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Prevention is Invisible, Invaluable

Each Memorial Day, I visit St. Mary's Cemetery to pay respects to fallen members of my family. On the way out, I always stop at the grave of a man I never knew, Vasily Thymoczyk, my grandmother's first husband. He died from influenza in 1918 at age 22.

The pandemic that followed World War I killed as many as 40 million people. One half of American service deaths during the war may have been due to the influenza, not battle wounds. It is estimated that 675,000 Americans died from influenza during 1918 and 1919.

Many of us think they died from "the flu," the common malady causing aches, fevers and chills. Not so. Their strain of influenza struck them hard and fast. It turned pulmonary fluids into viscous globs that could not be cleared by coughing. Patients simply suffocated, often within hours of developing symptoms. It was not uncommon to leave for work healthy, and be dead by noon.

Today, we are cautiously watching the Bird Flu, which is already killing people each day in Southern Asia. Scientists are working feverously to develop a vaccine to protect us. Will it be needed? Will it be developed in time?

Remember this: Disease prevention, when effective, is invisible. The proof of the value of preventative measures is that nothing happens. Disease occurs when prevention fails.

Focus on the True Enemy

If the Bird Flu comes, and if a modern vaccine protects us all, then no one will die. If no one dies, does that prove that we never needed the vaccine? If no one dies, will we wonder whether the flu really did hit our shores, and whether it was potentially lethal? Will we require a certain number of preventative failures, i.e., deaths, to document the need for the preventative measures, or will we be able to accept that prevention's success will be invisible, i.e., no deaths?

If no one dies, will we consider vaccine manufacturers national heroes for saving our lives, or will we consider them the greedy suppliers of an unnecessary treatment for a non-existent disease and attempt to make them liable for every reaction a patient developed?

Must some people die, proving the vaccine was necessary? Would, perversely, a less effective vaccine offer vaccine makers more legal protection than a very effective vaccine? While vaccines rarely affect us directly in ophthalmology, if we want the best vaccines for ourselves and our families, we must join with the medical community to stop the attack on scientists who develop them.