World Still Unprepared for
Deadly Avian Flu
by Laurence Hecht
The deadliest strain of flu virus ever known, the H5N1 avian influenza, is now spreading into southeastern Europe and Turkey, carried by infected populations of migratory birds which began their journeys in China last spring. New outbreaks are also now appearing in Indonesia and the Philippines.
So far, the virus has infected millions of domestic poultry and 120 human beings, of whom 62 died quickly. Most of the human victims caught the flu from direct contact with infected birds. But with each new infection, the virus evolves toward a form that will become easily transmissible from human to human. When that happens, an almost unstoppable pandemic will spread around the world as fast as the common cold, quickly killing perhaps one out of five of every human beings now alive.
Yet no clear leadership has emerged to take on this deadly crisis. In the last 30 days, statements from disease specialists and public officials around the world, including the weak and politically faltering U.S. President, have acknowledged the threat. But the reaction is marked by a paralysis in taking effective action. Behind that paralysis is the same tragic flaw in thinking which has prevented action on economist Lyndon LaRouche's repeated emergency proposals to avert the looming hyperinflationary collapse of the world financial system. Now the two crises are fast coming upon us, head to head.
Among the most urgent needs to combat the pandemic are crash programs for production of vaccines and of anti-viral drugs, which have shown some effectiveness in reducing flu symptoms, if administered early enough. Presently only a few countries, Japan, Germany, and Australia among them, have produced sufficient stocks of the anti-virals to protect any significant part of their population.
Large-scale production of a human vaccine, which would require a crash mobilization of the very high-technology capabilities available only in a few countries, has not begun anywhere. A demonstration project by the U.S. National Institutes of Health is scheduled to have limited doses of a vaccine ready for human testing by no sooner than early next year.
An Oct. 7 meeting of President Bush with U.S. drug manufacturers did not produce any effective plan of action. The White House itself is infected with an ideological virus—the Friedmanite nonsense that the "free market" solves all problems—which prevents the effective mobilization of government resources under the General Welfare clause of the Constitution. Thus, the Administration opposes government guarantees to purchase unsold inventories of vaccines—a measure that could ensure production of vaccines by protecting manufacturers from potential loss. Paul Offit, director of the Vaccine Education Center at Philadelphia Children's Hospital, said of the situation: "You have this thing boiling, the virus is mutating and mutating, and we don't have an infrastructure to make a flu vaccine. That's the most striking example of what's wrong with the system, of how the system has failed."
Some city and state governments have begun to run emergency preparedness simulations around the flu, testing their communications and probing their capabilities for dispensing of medications and vaccines. One inherent flaw repeatedly pointed up, is the lack of surge capability in hospitals, because of decades of budget-cutting neglect. As John Cizbe, emergency planner for the Alexandria, Va. Health Department expressed it: "The one place where our planning needs continuing work is dealing with the large number of very sick people that could exceed the capacity of the normal health system. It's not that the planning doesn't exist; it's that the capacity doesn't exist."
The Flu and Globalization
Emergency action is also required in southeast Asia, the epicenter of the avian influenza pandemic. Here again, the rampant spread of the anti-American ideology of Adam Smith economics, has hampered the fight against avian flu, in a region already beset by poverty and backwardness.
A world-famous virologist familiar with poultry practices in the region, last week blamed the practices of major agriculture companies for allowing the virus to spread. In the frenzy of globalization and big money, necessary measures of biosecurity were not maintained, he said. The flu virus got out of hand in poultry flocks, and reinfected wild bird populations which are now spreading it around the world.
Virological studies over the past three decades have established that all influenza A viruses (the sort that hit every flu season) originate in the wild bird population. Ducks, geese, and other migratory waterfowl carry these viruses in their gut, usually without showing any symptoms. The viruses mutate slightly each year and may infect poultry flocks and other mammals, from where it is often transmitted to humans.
The H5N1 virus, which was first identified in a South African tern in 1961, has made other appearances, including an infection of poultry flocks in Pennsylvania by a less deadly strain in 1983. In 1997, a highly pathogenic strain appeared in Hong Kong, where it infected poultry and produced a number of human cases. In both cases, effective measures of surveillance and control prevented the outbreaks from getting out of control.
