Dan Snow's History Hit - Hong Kong Flu

Episode Date: November 2, 2020

Professor George Dehner is a world environmental historian who examines the intersection of humans and disease in the modern era. We talked about the great flu pandemics of the later 20th Century, 1968 and 1976.Subscribe to History Hit and you'll get access to hundreds of history documentaries, as well as every single episode of this podcast from the beginning (400 extra episodes). We're running live podcasts on Zoom, we've got weekly quizzes where you can win prizes, and exclusive subscriber only articles. It's the ultimate history package. Just go to historyhit.tv to subscribe. Use code 'pod1' at checkout for your first month free and the following month for just £/€/$1.

Hi everybody, welcome to Dan Snow's History here. I've got a treat for you today. We're going to be talking about some of the lesser known influenza pandemics of the 20th century. What lessons can we learn from those outbreaks in the second half of the 20th century? It's going to be fascinating stuff. Just before I do that, I want to address some of the criticism that's been coming in, particularly from some American listeners. They say, why does this guy, why does this British guy talk so much about US politics? What's it got to do with him? And this is what it's got to do with me. What happens in America massively impacts the rest of the world. You're a hegemonic power. You guys are in charge. You call your president the leader of the free world.

Well, I'm in the free world. The rest of us are in it. We're the citizens. When you land on the moon, we land on the moon. One small step for mankind. We're mankind. So what happens over there massively affects all of us. Let me describe what I'm doing here. I'm sitting here talking into an iPhone. I've got my MacBook Air. I podcast with Zoom. I upload it to Dropbox from an editor who puts it on iTunes. I'm wearing my Calvin Kleins. We listened to some Audible earlier on with the kids, and I'm going to watch some Disney Plus later on. All of these entities are American. They are all regulated.

They are all set up in response to American regulation or a lack thereof. I'm going to blast this out on social media, all of which are American. And I'm going to have my words, these words, no doubt, harvested by those social media companies in order to feed me to advertisers. So what happens there affects us. The changes that we want to see in tech, in finance, and of course the environment, the environment is coming from Washington. They're coming from Washington, they're not coming from London. So when I'm talking about the I-4 corridor, when I'm talking about the suburbs of Madison, Wisconsin, when I'm talking about Miami-Dade

County, when I'm looking at the Georgia Senate races, it's because not only your future is being hammered out there, it's ours too. Your air is our air. Your sea is our sea. Your scientific breakthroughs are our scientific breakthroughs. So I'm sure it is frustrating to have some weird accented English dude talking to you about US politics. But let me tell you, it's frustrating over on this side of the fence as well. We feel pretty powerless. Anyway, let's get on talking about today's podcast. We're going to talk to the wonderful Professor George Diener. He's an environmental historian who's looked at the intersection of humans and disease in the modern era. We're talking about the big flu pandemics of 1968, 1976. One of them was known as Hong Kong Flu. There are some chilling parallels,

some important parallels here. Lots of things that sounds like we should have learned that we perhaps did not learn well enough. If you enjoy this podcast, you might want to go and listen to all our back episodes of the podcast. They're all available at historyhit.tv. We've got like a Netflix for history there. Hundreds and hundreds of history documentaries, proper history documentaries. No aliens, no bizarre neo-Nazis. They're all straight history documentaries up there. So please go and check it out. Use the code POD1, P-O-D-1. You can go and check that out for a month for free. And your second month is one pound euro or dollar. Thank you very much to everyone who's subscribed. You are enabling this incredible experiment to take place. And I'm

so, so grateful. In the meantime, everyone, enjoy George Dena. Thank you so much for coming on the podcast. Dan, thanks for having me on. I'm looking forward to the talk. Well, I'm looking forward to it because this is the forgotten pandemic, right? Tell us briefly, how bad was the global pandemic in 1968? And then maybe explain why we don't remember it, because perhaps we were too successful. Well, 1968 is kind of overshadowed by other influenza pandemics. You know, when people begin to talk about influenza pandemics, their mind goes immediately to Spanish flu, which was so

catastrophic. And then in the post-World War II period, people start thinking about 1957, which was also a dramatic pandemic year. And here in the United States, some of the older folks remember the 1976 swine flu program. So 1968 kind of gets overshadowed by these other pandemics, which is unfortunate because there's only a limited number of closely studied pandemics that we've had an opportunity to really work on the science and public health with. So the lessons from 1968 generated a number of changes in how public health responded to influenza pandemics, and they played a big role in pre-pandemic preparation, a lot of P's there, in terms of how this happens.

