The Coming Plague (145 page)

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Authors: Laurie Garrett

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130
P. E. M. Fine, “Herd Immunity: History, Theory, Practice,”
Epidemiologic Reviews
15 (1993): 265–302.
131
F. L. Black, “Why Did They Die?”
Science
258 (1992): 1739–40; and F. L. Black, “An Explanation of High Death Rates Among New World Peoples When in Contact with Old World Diseases,”
Perspectives in Biology and Medicine
37 (1994): 292–307.
132
Michel Garenne and Peter Aaby calculated, on the basis of more than 1,000 measles cases, that the first child had a chance of 1.0 of dying of the disease; the second sibling/cousin's chance of dying jumped to 1.9; the third's was 2.3; the fourth had a 3.8 chance of dying. See P. Aaby, J. Bukh, I. M. Lisse, and A. J. Smits, “Measles Mortality, State of Nutrition, and Family Structure: A Community Study from Guinea-Bissau,”
Journal of Infectious Diseases
147 (1983): 693–701; and M. Garenne and P. Aaby, “Pattern of Exposure and Measles Mortality in Senegal,”
Journal of Infectious Diseases
161 (1990): 1088–94.
133
A. Mitchison, “Will We Survive?”
Scientific American
, September 1993: 136–44.
134
C. R. Whitney, “Western Europe's Dreams Turning to Nightmares,”
New York Times
, August 8, 1993: Al; and M. Simons, “France Finds Room in Its Heart for the Homeless,”
New York Times
, December 9, 1993: A4.
135
M. J. Toole and R. J. Waldman, “An Analysis of Mortality Trends Among Refugee Populations in Somalia, Sudan, and Thailand,”
Bulletin of the World Health Organization
66 (1988): 237–41; M. J. Toole, S. Galson, and W. Brady, “Are War and Public Health Compatible?”
Lancet
341 (1993): 1193–96; R. Yip and T. W. Sharp, “Active Malnutrition and Childhood Mortality Related to Diarrhea: Lessons from the 1991 Kurdish Refugee Crisis,”
Journal of the American Medical Association
270 (1993): 587–90; Centers for Disease Control, “Status of Public Health—Bosnia and Herzogovinia, August-September 1993,”
Morbidity and Mortality Weekly Report
42 (1993): 973–82; Centers for Disease Control, “Mortality Among Newly Arrived Mozambican Refugees—Zimbabwe and Malawi, 1992,”
Morbidity and Mortality Weekly Report
42 (1993): 468–77; and C. J. Elias, B. H. Alexander, and T. Sokly, “Infectious Disease Control in a Long-Term Refugee Camp: The Role of Epidemiologic Surveillance and Investigation,”
American Journal of Public Health
80 (1990): 824–28.
136
R. W. Kates, “Ending Deaths from Famine,”
New England Journal of Medicine
328 (1993): 1055–57; G. G. Graham, “Starvation in the Modern World,”
New England Journal of Medicine
328 (1993): 1058–60; and G. Heppner, A. J. Magill, R. A. Gasser, et al., “The Threat of Infectious Diseases in Somalia,”
New England Journal of Medicine
328 (1993): 1061–68.
17. Searching for Solutions
1
The five-hour scenario was played out at the American Society of Tropical Medicine and Hygiene, Honolulu, December 11, 1989. See L. Garrett, “Medical War Game,”
New York Newsday, Discovery
section, January 23, 1990: 1, 5, 8–9.
