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A Cross-Cultural Investigation of Pandemic Influenza Paradoxes in Epidemiology

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A Cross-Cultural Investigation of Pandemic Influenza Paradoxes in Epidemiology One Flu East, One Flu West, One Flu Over the Cuckoo’s Nest: A Cross-Cultural Investigation of Pandemic Influenza Paradoxes in Epidemiology Chrissy Thuy-Diem Vu Dissertation submitted to the faculty of the Virginia Polytechnic Institute and State University in partial fulfillment of the requirements for the degree of Doctor of Philosophy In Science and Technology in Society Doris T. Zallen, Chair Anne Fitzpatrick Saul Halfon Ann LaBerge 11 April 2016 Blacksburg, Virginia Keywords: Dual Nature of Science, Epidemic, Epidemiology, Influenza, Paradox, Pandemic, STS, Social Construction, United States, Vietnam Copyright © 2016, Chrissy Thuy-Diem Vu One Flu East, One Flu West, One Flu Over the Cuckoo’s Nest: A Cross-Cultural Investigation of Pandemic Influenza Paradoxes in Epidemiology Chrissy Thuy-Diem Vu ABSTRACT This comparative case study examining epidemiological practices in Vietnam and the US revealed three pandemic influenza paradoxes: The paradox of attribution which asserts that pandemic influenza comes exclusively from Asia even though historical evidence points to the contrary; the paradox of prevention which encourages industrial methods (i.e., factory farming) for combating influenza even though there is conflicting evidence for any superiority of this method in terms of means of production or disease prevention; and the paradox of action where epidemiologists act in ways not consistent with prevailing epidemiological recommendations. The existence of these paradoxes may, in fact, impede efforts at stopping and preventing pandemic influenza. In order to find the root causes of these paradoxes, this study examined indigenous media and historical and contemporary research reports on pandemic influenza. This archival information was juxtaposed to viewpoints garnered from ethnographic interviews with epidemiologists who have worked in Vietnam, the United States, or in both countries. This study found that these paradoxes endure because of the dual nature of science – the known and the unknown elements of current knowledge – and assumptions made between the two. The dual nature of science describes both the information that has been codified and information that has not been codified and the implications between the two. In other words, in between the spaces of known information, there are attempts to fill in the gaps in knowledge, which results in paradoxes. Of particular importance in this gap-filling process are the three “C’s” of collaboration, conflict, and competition. Collaboration is integral to the successful prevention of influenza pandemics; however, it is this same collaboration wherein which epidemiologists are trained to be so highly specialized that they often depend on unvetted external expert information. Conflict and competition occur from the geopolitical level all they way down to the level of the individual epidemiologist and are influenced by the political and scientific economy along with social and cultural factors. iii DEDICATION This work is dedicated to Mrs. Lua Thi Vu, Mr. Phuc Cong Vu, Mrs. Tim, and Mr. W.H. with love. They actually do not enjoy reading non-fiction, so unless someone tells them about this heartfelt dedication, they will never know. iv ACKNOWLEDGEMENTS First and foremost, I must thank God for it was definitely through a miracle that I was able to complete this research. Perhaps it was through divine providence that I was blessed with an astounding committee. I must sincerely thank the Chair of my Committee, Dr. Doris T. Zallen. Without her tireless efforts, guidance, and patience; the completion of this work would not have been possible. Every discussion with her produced a treasure trove of information and ideas. I must also thank Dr. Saul Halfon, whose keen eye provided challenging discussions and helped this research grow immensely. I am thankful to Dr. Anne Fitzpatrick whose influence was integral to the development of this work. Last, but certainly not least, I am grateful to Dr. Ann LaBerge, whose expertise provided critical insights into the formation of this work. In addition, I would like to those who have provided critical insights into this work. This includes Dr. Barbara Allen, Dr. Janet Abbate, Dr. Paul Lehner, Dr. Amber Sprenger, Dr. Bradley Stastny, Dr. Nick Kohn, and Dr. Laura Leets. I must thank teachers, family, friends, and fellow students. They listened (sometimes unwillingly) to ideas in progress, provided help to find interview subjects, and provided help and guidance throughout my graduate journey. These include Dr. Shannon Brown, Dr. Jeff Sands, Ms. Nancy Foley, Dr. Claire Cuccio, Mr. Lawrence Thuotte, Jr., Dr. Doug Anderson, Mr. Mel Elau, and Dr. Bob Davis. For all these people who I have been blessed with him my life, and to those who I have supported me, but I have not named here, I will be eternally grateful. v TABLE OF CONTENTS Dedication .................................................................................................................................................... iv Acknowledgements ................................................................................................................................... v Table of Contents ...................................................................................................................................... vi Chapter 1 – Introduction – A Title Deconstructed .................................................................... 1 Purpose – Paradoxes and STS in Practice ....................................................................................... 4 Defining the Problem: Influenza Paradoxes ................................................................................... 5 Case Study: A Cross-Cultural Investigation of Pandemic Influenza ..................................... 8 Research Questions .............................................................................................................................. 10 Chapter Summary ................................................................................................................................. 11 Chapter 2 – The Development of Contemporary Medicine and Influenza Practices ......................................................................................................................................................................... 13 History of Medicine and the Discovery of the Influenza Vaccine in the United States ........................................................................................................................................................ 14 Influenza in the United States ....................................................................................................... 17 Healthcare in the US .......................................................................................................................... 25 History of Medicine and of Influenza in Vietnam ................................................................. 26 Avian Influenza in Vietnam ............................................................................................................ 37 Pandemic Politics ................................................................................................................................. 38 Vietnamese Media .......................................................................................................................... 39 Communications from Multinational Organizations ....................................................... 41 Foreign Media .................................................................................................................................. 43 The Political Economy of Influenza ............................................................................................ 46 Pandemic Response Frameworks ............................................................................................... 48 Summary ................................................................................................................................................ 50 vi Chapter 3 – Research Methodology And Population ....................................................... 52 Research Phase One ........................................................................................................................... 52 Research Phase Two .......................................................................................................................... 55 Chapter 4 – The Paradox of Attribution ..................................................................................... 58 Pandemic influenza can come from anywhere, but pandemic influenza comes from Asia ........................................................................................................................................................... 58 Does Pandemic Influenza Come from Asia? .............................................................................. 60 Do We Need to Find Pandemic Influenza Origins? .................................................................. 65 The Index Case ...................................................................................................................................... 66 Biochemistry of Pandemic Influenza ............................................................................................. 71 Naming Convention ............................................................................................................................. 74 Blame Metaphors .................................................................................................................................
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