5 Questions With . . . William Johnston on the History of Disease

This issue, we ask “5 Questions” of  William Johnston, professor of history, professor of science in society, professor of East Asian Studies. One of his areas of specialty is the history of disease and epidemics.

Q: How did you become interested in the history of diseases, and more specifically, flu outbreaks?

A: While in graduate school I examined a number of different fields of history, but was drawn to the history of medicine in Japan because it was in that field that the Japanese first absorbed European scientific ideas and methods.  My advisor suggested that I take courses in the History of Science Department, and one course I took was a history of tuberculosis in the Untied States.  It was an eye-opener because it made me realize the ways in which societies interpret and respond to disease tells us a lot about their most basic values and fundamental structures. Sometimes people get very excited about relatively minor diseases while accepting major causes of illness and death as somehow “normal.”

Q: What are among the more notable outbreaks over the last, say, 100 or so years?

A: The most important outbreak of flu in the past century was, of course, the one that occurred between 1917 and 1920. For that matter it was one of the deadliest pandemics of all time, killing about 2.5 percent of all infected, with a total mortality estimated between 20 and 50 million worldwide. Some estimates go even higher. It possibly was a swine flu, although it could have been an avian strain that infected swine and then mutated to infect people; its exact origins remain obscure but it was a variant of the H1N1 strain. It caused pneumonia as the result of a cytokine storm–an over-reaction of the immune system, thus affecting younger people more than the elderly. The other notable outbreaks are relatively minor: the Asian flu of 1957-58 and the Hong Kong flu of 1968-69 stand out. People have been getting excited about the H5N1 and H1N1 strains that have been in circulation since 2009, but neither has become pandemic.

Q: What are some of the more intriguing facts about the effect of these outbreaks that perhaps the general public doesn’t hear of?

A: All of these have resulted in major changes to public health administration and the monitoring of diseases. For example, the 1917-20 pandemic resulted in the imposition of stringent measures requiring isolation and the monitoring of cases that helped stop what could have become a pandemic in 1937. An outbreak in England was stopped in this way. Influenza was important in the development of virology as a science. All of these are the result of government efforts aimed at doing the most good for the most people. When politicians talk about cutting basic science research and public health measures in the name of “small government,” they are in effect saying that it is okay if governments don’t do the most they can to prevent pandemics–which is to say lots of illness and death.

In that respect, one of the most intriguing facts of recent times has been the military’s development of what it calls the “Joint Project Manager Transformational Medical Technologies.” According to its web site, it was “pioneered by The Department of Defense (DoD) in 2006 to better prepare and protect the warfighter and the nation from emerging, genetically engineered, and unknown biothreat agents.” By a Presidential Directive, this has established a program to “protect the health of the American people against all disasters.”  While a lot of the work done under this has been with terrorism in mind, it also created a two-tiered response to future influenza pandemics. On the one hand, it has begun developing new methods of creating a vaccination against the flu through genetic engineering of tobacco plants. On the other hand, it has also started the development of anti-retrovirals aimed at stopping the replication of viral RNA through the use of what is called “antisense.” By doing this kind of public health work through the Defense Department, it has become possible to develop new and effective technologies with which to respond to influenza pandemics without facing the threat of politicians cutting funding.

Q: Last year H1N1 (“Swine Flu”) caused some significant problems world wide, yet this year there is no analogous outbreak. Is there a reason for this, or did the human population just get lucky this flu season?

A: Just lucky. Pandemics will happen, no matter what. It is sort of like earthquake prediction. We know a big earthquake will hit the Tokyo area; it could be tomorrow and it could be after a decade or more. It isn’t like climate change, in which decreased carbon emissions could potentially decrease the effects of global warming. Rather it is a matter of preparation, with everything from vaccinations to planned measures for how to react.  Wesleyan, for example, should have in place a set procedure regarding what to do in event of an influenza pandemic hitting the community.

Q: Given the historical record of flu and other major outbreaks, what do you see looking forward into the next decade or so with regards to these types of events?

A: Hard to say. The budget cutting trends worldwide could easily mean less preparedness for the next pandemic or epidemic of other kind of disease. We should be teaching children in primary schools through high schools the basics of epidemic disease and public health. It would go a long way in providing support for the kinds of measures that will do the most good for the largest number of people.