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33
For details, see the CDC's
Morbidity and Mortality Weekly Report
(September 3, 1976): 270–76.
34
Crosby (1976), op. cit.
35
Eighteen months later, a medical journal, when referring to the Philadelphia outbreak, opened with the following florid language: “The explosive outbreak of acute respiratory disease that occurred in Philadelphia during the summer of 1976 was both mysterious and terrifying. Now, after a year and one half of painstaking investigation, much of the mystery and some of the terror are beginning to be dispelled.” (From “Legionnaires' Disease: An Unfolding Riddle,”
Hospital Practice,
February 29 [sic], 1978: 24–25.) The above article was followed by an editorial comment that noted: “Along with those of Lassa fever and Ebola-virus disease, the organism of Legionnaires' disease takes its place as one of the newly recognized infectious agents capable of causing severe, life-threatening illness in man.”
36
Committee on Interstate and Foreign Commerce, House of Representatives Proceedings, hearing before the Subcommittee on Consumer Protection and Finance, 94th Congress, November 23–24 (Serial No. 94–159) (Washington, D.C.: U.S. Government Printing Office).
37
“U.S. Center Assailed on ‘Legion' Disease,”
New York Times
, October 29, 1976: Al.
38
Silverstein (1981), op. cit.
39
An excellent analysis of press coverage during October 1976 can be found in D. M. Rubin and V. Hendy, “Swine Influenza and the News Media,”
Annals of Internal Medicine
87 (1977): 769–74.
40
H. F. Retailliau et al., “Illness After Influenza Vaccination Reported Through a Nationwide Surveillance System, 1976–1977,”
American Journal of Epidemiology
111 (1980): 270–78.
41
Centers for Disease Control, “Innuenza—Worldwide,”
Morbidity and Mortality Weekly Report
25 (1976): 331.
42
Centers for Disease Control, “Influenza Surveillance—United States,”
Morbidity and Mortality Weekly Report
25 (1976): 391–92.
43
Rubin and Hendy (1977), op. cit.
44
Centers for Disease Control, “Guillain-Barré Syndrome—United States,”
Morbidity and Mortality
Weekly Report
25 (1976): 401–2.
45
J. L. Reismann and B. Singh, “Conversion Reactions Simulating Guillain-Barré Paralysis Following Suspension of the Swine Flu Vaccination Program in the U.S.A.,”
Australian and New Zealand Journal of Psychiatry
12 (1978): 127–32.
46
L. B. Schonberger et al., “Guillain-Barré Syndrome Following Vaccination in the National Influenza Immunization Program, United States, 1976–1977,”
American Journal of Epidemiology
110 (1979): 105–23.
Fifteen years later, CDC researchers not directly involved in the events of 1976 reexamined all Guillain-Barré-associated medical records for 1976–77 in Minnesota and Michigan, submitting patient data to panels of neurologists for reanalysis. This was done because doubts still lingered—doubts fueled by the fact that 1.7 million military personnel were vaccinated in 1976 without a single resulting case of the syndrome. They concluded that some cases had been misdiagnosed in 1976, but Guillain-Barre was still clearly linked to the vaccine. Vaccine recipients in those two states were more than seven times more likely to suffer the syndrome. The study can be found in T. J. Safranek et al., “Reassessment of the Association Between Guillain-Barré Syndrome and Receipt of Swine Influenza Vaccine in 1976–1977: Results of a Two-State Study,”
American Journal of Epidemiology
133 (1991): 940–51.
47
J. Axelrod, personal communication, 1993. A total of $2.4 billion was sought in lawsuits, but less than $48 million was paid out as a result of litigation; a track record of which Axelrod is quite proud. The precise settlement payout was $92,833,020.
48
For details on the lasting impact of Swine Flu and other vaccine litigation upon research and development, see Institute of Medicine,
The Children's Vaccine Initiative,
V. S. Mitchell, N. M. Philipose, and J. P. Sanford, eds., (Washington, D.C.: National Academy Press, 1993).
49
Communicable Disease Center, “Institutional Outbreak of Pneumonia,”
Morbidity and Mortality Weekly Report
14 (1965): 265–66. S. B. Thacker et al., “An Outbreak in 1965 of Severe Respiratory Illness Caused by the Legionnaires' Disease Bacterium,”
Journal of Infectious Diseases
138 (1978): 512–19.
50
Centers for Disease Control, “Follow-up on Respiratory Illness—Philadelphia,”
Morbidity and Mortality Weekly Report
26 (1977): 9–11.
51
Osborn (1977), op. cit.
52
Neustadt and Fineberg (1982), op. cit.
