Every year the flu virus kills approximately 36,000 people in the United States. This year health analysts are saying that the extent of the damage will depend on whether the available vaccine will get to those most at risk, and whether this year’s strains are particularly virulent. However, the issue is really much more fundamental than that.

There are two vulnerabilities in the nation’s immunization system: first it relies on a few private, for-profit manufacturers that use old technology in an attempt to maximize financial gain. Second, the right-wing government turns a blind eye to the realities of profit maximization. The governing ideology is that private, barely regulated companies will make safe products and quickly report problems.

Public health professionals, have long warned that the fragile system needs reforms. They say it could prove even more catastrophic if bird flu sweeps the globe or bioterrorists hit.

Since the 1970s, the number of companies making all vaccines has dwindled from 25 to five, even as the types of vaccines have doubled. Vaccines against six diseases now have a single manufacturer. Shortages occur whenever the companies encounter difficulties. This is the end result of decades of public giveaways to the private sector, and the encouragement of for-profit monopoly industries in health care. The issue is as old as the industrial revolution.

In 1892 the New York City Health Department developed a small internal unit called the “diagnostic bacteriological laboratory” to develop testing methods for patients in the city hospitals to determine who had diphtheria. This was important because the sooner this highly contagious disease could be diagnosed, the sooner preventive actions could be taken and effective treatments administered. The program was tremendously effective and the public health professionals who ran the lab decided to produce diagnostic kits at no charge for the city’s physicians.

By 1894 the NYC Health Department was producing diphtheria serum in excess of what was needed by city hospitals so it began to sell the serum in drugstores, and give it away to physicians to treat low-income families. The program was tremendously effective in reducing cases of diphtheria and, consequently, greatly reduced deaths and severe complications that resulted from the disease.

Other cities across the nation heard of this great success but did not have the capacity to produce the serum, so they began to place orders for it with the NYC Health Department. In short order, the Health Department had expanded production and distribution and was central to a dramatic nationwide drop in deaths and serious illnesses due to diphtheria. The Health Department was so efficient in the production of the serum that costs dropped from $12 per vial to $1 per vial.

Diphtheria serum production and distribution was so successful in protecting the public health that the Health Department expanded its operations to include the production and distribution of tetanus vaccine, rabies vaccine, and a testing kit for typhus. By this time the NYC Health Department had earned an international reputation for its aggressive stance in protecting the public’s health, including the health of the working class and those living in poverty.

However, at the same time, an organized and vicious opposition was growing. Local drug manufacturers and physicians denounced the Health Department’s activities as “municipal socialism” and “unfair competition.” The enormous public health successes were not followed by enormous profitability in the private sector, and this, in the eyes of the local capitalists and entrepreneurs, was heresy. For these entrepreneurial denizens, public health was simply a vehicle to make private profit. Public health without private profit would not be tolerated.

In 1898 New York City had a new mayor who did not share the vision of public health for all. Acting on behalf of the local interests of profit maximization, he ordered the Health Department to drastically cut its production and distribution of the life-saving serums and diagnostic kits. The Health Department complied, but kept a stockpile of vaccines and serums for emergencies.

A few years later, the Health Department sold a batch of emergency diphtheria serum that was outdated and about to spoil. That was the final straw for the local entrepreneurial drug manufacturers and physicians. Over 1,000 of them signed a letter petitioning the mayor to permanently prevent the sale of any such products by the Health Department. This, of course, freed the local drug manufacturers and druggists to sell vaccines and serums for what the market would bear, and once again opened the door to an increase in illness and death among the city’s poorest families.

It is now 2004. The corporate health entrepreneurs are international instead of local. Entire nations rather than a single health department have been forced to give away their public health responsibility to corrupt, dangerous, profit-maximizing corporate entrepreneurs. The solution lies in the struggle for a democratically controlled national health service that would provide drugs and medical care for all as an accountable public service.

The author can be reached at pww@pww.org.