The end of a pandemic

Last week, the director of the World Health Organization announced that the swine flu pandemic is officially over. That news was mostly good and a little bad.

It was good for the obvious reasons. Despite the first alarming reports of people dying in Mexico, the World Health Organization had reported only 18,398 deaths from it as of a month ago. While a recent outbreak was reported in India, the overall toll is roughly half the total of yearly deaths from the regular flu in the United States alone (a figure that, admittedly, varies from year to year). The majority of those infected with the H1N1 virus in the United States experienced only mild symptoms and recovered quickly.

It was good also because now the H1N1 strain will be a part of the regular flu vaccine and because health officials now have greater knowledge about some of the ways the flu can mutate and spread among humans.

It was bad because this relatively mild experience may breed skepticism among some toward official health pronouncements. They may be less likely to follow warnings that come along in the future.

Politically speaking, a pandemic is like a tightrope over snapping alligators. You walk it carefully, at your own peril. President Gerald Ford thought the nation was facing a swine flu pandemic in 1976, so he persuaded Congress to fund a nationwide inoculation effort, complete with television ads that warned people of how quickly the deadly disease could spread. But in a cruel twist, the inoculation ended up being worse than the disease. Only one person died of the swine flu that year. Several died from complications of the vaccine.

This latest pandemic did not mirror that experience. While many of the symptoms were mild, no one can deny that a different sort of flu was spreading itself across the landscape.

Health officials are, of course, aware of history. The 1918 Spanish influenza remains the standard against which all influenza mutations are measured. That one, fed by the unsanitary conditions rampant in a world war, killed an estimated 20 million people worldwide. It was so virulent that some people were said to have been perfectly healthy one moment and dead 12 hours later.

If 1918 and 1976 are two ends of the spectrum of influenza pandemics, 2009-10 falls somewhere in the middle. Pandemics are difficult to predict and expensive to counter. Given that, the World Health Organization had little choice but to respond as it did last year, and the world is lucky the outcome wasn't worse.