53
M. Goldfield et al., “Influenza in New Jersey in 1976: Isolations of Influenza A/New Jersey/ 76 Virus at Fort Dix,”
Journal of Infectious Diseases
136 (1977): S347–S355.
54
H. F. Top, Jr., and P. K. Russell, “Swine Influenza A at Fort Dix, New Jersey (January-February 1976). IV: Summary and Speculation,”
Journal of Infectious Diseases
136 (1977): S376–S380.
55
Dowdle and LaPatra (1985), op. cit., 88–89.
56
Centers for Disease Control,
Laboratory Manual: “Legionnaires',” the Disease, the Bacterium and Methodology
(Washington, D.C.: Department of Health, Education, and Welfare, 1979).
57
Centers for Disease Control, “Legionnaires' Disease—United States,”
Morbidity and Mortality Weekly Report
26 (1977): 300.
58
Centers for Disease Control, “Follow-up on Legionnaires' Disease—Ohio,”
Morbidity and Mortality Weekly Report
26 (1977): 308; and J. S. Marks et al., “Nosocomial Legionnaires' Disease in Columbus, Ohio,”
Annals of Internal Medicine
90 (1979): 565–69.
59
Centers for Disease Control, “Follow-up on Legionnaires' Disease—Vermont,”
Morbidity and Mortality Weekly Report
26 (1977): 328.
60
Centers for Disease Control, “Legionnaires' Disease—Tennessee, Vermont,”
Morbidity and Mortality Weekly Report
26 (1977): 336; and C. V. Broome et al., “The Vermont Epidemic of Legionnaires' Disease,”
Annals of Internal Medicine
90 (1979): 573–77.
61
Centers for Disease Control, “Sporadic Cases of Legionnaires' Disease—United States,”
Morbidity and Mortality Weekly Report
26 (1977): 388; and Centers for Disease Control, “Follow-up on Legionnaires' Disease—United States,”
Morbidity and Mortality Weekly Report
26 (1977): 443.
62
Centers for Disease Control, “Legionnaires' Disease—England,”
Morbidity and Mortality Weekly Report
26 (1977): 391.
63
“Hospital Haunted by Legionnaires' Disease,”
New York Times
, November 13, 1978: Al; and C. E. Haley et al., “Nosocomial Legionnaires' Disease: A Continuing Common-Source Epidemic in Wadsworth Medical Center,”
Annals of Internal Medicine
90 (1979): 583–86.
64
W. L. L. Wang et al., “Growth, Survival, and Resistance of the Legionnaires' Disease Bacterium,”
Annals of Internal Medicine
90 (1978): 614–18.
65
R. P. Hudson, “Lessons from Legionnaires' Disease,”
Annals of Internal Medicine
90 (1978): 704–7.
7. N'zara
1
After the fall of the Soviet communist state, documents pertaining to the former regime's biological weapons practices slowly came to light, revealing that McCormick and the CDC were justified in suspecting the intentions of some Soviet Lassa researchers, as well as the efforts of their counterparts working on other infectious diseases. Well after 1972 treaty agreements between the U.S.S.R. and the U.S.A. allegedly suspended all such research and development, the Soviets continued trying to develop weapons based on Legionnaires' Disease, anthrax, bubonic plague, tularemia, Lassa fever, and a variety of other diseases. The effort continued into the 1980s, despite an accidental leakage of anthrax from the government's Sverdlovsk laboratory in 1979, and involved over 25,000 scientists toiling in eighteen laboratories dispersed throughout the U.S.S.R. A summary of the findings revealed in newly released Soviet documents appeared in
Newsweek
, February 1, 1993: 40–41.
2
The biological weapons treaty between the United States and the U.S.S.R. was signed by the two parties on April 10, 1972, in London, ratified by the U.S. Congress on December 16, 1974, and proclaimed as law by President Gerald Ford on March 26, 1975. Formally titled the “Convention on the Prohibition of the Development, Production, and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction,” the treaty had been signed by 125 nations as of January
1993. Article X of the Convention states that all parties to the treaty shall facilitate “the fullest possible exchange of equipment, materials, and scientific and technological information for the use of bacteriological (biological) agents and toxins for peaceful purposes.”
3
Throughout the late 1970s and early 1980s Guido van der Gröen followed the Biological Weapons Convention quite literally, personally working inside the top security laboratories on both sides of the Iron Curtain and freely distributing samples of dangerous viruses—including Ebola and Lassa—to scientists in Moscow, Leningrad, Paris, London, Porton Down, Fort Detrick, Atlanta, and anywhere else he went. The Belgian reasoned that “science knows no politics,” and told curious intelligence officers from the CIA, Sûreté, Interpol, KGB, and MI5 who repeatedly grilled him that, as a scientist, he simply refused to acknowledge the Cold War.
