Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused It

  • Gina Kolata
Farrar, Straus & Giroux/Macmillan: 1999/2000. 256/330 pp. $24/£12.99

Gina Kolata's book is not the usual sort of scientific review, even though it is based on wide reading of archival and published material and on many interviews with scientists in the field. Kolata studied microbiology, but has worked mainly as a journalist for The New York Times. As a result, the book, which outlines the science behind the influenza story, can be enjoyed both by general readers and by scientists.

Deadly delivery: the 1918 pandemic struck down the young and fit. The top picture shows lung tissue samples, preserved in paraffin, from victims of the pandemic.

Kolata describes the horrifying scenes of mass deaths that marked the 1918 influenza pandemic, and puzzles over the fact that it was referred to so little subsequently. Probably it was linked in memory with the horrors of the First World War that everyone wanted, and probably needed, to forget.

The epidemic in humans subsided, but it was noticed that outbreaks of a similar disease occurred that autumn in pigs in the American Middle West. Kolata includes agreeable pen portraits of important early figures, such as Richard Shope, who stumbled into growing the swine influenza virus, and she draws on the biography written of him by his friend Christopher Andrewes, who, with his colleagues Wilson Smith and Patrick Laidlaw, first grew a human influenza virus in ferrets in 1933. Kolata gives a realistic description of the world of research — as a series of recurrent bafflements prompting various possible explanations, repeated probing and technical frustrations, then success that is quickly taken for granted — not at all the smooth course from initial question to complete solution that the general reader is fed by some newspapers and TV programmes.

Swine influenza comes into focus again as Kolata describes the 1976 outbreak of flu among young men in New Jersey. Scientific opinion at the time varied as to whether this was the beginning of another pandemic, although privately the chances were thought to be small — but not zero. So the question was, should the nation be vaccinated? This would require a formal report and politics at the highest level. Kolata infers that a consensus was manipulated by the politicians, and that alternative approaches and the possible adverse effects of vaccination were not considered in depth. The new vaccine was needed within months, and the government wanted the manufacturers to go ahead and also to obtain indemnity for possible harmful effects, but on this the insurance companies would not oblige. There was more delay. And then, as was forecast, when thousands of elderly people had been vaccinated, deaths began to occur. The deaths were probably coincidental, but the newspapers started to produce “body counts” that were no doubt good for headlines but bad for public collaboration. Although vaccination appeared to cause Guillain–Barré syndrome, Kolata suggests that the evidence for this was flawed and describes the problems of assessing complex scientific evidence in the law courts. The situation illustrates the difficulties of assessing risk when the facts are being debated by the public, attention-grabbing journalists, scientists, government and lawyers — Britain has had its share of this with BSE recently. It is a timely reminder of the need to develop an agreed ‘framework of discourse’, because something analogous to this will certainly arise again in the future.

Most enjoyable in the book is Kolata's description of the recent success of Jeffrey Taubenberger and his team in recovering and sequencing virus genomic material from fixed and embedded lung tissue taken from soldiers who had died in the 1918 pandemic. The tissue had been stored in the Walter Reed archive. The study originated in lateral thinking (the chapter is called “John Dalton's eyeballs”), since the team's main job was to develop improved molecular-based diagnostic methods for general use.

The story intertwines with that of another fascinating personal odyssey. In 1949, Johan Hultin was a young Swedish student who, with his wife, came to the United States. On his way to a studentship in Iowa, he visited Alaska and met a palaeontologist there. Later, he returned to Alaska to look for influenza virus in the bodies of victims of the 1918 pandemic buried in the permafrost. His expert local knowledge and good relations with the local people meant that he was able to visit suitable graves and obtain appropriate material. He failed, however, to recover the virus in the laboratory.

Hultin went on to become a successful pathologist and, in due course, retired. But he subsequently read about Taubenberger's new identification techniques, and within days was on his way back to Alaska, at his own expense. In spite of the further lapse of time since his last attempt, Hultin obtained lung tissue from the frozen bodies, from which Taubenberger identified the influenza virus genome.

Kolata also describes a large and expensive international collaboration, which was given heavy television coverage, to try to recover viral material from similar graves in Norway. It seems to have been unsuccessful and it is clear which enterprise the author prefers.

Finally, Kolata brings us up to 1998, when a chicken virus of type H5N1 was recovered from human influenza patients in Hong Kong. The type had never been recovered from man before and thus was a potential pandemic strain. It turned out that there was an epidemic of the virus in the poultry markets in Hong Kong, fuelled by a constant influx of healthy birds from mainland China. The virus did not become established in humans and the outbreak was eliminated by slaughtering all the poultry in the territory. Possibly this action saved the world from another pandemic. But of course, successful public-health management, even on a world scale, gets little notice and less praise.

All in all, the book is a good read, but my advice would be to get a good textbook on influenza as well if you want the full picture.