2
A few months after Bernard Mandrella's celebrated Lassa case, a Scottish missionary in Zonkwa, Nigeria, contracted the disease. Nobody told him that antiserum was available in nearby Jos. Instead,
the Scotsman flew a commercial airline to England in search of a cure, causing panic throughout Europe, and dying on English soil. In February 1976 an American Peace Corps volunteer left Sierra Leone because she was sick. The forty-two-year-old woman traveled to England, spent four hours in London's crowded Heathrow Airport, and went on to Washington, D.C., where she stayed in a popular hotel. Throughout the journey, the Peace Corps volunteer unknowingly respired Lassa virus around 522 strangers. Her diagnosis was only reached afterward, when virus was recovered from her urine. See J. A. Bryan and R. M. Zweighaft, “Surveillance and Transport of Patients with Suspect Viral Hemorrhagic Fevers: The United States Experience,” in
Ebola Virus Haemorrhagic Fever
(New York: Elsevier, 1978), 415–25.
By mutual agreement, the U.S. government took responsibility for all the Peace Corps volunteer's contacts during her transatlantic flight and time in Washington, while the British government carried the onus of investigating all her co-passengers aboard the British Airways flight from Sierra Leone and during her layover at Heathrow. At extraordinary expense, the CDC, District of Columbia authorities, and health agencies in twenty-one states tracked down 505 of the Lassa victim's co-passengers, fellow Washington hotel guests, and assorted other individuals with whom she had contact: none tested positive for Lassa infection.
Similarly, the U.K. government issued press releases to airline passengers, tracking down 41 British Airways passengers who had remained in the U.K. and 54 who had traveled on to other countries. Again, none tested Lassa-positive. See Centers for Disease Control, “Possible Lassa Fever—Washington, D.C.,”
Morbidity and Mortality Weekly Report
25 (1976): 64; Centers for Disease Control, “Follow-up on Lassa Fever—Washington, D.C.,”
Morbidity and Mortality Weekly Report
25 (1976): 68; and Centers for Disease Control, “Follow-up on Lassa Fever—Washington, D.C.,”
Morbidity and Mortality Weekly Report
25 (1976): 83.
The cost in work-hours and expenses for these two enormous manhunts has never been published.
3
A good deal has been written about the Reston outbreak. See P. B. Jahrling, T. W. Geisberg, D. W. Dalgard, et al., “Preliminary Report: Isolation of Ebola Virus from Monkeys Imported to USA,” Lancet 335 (1990): 502–5; M. Sun, “Imported Monkey Puzzle,”
Science
247 (1990): 1538; L. Garrett, “Luck in a Virus Outbreak,”
Newsday, Discovery
section, January 23, 1990: 9; J. Palca, “Import Rules Threaten Research on Primates,”
Science
248 (1990): 1071–73; R. Preston, “Crisis in the Hot Zone,”
New Yorker
, October 1992: 58–81; and T. J. Moore, “A Virus Emerges,” in
Lifespan
(New York: Simon & Schuster, 1993), chapter 6.
4
Similar outbreaks would subsequently be reported in a number of facilities around the world, including Sandoz laboratories in Italy, where the monkey tissue was used for development of polio vaccines. See World Health Organization, “Viral Haemorrhagic Fever in Imported Monkeys,”
Weekly Epidemiology Report
67 (1992): 142–43.
5
W. L. Roper, “Dear Importer,” letter to all private importers, March 15, 1990, U.S. Department of Health and Human Services, CDC, Atlanta, GA.
6
Centers for Disease Control, “Update: Filovirus Infection in Animal Handlers,”
Morbidity and Mortality Weekly Report
39 (1990): 221; and Centers for Disease Control, “Update: Ebola-Related Filovirus Infection in Nonhuman Primates and Interim Guidelines for Handling Nonhuman Primates During Transit and Quarantine,”
Morbidity and Mortality Weekly Report
39 (1990): 22–24, 29–30.
The CDC later reported that one of its employees—an animal caretaker—also tested antibody-positive for Reston virus exposure. See Centers for Disease Control. “Update: Evidence of Filovirus Infection in an Animal Caretaker in a Research/Service Facility,”
Morbidity and Mortality Meekly Report
39 (1990): 296–97.
