Towards Effective Emerging Infectious Disease Surveillance: H1N1 in the United States 1976 and Mexico 2009

Emerging infectious diseases (EIDs) pose international security threats because of their potential to inflict harm upon humans, crops, livestock, health infrastructure, and economies. Despite the scale of this threat, there are inherent limitations in preventing and controlling EIDs, including the scope of current disease surveillance efforts. All of this leads to the following questions: What would it take to have this infrastructure available in developing countries? Within developing countries, what are the cultural, political, and economic challenges that would be encountered? Finally, are there any generalizations that can be drawn across the board for developed countries? This paper, the second in a series on the political economy of EIDs surveillance by the same author, explores these questions through research on the 1976 U.S. H1N1 influenza virus outbreak, often recalled as the “Swine Flu Affair,” and the recent 2009 influenza virus A/H1N1 outbreak in Mexico. Research provides notable observations—based on the strengths and weaknesses of each country’s response—that can be used as a starting point of discussion for the design of effective EIDs surveillance programs in developing and middle-income countries. The U.S. case looks at building a base for program review, maintaining credibility, and thinking twice about medical knowledge, among other themes. In the U.S., the speed and efficiency of the 1976 U.S. mobilization against H1N1 was laudable. Although the U.S. response to the outbreak is seldom praised, the unity of the scientific and political communities demonstrated the national ability to respond to the situation. Mexico’s strongest characteristics were its transparency, as well as the cooperation the country exhibited with other nations, particularly the U.S. and Canada. While Mexico showed savvy in its effective management of public and media relations, as the paper details, political, economic, and cultural problems persisted.