This book examines major threats from disease to the people of the USA, and the ways in which American presidents have responded to such threats. It will look critically at two presidents who had direct roles to play in pandemics, Woodrow Wilson and Dwight Eisenhower. It will look most extensively at another who faced what appeared as though it might develop into a horrendous pandemic, but did not materialize. That president was Gerald Ford, whose National Influenza Immunization Program (NIIP) sought to vaccinate all Americans against a swine flu virus that many experts thought was impending. Without a pandemic to fight, his program was derided as a fiasco. Officials from the incoming Carter administration were triumphantly scornful of the defeated President Ford, and their scorn was exceeded by that from the forces of Ronald Reagan, who had sought to seize the nomination from the sitting president of their own party, but had failed to do so, and thus seethed with disdain for Ford’s policies. This study will offer a rather favorable assessment of President Ford’s program, one that is rare for reasons that it will make clear. It will consider the health policies of Presidents Clinton and Obama favorably, and will give a mixed assessment to the policies of George W. Bush: highly critical for the most part, but surprisingly favorable in others. Above all, it will make the case that guarding against pandemics is and must be an integral part of national security. Despite the book’s title, now and then it will look beyond pandemics when it seems that doing so will help to evaluate presidential actions that would be relevant if the situation involved were a pandemic.
Presidents and Pandemics will argue that we must learn from past experience—mistakes and successes—in preparing for the future, and that future preparation is vital to the maintenance of civilization, here and elsewhere. As critical as terrorism is in the modern world, including bioterrorism, an even greater threat comes from natural causes. It will be necessary to overcome the tendency to respond only to the most dramatic danger—the obscenities, say, of a scowling enemy decapitating a helpless captive, attacking innocent schoolchildren, or snarling evil intent that might take place here—as opposed to preparation also for what assuredly will take place here: ever more virulent pandemics.
An examination of this kind obviously has implications not only for this country but for the rest of the world as well. The role of government will be key to national efforts; presidential understanding, commitment, and action will be prerequisite to effective government. Therefore, presidents are crucial to successful public policies.
At one time, there was little the world’s population could do in the face of pandemics. Modern medicine has given us many tools to employ. The decades since the beginning of the twentieth century have been characterized, time and again, by outbreaks of new and deadly diseases that either are or have the potential to become major threats to humanity. The greatest of these to date was the misnamed “Spanish Flu” of 1918 during World War 1, a swine flu pandemic that, with a death toll of some 675,000 for this country alone, killed more Americans than even the 600,000 of the Civil War, the conflict most lethal to its citizens. Worldwide, as later chapters make clear, the pandemic’s deaths exceeded those of any other cause in world history, upward of 50 million, sparing virtually no part of the planet in which there were human beings. Decades later, pandemics resulted first from Asian flu, and then from Hong Kong flu, each less lethal than its predecessor. Later in the century, despite being far less easy to transmit than influenza, came the march of HIV-AIDS. It was slower than the explosion of influenza, but its many tragic deaths were accompanied by sweeping cultural effects that were as serious as those of the wartime pandemic.
