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Daniel Tarantola, MD

International Associate Editor, AJPH

The current emergence and spread of H1N1 flu in North America and beyond reminds me of a book I devoured many years ago. In his 1940 novel, The Tartar Steppe (Boston, MA: D. R. Godine, 2005), Dino Buzzati recounted the story of Giovanni Drogo, a young lieutenant assigned to a remote frontier citadel to guard against the illusionary invaders, the Tartars. Drogo's life-long and monotonous vigil became the central purpose of his life. But the Tartars never came. As a general about to retire, a disgraced and disgruntled Giovanni Drogo was on the road back to the civilian life he had come to despise. As the specter of the citadel he had governed was gradually vanishing behind the hills, Drogo's convoy crossed regiments in arms marching in the opposite direction to the front line—the feared Tartars had finally come! The results of Drogo's obsessive efforts would finally be put to good use, albeit without him.

In 1976, as a young epidemiologist in training at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, I witnessed with great admiration the unprecedented mobilization of large-scale surveillance systems, public information campaigns, and immunization programs to prevent a predicted epidemic of swine flu. There was great enthusiasm among public health practitioners throughout the United States, while others, from around the world, were watching over their shoulders, eager to learn whether and how a massive preemptive strike on an emerging epidemic would succeed. Although the 1976 swine flu epidemic never emerged, there were 501 victims: 500 people, who received the swine flu vaccine and developed Guillain-Barré Syndrome, and former CDC Director David J. Sencer, when the political ax fell on the widely respected architect of the campaign.

Whether the current H1N1 flu pandemic will grow to deadlier proportions, this cautionary tale reminds us of the hazards involved in scaling up a preemptive strike on a rapidly evolving viral foe. Never before has the United States and other countries invested so many resources to prepare for a flu pandemic. And never before has the level of preparedness been so high. But in either scenario—H1N1 pandemic or no H1N1 pandemic—there will be victims. If the flu pandemic materializes, people will succumb to the virus, especially already vulnerable populations. If it does not, the victims will include those who would have benefited from more resources and attention had practitioners not been engulfed in flu preparedness and response, first line responders who were on high alert for extended periods of time, public health authorities targeted by the media for having underrated or overrated the risks and impacts of the pandemic or who appeared to have failed in their duties, and politicians who positioned themselves on the wrong side of the dollar-per-averted case equation—although politicians generally have robust naturally acquired immunity against discredit.

The Tartars have arrived and the time has come to pass the developed influenza preparedness strategies through the test of fire. Hearty best wishes and sincere thanks to our fellow public health colleagues in the United States and around the globe who have worked diligently to create and roll out robust preparedness, response, and impact mitigation plans! No matter the outcome, there will be a price to pay in the current emergency. Public health has always been a high-stakes profession fraught with perils.

This Article Extract Full Text (PDF) Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Tarantola, D. PubMed PubMed Citation Articles by Tarantola, D. Related Collections Global Health Health Policy Health Professionals History Government