The data seemed ominous, but the nerve disorder, with its varied symptoms, is also notoriously difficult to diagnose. Despite conflicting evidence, the government was forced to halt the vaccination program in December. A wave of damages claims, ultimately totaling $3.5 billion, were filed by 1980. In the end, though, the claims remained unpaid, as no clear correlation had been established between the vaccine and the disease. While some doctors were certain of the connection, epidemiologists opposed it. The enduring lesson from the episode, Dr. Keiji Fukuda summarizes, is not to “jump the gun and assume a pandemic is happening” when a new virus appears.

Chapter 7: John Dalton’s Eyeballs

In 1995, Dr. Jeffery Taubenberger of the Armed Forces Institute of Pathology was struck by an idea that led to an astonishing find in influenza research. Dr. Taubenberger came across an article in the February issue of Science magazine about the preserved eyeballs of scientist John Dalton (1766–1844). Dalton, the legendary chemist behind the atomic theory of matter, was color-blind. Dalton’s hypothesis was that something in the vitreous fluid of his eyeballs caused color-blindness, and he asked his assistant to autopsy his eyes after his death. Though the autopsy proved Dalton wrong, the scientist’s eyeballs were preserved in a jar. Meanwhile, by 1995, a revolutionary technique called polymerase chain reaction (PCR) had enabled scientists to extract and study the smallest of cells. The Science article proposed that PCR be used to extract nerve cells from Dalton’s preserved eyeballs and study them for gene mutations that cause color-blindness.

Excited by the possibilities of PCR, Dr. Taubenberger and technician Ann Reid decided to use it to decode the “unknown” 1918 flu virus. As it happened, their facility housed thousands of lung tissue samples from flu victims. Reid retrieved six samples—chunks of wax the size of a fingernail—from a warehouse a few miles away from the facility. She meticulously shaved off pieces several times thinner than a sheet of paper and dissolved the wax in a solvent. She then extracted genetic material from the tissues to use for PCR, the “miraculous method that can make millions of copies of a single fragment of a gene floating in a solution.”

For the process, Reid chose a fragment of the virus’s “matrix” gene, as it changes very little over mutations. She mixed the genetic material with a custom-made primer designed to hook the flu genes. If the primer found and hooked the virus’s genetic material, an enzyme could create millions of copies of the gene, which Reid could then spot by labeling the copies with a radioactive probe. Thus marked, these copies, if produced, would burn black marks into an X-ray film.

However, Reid’s initial studies—lasting eighteen months—proved unsuccessful. Finally, the lung tissue of Roscoe Vaughan, a soldier who died of the 1918 flu in Camp Jackson, South Carolina, led to the elusive black dots on Reid’s X-ray film. Almost eighty years after it killed millions, the 1918 flu virus had been ensnared. “Very few in science are given that kind of moment,” Reid said of the discovery.

The team’s findings were published in the March 1997 issue of Science and instantly placed the little-known researchers into the spotlight. Oddly, within two months of the publication, a mysterious death in Hong Kong signaled the possible start of a fresh flu pandemic.

Chapter 8: An Incident in Hong Kong

When a healthy three-year-old child tragically died of a respiratory illness in Hong Kong in May 1997, doctors were both saddened and flummoxed. Tests showed that the illness was a kind of flu, but it didn’t completely match a known human strain. The sample was ultimately passed to the team of Dr. Nancy Cox, a virologist at the CDC. When the CDC tested the Hong Kong child’s samples in August, they found a match—but not with a human strain. The strain, H5N1, matched the antibodies from a bird flu virus that the lab maintained for reference.

The events confirmed a hypothesis proposed by Dr. Robert Webster in the US and Dr. Kennedy Shortridge of Hong Kong: that the worst flu pandemics, like the one in 1918, begin with bird flu. Before it can infect humans, the virus has to incubate and mutate in a pig, which forms the bridge between birds and humans. As evidence, Dr. Webster and Dr. Shortridge referred to the 1857 and 1968 flu outbreaks in Asia, both of which were indirectly linked to birds. Further, the scientists noted that all major flu outbreaks “seem to start in Asia—in Southern China in particular,” where ducks and pigs are farmed in close proximity.

In November 1997, the virus resurfaced in Hong Kong. By December, eighteen people were hospitalized due to the new virus; of these, six died. While scientists worked on the vaccine, Dr. Shortridge tried to trace the virus’s origin in Hong Kong. He turned to the “wet markets” of Hong Kong, where chickens, mostly imported from China, are killed in front of customers.

Shortridge tested samples from the chickens and found them to be infected with the H5N1 virus, and he determined that all birds in wet markets needed to be culled to stop the spread of the flu. In just a day, 770,000 of the birds in Hong Kong were killed, including chickens, ducks, quail, and pigeons. Poultry imports from China were stopped. The pandemic seemed to have halted, but Dr. Cox believed it was a “wake-up call” for governments to improve their preparedness for a pandemic.