Managing Flu

The hyperbolic response to the recent bout with swine flu reveals how much our antiquated public health policy motivates fear. Neither the number of deaths attributed to the H1N1 virus nor the geographic distribution of cases makes this a worrisome epidemic. But with flu policy guided by a horror vision of a return of the "Spanish flu," which caused tens of millions of deaths worldwide in 1918, even the present mild outbreak looks like a fearsome challenge.

Despite a wealth of knowledge not available in 1918, we still deal with each new outbreak of flu as if the virus were an invading army and the US population its target. We meet each year's flu with immunization, "stockpiles" of Tamiflu and a command and control center at the CDC. A few programs normally held in reserve, like school closings and airport screenings, are brought up to the front lines when we're feeling particularly menaced. Each year, we win a Pyrrhic victory--there are piles of casualties on our side, but the enemy deserts the field. Then, when flu returns the following year, we do the same thing all over again.

The traditional armamentarium works against flu only in the limited sense of reducing casualties in developed countries. It doesn't work if we recognize that our policy of arming ourselves against communicable diseases allows us to ignore them when they devastate the world's poor. It doesn't work if we consider the costs to poor farmers' economic welfare and physical health when flocks or herds are slaughtered to protect rich-country livestock from flu. And it fails utterly if we count the long-term costs of letting flu viruses infest herds and flocks, recombine and start the cycle again.

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