FIVE QUESTIONS: William Johnston, Professor of history, Science in Society, and East Asian Studies

Q: How did you become interested in the history of diseases, and more specifically, flu outbreaks?

A: While in graduate school I was drawn to the history of medicine in Japan because it was in that field that the Japanese first adopted European scientific ideas and methods. The ways in which societies interpret and respond to disease tell us a lot about their most basic values and fundamental structures. Sometimes people get very excited about relatively minor diseases while accepting major causes of illness and death as somehow “normal.”

Q: What are the more notable outbreaks over the last 100 or so years?

A: The most important outbreak of flu in the past century was, of course, the one that occurred between 1917 and 1920. For that matter it was one of the deadliest pandemics of all time, killing about 2.5 percent of all infected, with a total mortality estimated between 20 and 50 million worldwide. Its exact origins remain obscure but it was a variant of the H1N1 strain. It caused pneumonia as the result of a cytokine storm—an overreaction of the immune system, thus affecting younger people more than the elderly. People have been getting excited about the H5N1 and H1N1 strains that have been in circulation since 2009, but neither has become pandemic.

Q: What are some of the more intriguing facts about outbreaks?

A: They have resulted in major changes to public health administration and the monitoring of diseases. For example, the 1917–20 pandemic resulted in the imposition of stringent measures requiring isolation and the monitoring of cases, which helped stop what could have become a pandemic in 1937.

More recently, the military has developed a project called the “Joint Project Manager Transformational Medical Technologies.” According to its website, the purpose is to “better prepare and protect the warfighter and the nation from emerging, genetically engineered, and unknown biothreat agents.” Though undertaken with terrorism in mind, this program also created a two-tiered response to future influenza pandemics—by developing new methods of creating a vaccination against the flu through genetic engineering of tobacco plants, and by developing anti-retrovirals aimed at stopping the replication of viral RNA through the use of what is called “antisense.” By doing this kind of public health work through the Defense Department, it has become possible to develop new and effective technologies with which to respond to influenza pandemics without facing the threat of politicians cutting funding.

Q: Last year H1N1 (“Swine Flu”) caused some significant problems worldwide, yet this year there has been no outbreak. Is there a reason for this, or did the human population just get lucky this flu season?

A: Just lucky. Pandemics will happen, no matter what. What counts is preparation, with everything from vaccinations to planned measures for how to react. Wesleyan, for example, has in place a set procedure regarding what to do in the event of an influenza pandemic hitting the community.

Q: Given the historical record of flu and other major outbreaks, what do you see looking forward into the next decade or so with regard to these types of events?

A: Hard to say. The budget-cutting trends worldwide could easily mean less preparedness for the next pandemic or epidemic of other kinds of disease. We should be teaching children in primary schools through high schools the basics of epidemic disease and public health. It would go a long way in providing support for the kinds of measures that will do the most good for the largest number of people.