Now, Georgia, it's probably no accident we think of 1968 as a tumultuous year. We think of 2020 as a tumultuous year politically in both the US and around the world. I'm sure those two things are probably more related than we might have thought. Is the pandemic part of the 1968 political and cultural story too? That's interesting because you refer to the forgotten pandemic and influenza. Spanish flu is for a long time referred to as the forgotten pandemic. And it too was swallowed up by events that seemed larger at the time, right? So the conclusion of World War I, the Great War, the tumult of 1919, everything that's going on really overshadowed any discussion about Spanish flu

for a very long time. And in 1968, the first thing that comes to people's mind is not the Hong Kong flu as it was referred to. There's many other things in 1968 that leap to people's minds. And in terms of pandemics, 1968 is sadly overlooked. How did Hong Kong flu emerge? So the science behind influenza pandemic strains, the influenza strain is an RNA virus. So it has a high rate of mutation. It's a very mutable virus. So that sort of change from, you know, making copies is one type of change, which is why every year we have to get a new flu shot

because the virus itself suddenly changes. The other thing that influenza viruses do is a dramatic change is called a viral shift. And that's when a new component is kind of spliced into the virus. Influenza is an avian disease. It's an aquatic waterfowl disease. And so some component of that combines with a strain that was circulating in pigs or in humans and creates a whole new strain. So Southeast Asia is a nexus for influenza virus generation,

I suppose, because you have in such close proximity, pigs, waterfowl and people, and they swap viruses and the components kind of get jumbled up and create new viruses. We've now lived through the creeping awareness of this new pandemic coming out of that part of the world. Was it a familiar story back in 1968 or was it harder to get information about what was going on in that part of the world? Well, that's why it's called Hong Kong flu, because much in the same way in 1957, it doesn't appear on anybody's radar screen actually until it's reported in the newspaper. appear on anybody's radar screen actually until it's reported in the newspaper. In 1968, it was a reader from the WHO, Charles Cockburn, who was reading the Times of London and saw this report

and identified, wait a minute, this sounds like a new influenza strain, which was very similar to what happened in 1957, where a New York Times reader, Maurice Hilleman, who was at Walter Reed, saw a short piece about how there's this new respiratory illness circulating in Hong Kong. Because the People's Republic was not part of the WHO and had largely absent itself from international communication, it wasn't until it showed up in Hong Kong that there was the first reports. So at the time, you named pandemic strains after where they first appeared. So it first appeared in a newspaper story, Dateline Hong Kong.

And Cockburn sent someone who was part of the influenza surveillance system, a Dr. Chang, to go see if he could find any cases in the hospital. And he cabled back, no, there's really nothing circulating. And then two days later, he said, oh, wait a minute. There's a lot of cases. And that's sort of the hallmark of an influenza pandemic. You have such a steep rise when you have a novel strain. And the Hong Kong flu in 1968 is a novel strain. It's a viral shift, but it's not as dramatic a virus shift as the 1957 strain was or the catastrophic 1918.

I want to talk about 1957 in a minute because there's some forgotten heroes there who I find fascinating. I know you've worked on extensively. Let's talk, just keep on the Hong Kong in 1968. It did eventually became a global pandemic. But what kind of mortality, morbidity are we talking about perhaps compared to now? So in 1968, the case fatality rate was 0.1%, which is not a terribly sizable number unless you start thinking about the number of cases. And because influenza is so transmissible that a lot of people contracted it. So you end up with a global mortality total of somewhere around a million people died in 68, 69, and into early 1970 from this novel influenza strain. And it had a fairly high

reproductive rate. The R0 score was estimated to be 1.8, so that every individual who contracted it infected 1.8 more people. So it's very transmissible. And the pandemic rise is very steep. So you know when flu hits a community, especially pandemic flu, because it is so infectious that the number of cases rise dramatically, which also contributes to its mortality because you have so many cases in a short period of time. Some countries inevitably suffered worse than others. Was it in Germany where it's particularly bad mortality? The UK had a bad mortality as well. So what's really interesting about 68 is, you know, each influenza pandemic has its own characteristics. They share similarities, but there are certain unique features. So the 68 pandemic hit really hard

in North America, the United States and Canada in what's called the first wave. So it was discovered in July. It hit its epidemic peak in North America in the first week of January. So that first wave had a high mortality rate. Europe and Asia also experienced that first wave, but the mortality rate was not particularly high. However, the second wave that came around in the fall of 1969 into December, there was a very sharp peak in terms of mortality in Europe and Asia, but not in North America. So totaling it up, 70% of the mortality in 1968 in North America occurred in the first wave, and in Europe and Asia, 70% came in the second wave. It's still not clear why that's the case. It's just these things are so unpredictable that they take on their own patterns.

So a first and second wave difference in mortality, when everybody experienced the first wave, it's really hard to understand how that came to be. In terms of the CDC, we now hear about every day, governments across the world, how did they respond? Were there lockdowns? Was there public information campaigns? Or was it a case of just take it on the chin?