7
A. Sánchez, M. P. Kiley, B. P. Holloway, et al., “The Nucleoprotein Gene of Ebola Virus: Cloning, Sequencing, and
in vitro
Expression,”
Virology
170 (1989): 81–91.
8
D. Axelrod,
Department of Health News
, Albany, NY, March 21, 1990; and
Order for Summary Action, State of New York Department of Health, In the Matter of Filovirus Infections in Monkeys,
Albany, March 21, 1990.
9
Physicians Committee for Responsible Medicine, “Nation-wide Ban Sought for Public Health Reasons,” Washington, D.C., March 22, 1990; and American Society for the Prevention of Cruelty to Animals, “ASPCA President Assails CDC's Failure to Impose Immediate Ban on Monkey Imports,” Press Release, March 23, 1990.
10
L. Garrett, “Monkey-Import Plans Challenged,” Newsday, March 24, 1990: 4.
11
Centers for Disease Control, “Update: Filovirus Infection Associated with Contact with Non-human Primates or Their Tissues,”
Morbidity and Mortality Weekly Report
39 (1990): 404–5.
12
S. P. Fisher-Hoch, G. F. Pérez-Ornonoz, E. L. Jackson, et al., “Filovirus Clearance in Non-Human Primates,” Lancet 340 (1992): 451–54.
13
S. P. Fisher-Hoch, T. L. Brammer, S. G. Trappier, et al., “Pathogenic Potential of Filoviruses:
Role of Geographic Origin of Primate Host and Virus Strain,”
Journal of Infectious Diseases
166 (1992): 753–63.
14
Institute of Medicine,
The U.S. Capacity to Address Tropical Infectious Disease Problems
(Washington, D.C.: National Academy Press, 1987); Institute of Medicine,
The Future of Public Health
(Washington, D.C.: National Academy Press, 1988); Institute of Medicine,
Emerging Infections: Microbial Threats to Health in the United States
(Washington, D.C.: National Academy Press, 1992); National Institute of Allergy and Infectious Diseases, “Report of the Task Force on Microbiology and Infectious Diseases,” U.S. Department of Health and Human Services, Washington, D.C., 1992; and Centers for Disease Control and Prevention,
Addressing Emerging Infectious Disease Threats
:
A Prevention Strategy for the United States
(Atlanta, GA: U.S. Department of Health and Human Services, 1994).
15
Division of Communicable Diseases,
Global Surveillance Programme for Recognition and Response to Emerging Diseases, 1994–1995
(Geneva: World Health Organization, 1994); and Conference on Global Monitoring and Response for Emerging Infectious Diseases, Co-sponsored by the Federation of American Scientists and World Health Organization, Geneva, September 11–12, 1993.
16
Classically microbial biology, as a discipline, referred to the study of microbes that grew in unusual settings and affected their physical surroundings. Organisms, for example, that thrived inside highly sulfurous hot springs contributed to the erosion of rocks. What was new was the application of ecological principles to the study of pathogenic microbes.
17
Program for Monitoring Emerging Diseases.
18
Morse has written extensively on both the need for, and likely outlines of, emerging disease surveillance. See, for example, S. S. Morse, “Global Microbial Traffic and the Interchange of Disease,”
American Journal of Public Health
82 (1992): 1326–27; S. S. Morse, ed.,
Emerging Viruses
(Oxford, Eng.: Oxford University Press, 1993); and S. S. Morse, “Regulating Viral Traffic,”
Issues in Science and Technology
(Fall 1990): 81–84.
19
C. Piller and K. R. Yamamoto,
Gene Wars: Military Control over the New Genetic Technologies
(New York: Beech Tree Books, 1988).
20
R. W. Titball and G. S. Pearson, “BWC Verification Measures: Technologies for the Identification of Biological Warfare Agents,”
Politics and Life Sciences
, August 1993: 255–63; B. H. Rosenberg, “North vs. South: Politics and the Biological Weapons Convention,”
Politics and Life Sciences,
February 1993: 69–77; and L. A. Cole, “The Worry: Germ Warfare. The Target: Us,”
New York Times
, January 25, 1994: A19.
