An Ounce of Prevention

In early February I happened to visit a farm in Umbria where there were chickens. On my drive home, I became seized with terror when I heard on the radio that avian influenza had been detected in Italy. For weeks I had been following the virus’s westward progress on maps at the website of FAO (the Food and Agriculture Organization of the United Nations). I had read about the disaster in Turkey, where the outbreak had gone unchecked for weeks while the H5N1 virus was tracked all over the country by vehicles, people, and the movement of animals. As migrating birds returned to Africa in the spring, the disease was predicted to spread further west and south. And now it was here, ahead of schedule—and I’d just walked through an outdoor chicken coop.

I began to think of my own flight scenarios, if the dreaded pandemic about which I had read various and conflicting reports in the American press suddenly broke out. Could I flee back to the United States? Would the U.S. close its borders and impose quarantines, as some (including the president) have suggested? Where would be the best place to get Tamiflu—the U.S. or Europe?

The news in February was bad. The H5N1 virus spread to 14 countries in three weeks. A dead cat found on the island of Rugen in Germany was discovered to have the virus. The virus reached Africa, where many predicted it would be uncontainable. In Nigeria, workers “culled” birds with their bare hands due to a lack of proper protective gear—even though human/bird contact is exactly the kind of precipitating event that could lead the virus to mutate into a new form transmissible from person to person.

But in March, the news shifted the other direction: You could see it in the headlines (“Studies Suggest Avian Flu Pandemic Isn’t Imminent,” “A Pandemic of Fear”) and suggestions that the threat was exaggerated. Like many citizens, I continued to ride the roller coaster of fear and reassurance.

Since the discovery of avian flu in Italy, the country’s poultry sales have dropped by 70 percent. Never mind that this hurts the economy, and in some roundabout way must reduce tax revenue that can be used for things like fighting bird flu, people have begun to be afraid of birds in a visceral, Hitchcockian way.

But it’s not about the birds—or not completely. As Nick Parsons, the director of FAO’s information division, told me, “Migrating birds are not the most significant factor,” though they are important—a scientific conference organized by FAO, the World Organization for Animal Health and the World Health Organization has been scheduled for later in May to discuss avian influenza and wild birds. But the media focus on countries’ domino-like fall to the avian invaders has distracted attention from the human role. As Parsons points out, the fact is that the spread of the virus within countries is mainly caused by human action.

Birds that get HPAI (highly pathogenic avian influenza) and recover continue to excrete virulent quantities of virus for 10 days, which means we really ought to be careful what we’re stepping in. The only animal behavior we can really affect is our own, and that of the creatures we raise and sometimes eat. Thus, it’s not what chickens do but what we do with chickens that ultimately determines whether an outbreak gets out of control.

There was action all right, but not all of it was rational. What happened in the United States was the leap to the pandemic scenario and pandemic preparedness. For example, those Umbrian chickens I saw on the farm were being kept in a coop with screening over it, which prevents mixing of poultry with wild birds and is a key part of combating the spread of the disease. However, several months (and mountains of publicity) later, elsewhere I have seen chickens left to roam about outside. This was in the more distant province of Marche; even in a highly industrialized country such as Italy, the news apparently doesn’t always get around. Imagine, then, what happens in Africa, where the only two labs that can even test for H5N1 are in Egypt and South Africa—at opposite ends of the continent.

Given that this is still primarily an animal disease, combating an epidemic means combating HPAI in animals first. Jacques Diouf, FAO’s director-general, said as much in October of last year: “The current bird flu scenario should not cause panic and fear; instead it calls for rational and immediate action to fight the disease at its origin—that means in animals.” However, the message doesn’t seem to have gotten through. At that point, Diouf reported, FAO estimated it needed $175 million to support “surveillance, diagnosis, and other control measures, including vaccination,” but had only received $30 million.

In the months following Diouf’s call for “rational and immediate action,” there was action all right, but not all of it was rational. What happened in the United States was the leap to the pandemic scenario and pandemic preparedness. The press and the government basically ignored the idea that HPAI should be fought on the battlefield where it now is—the animal world. Instead, the Bush administration is pumping billions of dollars into drug and vaccine research and promoting civil-defense-type plans for handling a pandemic in the U.S.

Preparedness and new vaccines are certainly worthy goals. But the major fact that has escaped much notice is that preparing for a pandemic and combating avian influenza are two different things. HPAI exists and, if left unchecked, could lead to the mutation that would spark a global pandemic. The pandemic, on the other hand, does not exist, yet that is where most of the money is being spent. Meanwhile, more effort is desperately needed in the parts of the world—Asia and Africa—where, we’re told, HPAI is raging, and whose countries lack the money, expertise, and technology to fight the disease on their own.

The WHO has said that worldwide alarm over avian flu “has opened an unprecedented opportunity for international intervention aimed at delaying the emergence of a pandemic virus or forestalling its international spread.” [PDF] So where’s the money to fight the current battle against HPAI overseas, to keep it restricted to the animal world so that we avoid a human pandemic in the first place?

