global health

The 1918 Flu Pandemic

“Virus” by ddpavumba at freedigitalphotos.net

The 1918 influenza pandemic was the disease outbreak that took the greatest toll in the twentieth century. Globally, perhaps between fifty and a hundred million people died. There are a wealth of wonderful books on the topic. I particularly recommend both Alfred Crosby, America’s Forgotten Pandemic and John Barry, The Great Influenza. Eileen Pettigrew’s Silent Enemy is an excellent popular account of Canada’s experience of the pandemic.

Years ago I was visiting a graveyard in Portland, Oregon. There were three graves next to each other, a man, a woman, and a child, who had all died within a few days of each other in November, 1918, almost certainly from the flu. It’s hard to imagine now what that lived experience must have been like. So many families have stories of ancestors who fought in World War One and survived, only to die on their way home.

My own grandfather was traveling in the Peace River country of northern Alberta at the time. He had decided that he was bored on the farm in southern Ontario. He and a friend had set out on an adventure to travel to the Yukon. Then his friend came down with the flu that fall in 1918. Although they never did make it to the Yukon, my grandfather helped to get his friend Frank home, where -as far as I know- he had a long and happy life. Of course, this was only one insignificant moment in the global disaster that impacted families from India to Australia, and took tens of millions of lives.

There is a fascinating new podcast series on this outbreak, which is well-researched and thoughtfully presented: Going Viral: the Mother of All Pandemics. The presenters have deep historical knowledge, and have invested an immense amount of time in preparing this engaging work. I enjoyed their trip to the former battlefields of France to try to track down the pandemic’s origin with Dr. John Oxford. One would think that there wasn’t much new left to say on this topic. Yet in their search for the true origins of the pandemic they look at provocative thinking and current debates, such as Mark Osborne Humphries’ idea that perhaps the pandemic actually began in China. They are also engaging speakers; one can imagine listening to them as a student, and being captured by their lecture style. You can find the podcast on iTunes and similar venues. Given the proliferation of H7N9, the diversification of influenza clades, and the fact that we still don’t have a universal influenza vaccine, this history remains sadly relevant. Highly Recommended. If you are interested to learn about more recent debates, you can also read my own work on influenza and pre-pandemic vaccines as well as conspiracy theories. Both of these articles are publicly available for free. You can also find more freely available articles on influenza here.

Shawn Smallman, 2018.

 

Fighting Conspiracy Theories

“Witness Howard Brennan sitting in the identical spot across from the Texas School Book Depository four months after the assassination. Circle “A” indicates where he saw Oswald fire a rifle at the motorcade.” By Howard Leslie Brennan [Public domain], via Wikimedia Commons. Caption text from Wikimedia Commons also.
Apart from Murray in Stranger Things, and the Lone Gunmen in the X-files, most conspiracy theorists don’t have secret knowledge that the majority of humanity is unable to accept. Instead, people turn to conspiracy theories when they feel disempowered and desperate. Conspiracy theories thrive during times of crisis, such as a pandemic, or a profound political crisis. They also emerge at times when trust in government is low. I’ve done work (with my wonderful colleague Leopoldo Rodriguez) on a conspiracy theory in Argentina that focused on the death of government prosecutor Alberto Nisman. In the Argentine case, these conspiracy theories absorbed the news and attention of an entire nation. But during the 2009 influenza pandemic, conspiracy theories became truly global, as people told these narratives from Mexico to Europe. I studied this phenomenon in an article that is open access:

Shawn Smallman, “Whom Do You Trust? Doubt and Conspiracy Theories in the 2009 Influenza Pandemic” Journal of International and Global Studies, Vol. 6, No. 2: pp. 1-24. While its helpful to document instances of conspiracy theories, it’s more important to understand how to combat them when they can cause damage, particularly in the field of global health. How do health authorities fight conspiracy theories about vaccination, which are not only making it more difficult to eradicate polio, but also costing health workers their lives?

Book Review of Diniz’s Zika

Diniz, D., & Grosklaus Whitty, Diane R. (2017). Zika : From the Brazilian backlands to global threat. London: Zed Books.

This brief book is built upon extensive ethnographic fieldwork with mothers, doctors and scientists during Brazil’s Zika outbreak. The translation from Portuguese by Diane Grosklaus Whitty is masterful. Translation is always hard, and I have read too many books by Brazilian authors that suffered from overly formal wording, or endless run-on sentences. On a very small scale I understand this challenge from translating quotes in my first two books, for which I could easily spend an hour for a single statement. Of course, a developed narrative -with multiple voices-  is an exceptional challenge.  Diniz was very fortunate with her or the press’s choice for a translator. The prose is clear, energetic and yet still carries the feel and beauty of Portuguese. …

Conspiracy Theories and Zika

Conspiracy theories have long fascinated me. I’ve published (with my colleague Leopoldo Rodriguez) on the death of Alberto Nisman in Argentina, and the conspiracy theories that tragedy spawned. I’ve also written about the conspiracy theories that circulated regarding the 2009 H1N1 influenza epidemic. More recently, I’ve been doing research on the Zika epidemic. I’ve just published an article, “Conspiracy Theories and the Zika epidemic,” which you can view in the open-access Journal of International and Global Studies. …

Canadian doctors

In case you have ever wondered if Canada’s culture is truly different, you might want to read Amy Wang’s article in the Washington Post, “Hundreds of Canadian doctors demand lower salaries.” While most people who read the article comment on the fact that Canadian doctors are willing to give up part of their salaries to help others, I think that the picture it paints of an overstrained health care system is equally important. Free health care is a core Canadian value, but it’s also important to receive that care in a timely fashion, from caregivers who are treated well.  The article describes a disturbing Facebook video by an exhausted nurse, who has been pushed past the limit. Still, it’s hard not to finish the article without a smile on your face.