There was ample evidence of past interest in biological weapons, particularly in Lassa. “The U.S. Central Intelligence Agency (CIA) was very interested, apparently as a part of its general intelligence gathering mission,” Frame writes. [See J. D. Frame,
“The Story of Lassa Fever Part IV: The Politics of Research,” New York State Journal of Medicine
, 93:35–40 (1992). “A CIA representative visited me twice, first to discuss what the outbreaks in Nigeria might mean in terms of infectious disease in West Africa, and later, whether my finding of LV infections in missionaries in Ivory Coast, Mali, and Burkina Faso indicated the spread of the disease up the Niger River.” (The Niger River flows through Liberia, Guinea, Mali, Niger, and Nigeria.)
Over the years, Johnson, Casals, McCormick, and Frame were all questioned by CIA representatives regarding Lassa and the other hemorrhagic diseases. Other scientists may have been similarly grilled, though it has not been possible to systematically survey researchers on the matter. CDC director David Sencer told the CIA that no scientist in his agency could be questioned without requests first to his office. Furthermore, he insisted that all CDC personnel had the right to refuse such interrogations. No public records were ever kept of CIA inquiries to CDC personnel, nor is there clear indication of what inspired such interest in the intelligence community. Sencer was adamant in telling CIA investigators that Lassa and other hemorrhagic viruses would make poor biological weapons, as they did not spread through casual contact. Nevertheless, the U.S. military's Medical Research Development Command (USAMRDC) had an active hemorrhagic virus research effort throughout the 1970s and 1980s.
The Soviets were also keenly interested in Lassa and other hemorrhagic viruses. By the mid-1970s, Soviet scientists were openly competing with Frame and Johnson's efforts in Liberia. It is assumed they were debriefed by the KGB.
21
Formally titled “Convention on the Prohibition of the Development, Production, and Stockpiling of Bacteriological (Biological) and Toxin Weapons and Their Destruction,” entered into force March 26, 1975.
22
D. A. Henderson, “Surveillance Systems and Intergovernmental Cooperation,” Chapter 27 in Morse, ed. (1993), op. cit.
23
“Vigilance Against New Virus Disease Is Urged,”
Hospital Practice
, April 1977: 35–36.
24
F. A. Murphy, “New Emerging and Reemerging Infectious Diseases,”
Advances in Virus Research
43 (1994): 1–52.
25
M. L. Zoler, “Emerging Viruses,”
Medical World News
, June 26, 1989: 36–42; and Morse (1992), op. cit.
26
Institute of Medicine,
Emerging Infections
(1992), op. cit.
27
Centers for Disease Control, “Update: Surveillance of Outbreaks—United States, 1990,”
Morbidity and Mortality Weekly Report
40 (1991): 173–75.
28
R. L. Berkelman, R. T. Bryan, M. T. Osterholm, et al., “Infectious Disease Surveillance: A Crumbling Foundation,”
Science
254 (1994): 368–70.
29
Such private labs had proven scandalous in many states. In New York City, for example, private labs failed to inform hundreds of women that their Pap smears were precancerous, possibly contributing to many deaths. In several states private labs routinely falsely reported negative results on sexually transmitted disease tests—tests that they never even bothered to perform.
30
Division of Communicable Diseases,
Global Surveillance Programme
(1994), op. cit.
31
L. Garrett, “Crusade on New Disease Sought,”
New York Newsday,
April 21, 1994: A21.
32
Global development policies were also held responsible in more direct fashion for disease emergence and spread. For analysis of IMF, World Bank, and other donor policies and their impact on disease, see D. E. Cooper Weil, A. P. Alicbusan, J. F. Wilson, et al.,
The Impact of Development Policies on Health
(Geneva: World Health Organization, 1990).

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