An outgrowth of vaccine discoveries in World War Two, and a discovery by a prominent British researcher, Christopher Andrews, talking about the spread of influenza viruses in 1947. Really, the only way you could deal with the influenza pandemic with the technology of the time was a vaccine. So there was concerted efforts to produce vaccines for the 1957 pandemic and for the 1968 pandemic. There's a lot of lead time that goes into producing lots of vaccine. So it was very difficult. So the response was not so much lockdowns, more in an effort to generate and distribute protective vaccines. more in an effort to generate and distribute protective vaccines. Tragically, in both 57 and 68, the vaccines appeared after the peak.

So when the vaccine hit the market, people weren't interested in purchasing it. So very few people were protected. In both 57 and 68, these were opportunities to learn about what works and doesn't work. So it was consciously involved in planning for what they anticipated would be the next pandemic. So each, the 5768 played a role in trying to mount a vaccine effort that didn't work and learning from what didn't work and then trying to apply it the next time.

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as little as a year. Well, hang on, 57 and 68, you're telling me they had vaccines months after identifying it. One of the differences, this is a completely new virus that we're talking about with coronavirus. And so this category of creating a vaccine to protect against coronavirus is breaking new ground. With influenza vaccines, they had been producing influenza vaccines since 1943. But tailoring them to fit the particular strain is not a new technology. What you're doing is adapting the virus on the production methods you have. So you already have a way of producing vaccine, but now you're producing one that fits the strain that's circulating. It's actually a result of 1968 that a new technology is developed right in the early period of this, which wasn't used

called recombinant production, which you purposely take this capacity of the virus to swap viral components to create a virus that grows very rapidly, produces lots of new copies, but is a perfect fit for the circulating strain. So you mentioned lessons learned from 68. So tell us, what were the big lessons learned? And have we forgotten any of them? Well, it seems that here in the United States, there's quite a bit of forgetting of how to respond to these pandemics and pandemics in general, not just influenza. We had, as you did, of course, a recent run with the 2009 novel swine origin flu,

which I call swine flu, even though they don't want us to call that anymore because of the pork producers. But we had an effort to protect against that. And so that built upon this whole record of response. And so what did they learn? Well, you have to have surveillance that works. So detect it early. You have to have a centralized purchasing and coordinating agency. Here in the United States, it became the federal government in which the CDC took the lead on this. You have to have the backbone of production already there. So in the United States, public health has invested in making flu shots available every year because you can't ramp up from zero rapidly. You have to have this baseline of production that you can then build

on top of it. So these were all things that were learned the hard way. So in 1957 here in the United States, and in 57-68, it's really a United States story in terms of vaccine because the United States had the lion's share of vaccine production. In the 1970s, a subsidiary of Glaxo called Evans Medical was producing about 1.2 million influenza doses a year for the UK market. So they thought they could maybe do a little bit better than doubling, but they could only produce about 3 million doses. That's not enough to protect people in the UK. But in the United States, in 1968, there were six vaccine producers who not only produced for a much larger U.S. market, they really produced for the global market. So ramping up a production of this vaccine meant ramping up these six vaccine companies to produce a lot more vaccine in a short period of time, something they could do in the United States because these were, at the time, U.S.-based companies. And so they could do that, and they commanded their production for the use of the United States programs. But that, too, is a reality that doesn't exist anymore. National companies really don't

exist for the global vaccine market. They're international conglomerates, so no one nation can control it. So you have to plan ahead of time distribution and production on a worldwide scale as opposed to a national scale. Before I let you go, I'd like to just ask about 1957. We've been focusing on 68. 57, such an interesting story, as you say, about the microbiologist at the Walter Reed. Tell me about his intervention and how important do you think he was? Oh, well, Maurice Hilleman was the first one to identify it, and he identified it from reading a newspaper. But he wasn't just a New York Times reader. He was positioned in a place that he could have dramatic impact. Because Walter Reed, the United States was part of the WHO influenza surveillance system, was intimately involved with one of the two typing centers in 1957. But he also sat at the center of a web for the United States military, who also had

sentinel sites around the world. And so when he read that, it's strange to think about, I think, in the present day, when there's so much activity that has to go through bureaucratic channels, he called up the heads of the vaccine manufacturers and told them not to kill their roosters, right? Now that seems kind of an odd statement, except that influenza vaccine is produced in fertilized chicken eggs. So roosters play an important role in that process. But when he read that in a paper in the spring of 1957, the producers, they sell off their roosters because it's too hot in the summer for them to do their business. So they're just a lost marker on your balance sheet. You got to get rid of those roosters. So they're sold off for the stew pot because he knew that that's what would begin to