4
J. B. McCormick,
Lassa Fever Update,
SME/80.5 (Geneva: World Health Organization, 1980).
5
“For a three-year study in Sierra Leone, it became evident that in many villages a substantial portion of the population was infected with Lassa during their lifetime, beginning at a young age. It appears that people in many of these villages live surrounded by virus-infected rodents which are excreting large amounts of virus in the houses both day and night, since many of the houses are closed during the day, creating a nearly twenty-four-hour nocturnal environment. This allows rodents to move around depositing urine at will in many places such as beds, floors, food supplies, etc. Transmission to humans did occur throughout the year. There is a general correlation between antibody prevalence in humans and percent of
Mastomys
found in the village and the proportion excreting virus. Infection may be frequent in both susceptible persons as well as persons with antibody titers who appeared to be boosted by these infections. Human-to-human infection also occurs and some evidence suggests that it may constitute an important source of human cases.” G. van der Gröen and J. B. McCormick,
Expert Committee on Viral Haemorrhagic Fevers, Agenda Item 2.3,
VIR/VHF/EC/84.13 (Geneva: World Health Organization, 1984).
6
D. Grigg,
The World Food Problem
(Oxford, Eng.: Basil Blackwell, 1985).
7
T. McKeown,
The Origins of Human Disease
(Oxford, Eng: Basil Blackwell, 1988).
8
F. Moore Lappe and J. Collins,
World Hunger
:
Ten Myths
(4th ed.; San Francisco: Institute for Food and Development Policy, 1979).
9
In the spring of 1993 the Russian government confirmed that nearly all Soviet heath statistics released during the communist era, and possibly during the prior czarist regime, were “artificially generated.” No data could be considered reliable if released before December 1992, according to the Yeltsin government.
10
World Bank,
Annual Report
(Washington, D.C., 1978).
11
World Bank,
World Development Report
(Washington, D.C., 1978).
12
“Carter en Route to Africa,”
Africa,
December 1977.
13
J. J. Gilligan, “America's Stake in the Developing World,”
U.S. Department of State Bulletin
77 (1977): 687–91.
14
World Bank,
Health Sector Policy Paper
(Washington, D.C., 1980).
15
Ibid.
16
Among the key water-related diseases are:
Disease
Pathogen (vector)
Amoebic dysentery
protozoa
Ascariasis
helminth
Bacillary dysentery
bacteria
Cholera
bacteria
Clonorchiasis
helminth (snail, fish)
Diarrheal disease
miscellaneous
Diphyllobothriasis
helminth (copepod, fish)
Dracunculiasis
helminth
Enteroviruses
virus
Fasciolopsiasis
helminth (snail, plant)
Gastroenteritis
miscellaneous
Infectious hepatitis
virus
Leptospirosis
spirochete
Paragonimiasis
helminth (snail, crab)
Paratyphoid
bacteria
Schistosomiasis
helminth (snail)
Typhoid
bacteria
In addition, several disease insect vectors thrive in conditions of ample fresh water, including:
Dengue (all types)
virus (mosquito)
Filariasis
helminth (mosquito)
Malaria
protozoa (mosquito)
Onchocerciasis
helminth (blackfly)
Rift Valley fever
virus (mosquito)
Trypanosomiasis
protozoa (tsetse fly)
Yellow fever
virus (mosquito)
Adapted from R. Feachem, M. McGarry, and D. Mara, eds.,
Water, Wastes, and Health in Hot Climates
(London: John Wiley & Sons, 1977); and A. Dievler and M. R. Reich, “The Aswan High Dam,” distributed by the Pew Curriculum for Health Policy and Management, Harvard School of Public Health, Boston, 1984.
17
World Bank,
Health Sector Policy Paper
(1980), op. cit., 13.
18
Dievler and Reich (1984), op. cit.; A. B. Mobarak, “The Schistosomiasis Problem in Egypt,”
American Journal of Tropical Medicine and Hygiene
31: (1982): 87–91; and WHO Expert Committee,
The Control of Schistosomiasis,
Technical Report Series 728 (Geneva: World Health Organization, 1985).
19
Mobarak (1982), op. cit.
20
R. Daubney, J. R. Hudson, and P. C. Gamham, “Enzootic Hepatitis of Rift Valley Fever: An Undescribed Virus Disease of Sheep, Cattle and Man from East Africa,”
Journal of Pathology and Bacteriology
31 (1931): 546–79.
