Muraskin, a professor of Urban Studies, has worked in the area of vaccine policy for the past 20 years. An authority on international public health policy and the history of infectious diseases, he recognizes the hazards of doing too much—or too little. In 1976, Muraskin points out, the Center for Disease Control (CDC) promoted widespread vaccination before the flu actually appeared; this approach backfired when the shot’s side effects proved more troublesome than the flu, which never had a “second wave.” Taking no action until a dangerous strain appears in the general population is equally problematic. By the time the virus was evident, Muraskin explains, it would be too late to protect entire communities, since vaccine recipients need two weeks to develop immunity. While Dr. Muraskin maintains that public health officials acted correctly in 1976, the scapegoating that occurred undermined confidence in them for decades.
This fall, he says, experts should monitor how—and what strain of—the virus ultimately spreads through Argentina, where it is now winter. As of July 2009, Argentina was the country with the third greatest number of cases, after the United States and Mexico. Increasing numbers of deaths are being reported there and more dangerous mutations could occur as swine flu spreads among low-income populations with little or no access to quality health care. Nonetheless, until information is available on the strain of the virus and its proximity to the United States, a mass vaccination campaign does not make sense, notes Muraskin. “If we stockpile vaccine, there should be enough time to respond effectively,” he concludes. “If a particularly severe mutant strain hits the southern hemisphere, then I would immunize more people than just schoolchildren.”
But if significant side effects occur—even in a small minority of vaccinated individuals, especially pregnant women and children—and the flu strain is not severe, the effect on public health could be disastrous. In order to deal with the anticipated return of the flu, there has been talk of using vaccines that have not met all the normal regulatory requirements. This policy is totally justified if a killer strain arrives. But if there are problems with the vaccine and the strain is too mild to justify its use, the policy could lead to a legal nightmare.
Professor Muraskin is the author of The War Against Hepatitis B; Politics of International Health; Vaccines for Developing Economies: Who Will Pay?; Crusade to Immunize the World’s Children: The Origin of the Bill and Melinda Gates Children’s Vaccine Program and the Birth of the Global Alliance for Vaccines and Immunization. Most of his research has been funded by the Rockefeller Foundation.