happen in the very near future. And he told him to stop because he was pretty certain, and he turned out to be absolutely correct, that there was going to be a new influenza pandemic and that it would strike in the United States when schools reopened in September after Labor Day. He said, we're going to have a pandemic then. And he not only called up these places and then started telling other people, he issued a press release announcing that exact same thing on his own initiative. Maurice Hilleman, working at Walter Reed, wanted to call attention to as many people as possible that we have what is likely to be a new influenza pandemic brewing, and so we have to get acting on it. And to link it to 1968, again, the report in the newspaper by someone who sits at a position to do something about it. But this occurred for 1968 in

the middle of July, which in the northern hemisphere is a very bad time for vaccine production because the roosters are long gone. So you have to generate this whole system of fertilized egg production in order to produce a vaccine. And even with these challenges, the rooster challenge, they were able to produce hitting the same benchmarks that they hit in 1957, a full month sooner in 1968 and 69. So even though they hit these benchmarks, it was still too late. Tens of millions of Americans would be infected in 57 to 58. But we do think Hillman, did he save lives? Well, see, that's the unfortunate part.

The production and distribution of the vaccine did not get into the arms of people prior to the appearance of the pandemic. So maybe a small percentage of the people who got the shots were protected. But most people got the shots just as the pandemic arrived. If they got were lucky, right, if they got them early. But once you get your shot, it takes about two weeks to generate sufficient antibodies to be protective. So there's a lag in that. So he probably saved some lives. I would say that just as an aside, Maurice Hilleman maybe has saved more lives on this planet than any other person because he generated, when he

moved to Merck, a vaccine house, and he produced a number of vaccines, a measles vaccine, a mumps vaccine. He's probably responsible for saving the most lives on this planet from the vaccines he produced. Unfortunately, 1957 didn't add to his total too much. I've heard that it said about him, and I was wondering if he was able to intervene in 57. So looking at 57 and 68, we're now in the middle of a pandemic. In fact, well, I guess we hope we're in the middle. We may still be at the beginning of a big pandemic in the world. What are the lessons? Come on, as a historian, we need historians more than ever.

What are the big lessons that you can draw? The big lesson is that this is a novel virus, but experience with pandemics is not novel. So this one has unusual features. In some ways, it's a respiratory disease like influenza. In other ways, the way it operates, the asymptomatic rate seems to be much higher than experience with other pandemics.

So there's unique elements, but there are certainly things that we could take lessons from. Letting public health take the lead, as opposed to politicizing public health response. Helping the science to move as rapidly as possible, but not directing the science. The science has to run unfettered from any sort of political involvement. It's too late now to invest in pre-pandemic

planning because we're in the middle of one, hopefully near the end, hopefully not near the beginning, but nonetheless, we're already in it. But these are lessons that have been learned at great cost before, and we haven't really been following them in the way we should be. The World Health Organization is seen in certain circles as having roles and responsibilities that it doesn't have the resources for. So people look to the WHO to do things, but they don't have the facilities. They don't have the production. The WHO is very poorly funded in general for pandemic planning, and it's largely relying upon national health services to do its work. So it has a power to persuade.

It has a power to cajole, but it doesn't have the power to compel. And so national health organizations are operating international arena of pandemics, and they need to operate in that fashion as opposed to trying to seal the borders, which is, of course, impossible with respiratory diseases. Okay, well, thank you so much, George, for coming on the podcast. What book is the most recent one? You've written so many. Tell us where we can go and buy and educate ourselves. So on influenza, I have Global Flu and You, which is put out by Reaction Press in the UK. And I have Influenza, a Century of Public Health and Science that's put out by University of Pittsburgh Press, all available from finer

bookstores and online book sites. I should just quickly ask, I've got to ask the question, when people say, you know what, it's just the flu. Tell me why COVID is not just the flu. Well, it's a completely different organism, which is operating in ways that we are just discovering what the impact is. We've had a long experience with flu. It kills people every year. There's unusual events like Spanish flu, which are literally off the charts and talking about it. So you can't say anything with certainty. But we are learning every day new things about this particular virus. It's deadly. It's insidious. It's hard to control. And we don't know even remotely enough about it to make comparisons to any pandemic and

long term effects of infection with this virus. Thank you, Professor. Thank you very much for coming on the podcast. You're welcome. I enjoyed it. Hi everyone, thanks for reaching the end of this podcast. Most of you are probably asleep, so I'm talking to your snoring forms, but anyone who's awake, it would be great if you could do me a quick favour. Head over to wherever you get your podcasts and rate it five stars, and then leave a nice glowing review. It makes a huge difference, for some reason, to how these podcasts do.

Madness, I know, but them's the rules. Then we go further up the charts, more people listen to us, and everything will be awesome. So thank you so much. Now sleep well.