I can tell you where it isn’t—in the Bush administration’s avian flu plan. The U.S. federal budgets for 2006 and 2007 appropriate nearly $6 billion for avian influenza, in order “to buy flu vaccine for every person in the United States and to provide antiviral drugs to one-fourth of the population in an emergency.”

Animals don’t vote or pay taxes in the U.S. Neither do people who live in the developing world, where the main danger of HPAI now lies. The avian flu problem has, like everything else in American life, run afoul of politics, if you’ll pardon the pun. Back in November, when the Bush administration unveiled its long-awaited bird flu plan, Sen. Bill Frist openly linked the plan to the searing criticism of the Bush administration’s handling of Hurricane Katrina: “People watching on TV see that the government isn’t there in time of need.” Though we can all be glad “Brownie” isn’t in charge of fighting HPAI, I can hardly think of a worse basis for a disease-fighting strategy than the Republican party’s electoral problems and a need to appear as if it’s acting decisively. That’s what buys you a half-trillion-dollar prescription drug plan that nobody likes and doesn’t give a single uninsured child health coverage. Or a hurricane plan where millions of dollars simply disappear.

The government’s plan is akin to dealing with a rash of murders and home invasions in a neighboring town by locking the door, getting in bed with a pistol and pulling the covers over your head. In fact, there are already signs of the Katrinization of the avian flu response. Cities and towns complain of a lack of federal leadership and assistance. (The feds cleverly responded that it was “up to individual states to develop their own plans to receive financing.”) Although the original plan called for global oversight and early detection efforts, “about 90 percent of the federal money is being devoted to research on a possible vaccine and to buying Tamiflu.” Like the prescription drug plan, that’s good news for pharmaceutical companies, mixed news for Americans, and bad news for everybody else.

Even if your congressman promises the government has a dose of vaccine with your name on it, that won’t help anyone who’s not an American. In the event of a pandemic, millions, regardless of which country they live in, will still die, which could spawn a worldwide economic collapse. (If that sounds catastrophist, even the Bush administration’s draft plan said that “power and food would be in short supply” and “riots would engulf vaccination clinics.”

Now comes the bad news: at the end of March, a team of researchers reported that the experimental bird flu vaccine being stockpiled by the government “protects only about half the people who receive it.” Furthermore, “it must be given in such high doses that if a pandemic were to start soon, manufacturers could not begin to make enough vaccine for all who would need it.” Oh, and by the way, “currently, the United States does not have the production capacity to make bird flu vaccine and the usual vaccines for seasonal flu.” And Tamiflu may not work all that well; it has been suggested its use could lead to resistant strains.

The government’s plan is akin to dealing with a rash of murders and home invasions in a neighboring town by locking the door, getting in bed with a pistol and pulling the covers over your head. (A better strategy might be to invest in community policing, form neighbourhood watch groups, and yes, fund community development projects.) And the problem is not just the Bush administration. The Democrats don’t seem to get it either—all that Sen. Charles Schumer could say about Bush’s plan was that it didn’t include enough Tamiflu.

Some people do have a forward strategy for defeating avian flu, to use a Bushism. To its credit, the Bush administration did send a thousand protective suits to Nigeria. However, Congress cut the original $7 billion avian flu appropriation for 2006 in half. An international conference in Paris in early April appealed for more assistance to fight HPAI in Asia, where $100 million is urgently needed—pocket change, given that Congress passed another $50 billion in tax cuts for the wealthy not long ago. However, “so far, only Germany, Japan, and the Netherlands have expressed their willingness to financially support affected Asian countries.”

While I wait for the administration to wake up and say, “We have to fight the virus over there so that we don’t have to fight it here,” the roller coaster continues. One week, a study in Science suggests that “only a couple of mutations might be needed to enable the H5 virus” to adapt for human-to-human transmission. The next week, other scientists report that “the avian virus would need to accumulate many mutations in its genetic material before it could become a pandemic strain.” This provokes a response three days later from the Center for Health and the Global Environment at Harvard Medical School, pointing out that bird flu is already a pandemic among birds, “harming wildlife, poultry, food security, and livelihoods.” But the United States has turned a global problem into a domestic political issue: Who’s got a plan for the pandemic that might not happen?

If you boil down all the contradictory reports, what you get is nebulous: A global pandemic is inevitable but unlikely. That puts it in the same class as the collapse of the overburdened health care system and the bankruptcy of Social Security. We all know what’s being done about those problems.

One hopes the billions the government is putting into the vaccine program produce something that will save lives—though you can bet it won’t be given out for free. But for now I still find myself wondering, why do people irrationally stop buying poultry, even when they’re told it’s safe? Not just because they’re afraid; it’s so that they’ll feel like they’re doing something.

I like the idea of doing something now. It seems more rational than closing the gates, pulling up the drawbridge, and hoping the assault never comes.