The Monster at the Door

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Avian flu could cause an epidemic far more catastrophic than many politicians are prepared to admit.

As in a classic 1950s sci-fi thriller, our world is imperilled by a terrifying monster. Scientists try to sound the alarm, but politicians ignore the threat until it's too late. Indifference ultimately turns into panic.

The monster is H5N1, the lethal avian flu that first emerged in 1997 in Hong Kong and is now entrenched in half a dozen South East Asian countries. It has recently killed scores of farmers and poultry workers who have had direct contact with sick birds.

For seven years, researchers have warned that H5N1 would eventually fall in love with a human influenza virus in the body of a sick person (or possibly a pig) and produce a mutant offspring that could travel at pandemic velocity from human to human. Ironically, in our 'culture of fear' - with the Bush administration ceaselessly ranting that the terrorist apocalypse is nigh - the least attention is given to the threat that is truly most threatening.

On 14 September, Dr Shigeru Omi of the World Health Organisation (WHO) tried to shake complacency with an urgent warning that human-to-human transmission of avian flu was a 'high possibility'. Two weeks later, grim-faced Thai officials revealed that the dreaded viral leap had already occurred. A young mother, who had died on 20 September, had probably contracted the virus directly from her dying child.

A crucial threshold has been crossed. Of course, as Thai officials hastened to point out, one isolated case doesn't make a pandemic. Human-to-human avian flu would need a certain critical mass, a minimum initial incidence, before it could begin to decimate the world. The precedent always invoked to illustrate how this might happen is the 1918-19 influenza pandemic - the single greatest mortality event in human history. In only 24 weeks, a deadly avian flu strain killed between 2 and 5 percent of humanity (50 to 100 million people).

But some researchers worry that H5N1 is actually an even more deadly threat than H1N1 (the 1918 virus). First of all, this flu - at least in its bird-to-human form - is a far more vicious killer. In 1918-19, 2.5 percent of infected Americans died. In contrast, more than 70 percent of this year's avian flu cases (30 out of 42) have perished. Moreover H5N1 appears to be immune to at least three of the four anti-viral drugs on the market.

Secondly, as the WHO has repeatedly emphasised, the avian flu seems to have conquered an ecological niche of unprecedented dimension. The rise of factory poultry farming in Asia over the last decade and the dangerously unhygienic conditions in farms and processing plants have created a perfect incubator for the new virus. Moreover, in the face of desperate WHO efforts to geographically contain the avian pandemic by destroying infected bird populations, the virus has literally taken flight. H5N1 has been identified in dead herons, gulls, egrets, hawks and pigeons. Like the West Nile virus, it has wings with which it can cross oceans and potentially infect bird populations everywhere.

In August, furthermore, the Chinese announced that the avian strain had been detected in pigs. This is a particularly ominous development since pigs, susceptible to both bird and human flu, are likely crucibles for genetic 'reassortment' between viruses. Containment seems to have failed.

Thirdly, a new pandemic will use modern transportation. The 1918-19 virus was slowed by ocean-going transport and the isolation of rural society. Its latterday descendant could jet-hop the globe in a week. Finally, the mega-slums of Asia, Africa and Latin America are like so many lakes of petrol awaiting the spark of H5N1.

What are the frontlines of defence against such an unthinkable catastrophe? One of the most urgent tasks is to ensure that poultry workers in South East Asia receive ordinary flu vaccinations in order to prevent possible mixing of human and avian genes. But seasonal flu vaccine is mostly consigned to the richer countries, and Thai officials have complained that they cannot obtain enough donated doses to conduct systematic vaccination.

Furthermore the recent closure of drug company Chiron's contaminated UK production facility eliminates a fifth of the global flu vaccine stock at precisely the moment when it is urgent to reinforce the vaccination programme in South East Asia.

A prototype H5N1 vaccine is under development, but only in quantities to safeguard frontline public health and safety workers in the US, Europe and Japan. Drug companies compete furiously in the market to cure minor ills, but lack profit incentives to increase the output of vital vaccines and anti-virals. As the New York Times emphasized on 30 September, there has been a disastrous 'mismatch of public health needs and private control of production of vaccines and drugs'. Indeed last April, at a historic WHO-convened summit about global defences against a possible pandemic, leading experts expressed their deep pessimism about existing preparations.

'The consultation concluded that supplies of vaccine, the first line of defence for preventing high morbidity and mortality, would be grossly inadequate at the start of a pandemic and well into the first wave of international spread,' the WHO reported.

'Limited production capacity largely concentrated in Europe and North America would exacerbate the problem of inequitable access.'

'Inequitable access' is, of course, a euphemism for the death of a large segment of humanity - a callous triage already prepared in advance of the H5N1 plague by indifference to Third World public health.

This is the moral context of the deafening silence about the H5N1 threat in the current US presidential debate. Only Ralph Nader has been awake to the peril. In a letter to President Bush in August, he repeated scientific warnings that the 'The Big One' was coming and urged a 'presidential conference on influenza epidemics and pandemics' to confront 'the looming threats to the health of millions of people'.

It has become fashionable, of course, in some 'progressive' circles to excoriate Nader's presence in the campaign as divisive egoism. But who else has warned us about the monster at the door?