Shawn Smallman, 2018.

Influenza Humans Commons

Colorized transmission electron micrograph of Avian influenza A H5N1 viruses. By Photo Credit: Cynthia Goldsmith Content Providers: CDC/ Courtesy of Cynthia Goldsmith; Jacqueline Katz; Sherif R. Zaki [Public domain], via Wikimedia Commons
The Influenza Humans Commons is a collection of open-access articles on influenza, which is a great resource both for research and for course materials. You can find my own article, “Whom Do You Trust? Doubt And Conspiracy Theories In The 2009 Influenza Pandemic,” at this site, where it was recently among the top ten downloads. This is the paper’s abstract:

The 2009 pandemic of H1N1 influenza led people around the globe to create narratives about the epidemic defined by the question of trust; these narratives ranged from true conspiracy theories to simply accounts in which mistrust and betrayal formed a motif. In particular, most of these narratives reflected a fear of capitalism and globalization, although in specific regions, other issues—such as religion—played a more central role. These stories were not unique to the H1N1 pandemic but rather have appeared with every contemporary outbreak of infectious disease. This paper will examine conspiracy theories and moral panics related to the H1N1 pandemic in different world regions to explore how the disease became associated with economic and social systems in these accounts.

Shawn Smallman, 2018

Flu, Protest and Iran

While many factors are driving the current protests in Iran, Michael Coston has pointed out that a significant outbreak of avian influenza in that country has driven up the cost of poultry and eggs, which has likely contributed to peoples’ food insecurity. His blog post is an interesting attempt to tie influenza to economic factors, which in turn may be connected to politics.

Shawn Smallman, 2018

CWD, Fear and Food

“Chronic Wasting Disease in North America.” By USGS, National Wildlife Health Center [Public domain], via Wikimedia Commons
In the mid-1980s a new disease, Bovine Spongiform encephalopathy (BSE) appeared in Britain. Better known as mad-cow disease, this disorder attacked the brain of first cattle, and later a small number of people who had consumed their meat. The most likely manner in which the disease was introduced into the food chain was through processing cattle into feed for other cattle. Only by converting cattle into unwitting cannibals -in order to  to take advantage of waste products from abbatoirs- was the prion that caused the disease introduced into humans. In Britain the images of quivering, drooling, staggering cattle on television unleashed a public panic. (1)

BSE was a classic example of an iatrogenic disease, which is an illness created by humanity itself. The disease is caused by a prion, which is not a living thing. Prions are strange. It’s believed that they are malformed proteins, which can trigger other proteins to similarly mis-form. This creates a terrible cascade that impacts the brain, thereby causing neurodegeneration. They are also incredibly resistant to heat, so they do not readily break down during cooking, which would eliminate the risk of most pathogens and helminths. Once a living organism such as a person is infected, there is no known treatment for the disease. …

Pandemics and Information

Colorized transmission electron micrograph of Avian influenza A H5N1 viruses. By Photo Credit: Cynthia Goldsmith Content Providers: CDC/ Courtesy of Cynthia Goldsmith; Jacqueline Katz; Sherif R. Zaki [Public domain], via Wikimedia Commons
There have seldom been as many times over the last 100 years when the world has faced such a diversity of emerging infectious diseases. For this reason, I want to review some of the best websites and blogs for tracking pandemic threats. Michael Coston has a wonderful blog titled Avian Flu Diary, which tracks emerging infectious diseases, particularly avian influenza. I particularly recommend his March 13, 2017 post “Avian Flu’s Global Field Experiment.” In this post, he describes in detail the diversification and geographic expansion of avian influenza threats over the preceding six months. Although the blog post is written for the lay reader, its information is scientifically sound and based upon a deep knowledge of influenza.

For the dangers that we face, and what we need to do to face them, it’s worth reading two articles. The first is Dr. Sanjay Gupta’s, “The big one is coming, and it’s going to be a flu pandemic.” It’s also worth reading Crawford Kilian’s, “A War We Should All Support — But Probably Won’t,” in the Tyee.

If you are interested in tracking news related to influenza, you’ll also want to follow the Virology Down Under blog. Ian Mackay often provides the best numerical analysis available regarding outbreaks. The Bird flu report collects tweets regarding avian influenza by experts in the field. FluTrackers.com is not a visually engaging site, but it collects detailed information on avian influenza, which is organized by world region. Finally, for influenza the H5N1 blog is one of the best sources on the web. The page also has links to almost every other valuable website regarding influenza and global public health. …

The sad human toll of Zika

There was a brief flurry of media coverage regarding Zika after the discovery that it was spreading within Florida last month. Over the last couple of weeks, however, it seems to have receded from the headlines. Some recent coverage, however, really provide a sense of the human toll of Zika. Reveal is a new podcast from the Center for Investigative Reporting, which provides long-form coverage based on work in the field. Their report, “From A to Zika” documents how people in Puerto Rico are experiencing the virus, and attitudes towards the outbreak in South Florida. It also describes the scale of the challenge that officials face fighting the virus during a deep financial crisis in Puerto Rico. …

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