Behind the Swine Flu Emergency

By declaring H1N1 a national emergency, Obama’s made it political—which is a shame, says infectious disease specialist Kent Sepkowitz. What we should really be talking about is how to get vaccinated for an even more deadly pandemic.

10.26.09 1:30 AM ET

Now that Obama has formally declared swine flu a national emergency, he has moved the virus from the realm of public health into the too familiar and greedy world of politics. Rather than hearing those quaint details about how to cover a cough or watching local shmokel not-ready-for-TV doctors say whether to go to the ER, we now will get the standard he says-she says spouting off, the snorts and whistles from the professional snorters and whistlers, the straight insider-trading dope from the guys in the know. Instead of that background footage of content laboratory technicians looking under microscopes, get ready for scenes of brisk lawyers hurrying up the steps of a courthouse.

The 2009 novel H1N1 influenza virus pandemic story is nothing if not a ringing endorsement for vaccination of human beings.

It’s a shame that the medical end of the story is now destined for the backseat, because thus far, despite all the hyperventilation, the epidemic has played out as predicted. This is an extremely contagious, mostly mild disease, and none of us has a whiff of immunity to it (except perhaps geezers vaccinated 35 years ago—the cute feel-good portion of the story). Swine flu has spread through the country just like, well, influenza. Just about everyone has or will get it unless the much touted vaccine arrives in time.

Instead we’re focusing on the chess match, the eternal micro-discussion of what everything really means: whether Obama is playing it up now to gin up support for his health-care initiative; whether the Republicans should stand up against something as flagrantly pinko as universal vaccination; what the cost in votes and press might be of standing here or moving there. The declaration of an official national emergency has reduced the H1N1 epidemic to something like the aftermath of a grim tornado—the president choppering in, a governor in a fleece coat and hardhat, a few lost souls picking through the rubble, some cute kids wearing PJs wandering in the bright daylight. I already miss the old days when figuring whether to stock up on Tamiflu was the moral crisis of the day.

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Swine flu is of course deeply steeped in politics, perhaps more than any other disease. Its first lap around the block, in 1976, doomed poor hapless Gerald Ford, when a novel swine strain killed a single soldier in Fort Dix, New Jersey, and seemed poised to cause even more harm. So the temperate Ford listened thoughtfully to his advisers, carefully weighed the pros and cons, and ordered the entire country to be vaccinated, just weeks before the presidential election. He even rolled up his sleeve for a jab to show how safe and hygienic the whole thing was. But instead of a hero, he turned out looking like a doofus—only a few more cases of severe disease occurred despite the threat of a killer epidemic, plus the vaccination itself caused a handful of unexpected but devastating complications. Ford soon lost the election by a whisker to Jimmy Carter. No swine, one could argue, no Carter. No Carter, no Reagan. No Reagan—please don’t get me started.

But really the story of swine is its demonstration of what happens when a new disease hits for which we have no vaccine. The 2009 novel H1N1 influenza virus pandemic story is nothing if not a ringing endorsement for vaccination of human beings. Ironically, this comes at a moment when the anti-vaccination people are in full voice, with celebrities and their tweet-brigade marching against shots and elixirs and all manner health-care interventions, even as we are witnessing a disease affect millions, perhaps billions, all because we haven’t quite got that vaccine ready yet.

Not that this inconvenient fact will chill the anti-vaccination fervor. In that regard, the anti-vaccine people resemble their bizarre-o world inverse twins—those who deserve everything the health-care system has to offer and right this instant, including and not limited to the few drips of vaccine currently available. One is sinned against for being offered, the other sinned against for an offer too small, but each shares the same dim vision. They fail to see the epidemic for what it is: a series of aimless unfortunate circumstances without reason or fault, without a grand design, a conspiracy, or a 10-year plan. Rather, it is a complicated set of facts thrown before us at exactly the wrong time, to be dealt with cautiously, anxiously, and mostly in the dark—just like the rest of adult life. When the novel H1N1 dust settles (and settle it will, probably in a month of so) the experience will give us an incredibly important public health lesson: vaccination works. It is certain, however, to be a lesson roundly ignored—it is the virus after all that is novel, not the public’s response to it.

Kent Sepkowitz is an infectious disease specialist in New York City. He has contributed to The New York Times, Slate, and, oh-so-briefly, O Magazine. He also writes academic medical articles that are at times pretty tough sledding.