With the twenty-first century came SARS. According to the Centers for Disease Control (CDC), “Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003. The illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003 was contained.” Fortunately, since 2004 there have been no reported cases of SARS anywhere. 1
In June of 2015, according to both official reports and the press, South Korea was facing the largest outbreak of MERS that had ever taken place outside of the Middle East. MERS, says the CDC, is “Middle-East Respiratory Syndrome,” a severe coronavirus infection affecting human beings. The earliest reports described MERS as having been identified in 2012 in Saudi Arabia, but later corrections indicated that there had been a case a few weeks earlier in Jordan. MERS spreads from one person to another “through close contact,” although the exact mechanism of transmission is not clear. It causes fever, coughing, and difficulty breathing. “About 3–4 out of every 10 patients reported with MERS have died.” 2 Citing a report from The World Health Organization (WHO), the Washington Post said that the South Korean government was implementing “strong control measures,” and that the virus—which gave no indication that it was increasing its ability to spread from one person to another—in South Korea had remained completely confined to hospitals and treatment centers. 3
At roughly the same time there was a widespread incidence of bird flu in the USA that was causing a serious egg shortage severely affecting American restaurants. Prices escalated, and in some locations sellers began limiting egg purchases, that is, in effect they were implementing rationing of eggs. 4 USA Today reported that the outbreak was “especially damaging in Iowa, the nation’s largest egg-producing state, with 40% of it egg-laying hens lost to the disease.” 5 Government in the USA seems always to be a prime target for complaint from all segments of the political spectrum, so under the circumstances, it is hardly surprising that there was considerable criticism of the government as having done too little, too late. A spokesman from the Department of Agriculture, John Clifford, “USDA’s chief veterinary officer,” defended the agency before an investigating committee of the US Senate, and said that despite difficulties, the response had been quick and decisive. Also, he said, USDA had learned from the experience, and will be able to respond in ways that will “minimize the effects of this disease going forward.” Iowa’s two conservative Republican senators, Charles Grassley and Jodi Ernst, according to USA Today’s article, “have said the federal government needed to respond more quickly and offer more resources to combat the disease.” 6 This is reasonable, but it seems poorly compatible with the attitudes of “small-government Republicans,” especially those of Senator Ernst, who ran for office condemning dependence upon government.
This illness was not infecting human beings, but influenza affecting human beings has emerged from other animals, and seems most often to have originated among birds. Avian flu, in fact, poses perhaps the most serious potential threat that humanity faces, along with those of climate change and environmental degradation. The New Yorker magazine, among all the publications directed toward the most literate and highly educated segment of the reading public, seems to be most likely to deal with issues of general concern, and to do so in a thoughtful and appropriate manner. In the matter of bird flu, it did so in an article under the rubric of its occasional “Annals of Medicine.” 7
The article began with the death in Hong Kong, on 21 May 1997, of a three-year-old boy from influenza. In itself, that was not unusual, in that influenza viruses “kill hundreds of thousands of people every year. Hong Kong is among the world’s most densely populated cities, and pandemics have a long history of first appearing there or in nearby regions of southern China, and then spreading rapidly around the globe.” 8 What quickly became unusual, though, was the nature of the virus. An “international team of virologists,” after three months of attempts, finally identified it as H5N1, an avian influenza that had killed hundreds of millions of chickens, but had not previously been known to infect a human being, even those who worked with poultry. By the end of the year, eighteen people had contracted the infection, and six had died, a “remarkably high mortality rate.” Hong Kong officials worked speedily, slaughtering all the chickens in the area, and bird flu seemed to have disappeared. Officials involved included those from Hong Kong, the WHO, the CDC in Atlanta, and elsewhere. They could only have felt great relief that a worldwide pandemic had not taken place. Then, the virus appeared once more, this time in Thailand. As of 2012, it was known to have infected 587 people, killing 346 of them. This made “H5N1 one of the deadliest microbes known to medical science.” 9
The core of the piece in The New Yorker was a discussion of the work of a Dutch virologist, Ron Fouchier, who had succeeded in causing mutations in H5N1 that made it extremely easy to transmit, both to mammals and from mammal to mammal. Was the mere existence of this transmittable virus so dangerous to the health of the world that it should never have been created—however stringent the security imposed to keep it well contained in vaults the laboratory? Did its creation enhance potential knowledge of how to combat the virus enough to justify the creation of such a deadly organism? Critics have pointed out that dangerous organisms have escaped from the most secure facilities. Fouchier responds that nature can easily do what he did in his laboratory, and says moreover that it inevitably will do so. He concedes that bioterrorists might find ways to acquire, or create, the organism, but argues that the threat from nature itself is far greater.
Before the reports regarding the outbreak of MERS in South Korea, and bird flu in this country, there had been hysterical hea...