21
F. Fenner, B. R. McAuslan, C. A. Mims, et al.,
The Biology of Animal Viruses
(New York: Academic Press, 1974), 636.
22
Mims, C. A. “Rift Valley Fever in Mice. VI. Histological Changes in the Liver in Relation to Virus Multiplication.”
Australian Journal of Experimental Biology and Medical Science
35 (1957): 595.
23
J. M. Meegan, “Rift Valley Fever in Egypt: An Overview of the Epizootic in 1977 and 1978,”
Controversies in Epidemiology and Biostatistics
3 (1978): 100–13.
24
A. Jouan, I. Coulibaly, F. Adam, et al., “Analytical Study of a Rift Valley Fever Epidemic,”
Research Virology
140 (1989): 175–86; J. Morvan, J. F. Saluzzo, D. Fontenille, et al., “Rift Valley Fever on the East Coast of Madagascar,”
Research Virology
142 (1991): 475–82; A. Jouan, F. Adam, D. Riou, et al., “Evaluation of the Indicators of Health in the Area of Trarza During the Epidemic of Rift Valley Fever in 1987,”
Bulletin de la Société de Pathologie Exotique et de ses Filiales
83 (1990): 621–27; and, R. E. Shope and A. S. Evans, “Assessing Geographic and Transport Factors, and Recognition of New Viruses,” in S. S. Morse, ed.,
Emerging Viruses
(Oxford, Eng.: Oxford University Press, 1993), 114.
25
World Bank,
Health Sector Policy Paper
(1980), op. cit., 14.
26
Ibid., 35.
27
Data obtained from ibid., 68–85.
28
J. Nyerere,
Arusha Declaration Ten Years After
(Dar es Salaam: Oxford University Press, 1977).
29
“In Tanzania, the Road to Medicine Is Paved with Magic,”
Hospital Practice,
April 1974: 133–57.
30
The world has experienced eight pandemic waves of cholera since 1837. The seventh pandemic began in Indonesia in 1961 and spread slowly around most of the world's poor nations. The eighth pandemic began in Madras, India, in December 1992.
31
“East Africa,”
Africa,
June 1979.
32
M. Honey, “How Amin Ran His Economy,”
African Business
, July 1979.
33
F. J. Bennett, “A Comparison of Community Health in Uganda with Its Two East African Neighbors in the Period 1970–1979,” in C. P. Dodge and P. D. Wiebe, eds.,
Crisis in Uganda
(Oxford, Eng.: Pergamon Press, 1985), 43–52.
34
F. Rodhain, J. P. Gonzalez, E. Mercier, et al., “Arbovirus Infections and Viral Haemorrhagic Fevers in Uganda: A Serological Survey in Karamoja District, 1984,”
Transactions of the Royal Society of Tropical Medicine and Hygiene
83 (1989): 851–54.
35
A. Enns, “The Clocks Have Stopped in Uganda,” in Dodge and Wiebe (1985), op. cit., 53–54.
36
“WHO: How It Is Making Public Health a Global Cause,”
Hospital Practice
, September 12, 1973: 205–18.
37
In the 1990s, it would become the capital of the nation of Kazakhstan.
38
G.A. res. 2200A (XXI), and 999 U.N.T.S. 171, March 23, 1976.
39
G.A. res. 2200A (XXI), 993 U.N.T.S. 3, entered into force January 3, 1976.
40
W. H. McNeill,
Plagues and Peoples
(New York: Doubleday, 1976).
41
Recently, McNeill described the microbial decimation of the Amerindians in greater detail, citing it as the key factor responsible for stimulating his initial interest in historic epidemics. Cortez, McNeill wrote, had fewer than 400 soldiers at his disposal when he laid siege to Tenochtitlán (Mexico City), yet they strolled right into the Aztec capital, taking power almost effortlessly. McNeill believes the smallpox devastation of the Aztecs, coupled with a variety of other European microbes, was so overwhelming that the Aztec people surrendered, having decided that their gods had sided with the white-skinned invaders. See W. H. McNeill, “Patterns of Disease Emergence in History,” Chapter 3 in Morse (1993) op. cit.
42
For a collection of representative views, see D. Brothwell and A. T. Sandison, eds.,
Diseases in Antiquity
:
A Survey of the Diseases, Inquiries and Surgery of Early Populations
(Springfield, IL: Charles C Thomas, 1967).
43
M. Burnet and D. O. White,
Natural History of Infectious Disease
(4th ed.; Cambridge, Eng.: Cambridge University Press, 1972).
44
R. Dubos and J. Dubos,
The White Plague: Tuberculosis, Man and Society
(New Brunswick, NJ: Rutgers University Press, 1992), 207.
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