The strain of H5N1 now threatening the world has been identified in samples taken from live bird markets in Hanoi, Vietnam, in 2001. The new deadly H5N1 strain may have evolved through contact of wild birds with domestic flocks in southern China. It was probably already present in some backyard flocks in Southeast Asia by 2001.
The huge outbreaks reported in Thailand and Vietnam in late 2003, however, were the result of lax biosecurity practices at major poultry producing installations, according to a leading virologist. Over the past 15 years, Thailand became the world's fourth largest poultry producer, exporting to Japan and Europe. CP Group, a Thai/Chinese-run conglomerate producing a wide variety of products, maintains poultry operations in Thailand, China, and Vietnam. Some of the factory farms house a million chickens. CP Group and others also run contract farming operations, supplying feed, breeding stock, and veterinary supplies to small- and medium-sized private producers.
In operations of this size, strict biosecurity measures must be maintained. These include disinfecting workers as they enter and leave the bird housings, spraying of trucks, sanitation of the cages, and vaccination and monitoring of workers for any influenza. When infection strikes, all surrounding flocks must be destroyed, and operations in the infected area must be suspended while clean-up procedures are carried out. Before restarting operations, unvaccinated sentinel animals must be introduced to test the environment. These procedures can take many months. Thailand, Indonesia, and most of the other developing nations do not have government programs to compensate farmers for this loss of production.
The avian flus are spread among poultry flocks by mechanical transmission, usually on clothing or equipment contaminated with feces from infected birds. The virology expert reported cases of contaminated trucks from some of these large poultry operations crossing national borders to supply other farms. There was also smuggling of infected chickens, and wide-scale failure to eradicate infected flocks and those in a surrounding radius. In Thailand in 2004, the government collaborated with poultry producers to avoid reporting infectious outbreaks for fear of the economic cost of destroying infected flocks. In Vietnam, there was vastly inadequate infrastructure to deal with the problem, once the flu became pandemic among birds.
After the widespread infections of Southeast Asian poultry flocks in the winter of 2003-2004, the evolved and deadly strain of H5N1 virus re-infected the wild bird population. The large die-offs of geese and other migratory birds at Qinghai Lake in China in the Spring of 2004 indicated that a human pandemic was probably on the way. The birds would fly into Mongolia, Russia, and Europe, and then down to the Mediterranean where they are now headed, carrying the deadly flu with them. Each infected chicken, and especially each human case, provides a new opportunity for evolution of the virus through recombination or reassortment, until it hits on a form which can be easily transmitted from human to human.
Emergency Measures Needed
Therein lies the threat of the new plague. Its spread has become almost unstoppable, now that the H5N1 virus is endemic in the wild bird population. Preventive measures for the protection of populations must be undertaken now. These include:
- Crash development and production of vaccine and production and stocking of antiviral drugs, authorizing funds and invoking emergency authority of government to accomplish the task;
- Massive aid to the frontline states in Southeast Asia and elsewhere to help contain further infection among animals and protect the human population;
- Crash programs to train new public health workers, expand and build new facilities, reopen all closed hospitals and medical research facilities;
- Emergency measures to assure and protect the food and water supply during the crisis; public education programs; and real emergency preparedness.
Longer-term measures must include an end to the quick-buck, globalized agriculture practices, such as the reliance on a monoculture of animals and crops, to prevent our vulnerability to future disease threats.
Some of these problems are being addressed now by international meetings called by world health officials. But the authority and funding remain vastly inadequate to the task. A closed meeting of health specialists from 80 nations took place Oct. 6-7 at the U.S. State Department. The background briefing released to the press showed that the emphasis of U.S. officials was to appeal for "transparency" of reporting from the affected nations, a difficult enterprise at a time when the diplomatic credibility of the United States is so sorely tested by the Iraq war.
At the time of the meeting, U.S. Health and Human Services Secretary Michael Leavitt took off for Asia to meet with health officials in eight nations most affected by the avian flu. Leavitt was accompanied by World Health Organization chief Jong Wook Lee and a team of world health officials. "The burning question is, will there be a human influenza pandemic," Mr. Leavitt said. "On behalf of the WHO, I can tell you that there will be. The only question is the virulence and rapidity of transmission from human to human."
Alejandro Thiermann of the World Organization for Animal Health told reporters that at least $200 million was needed to help farmers in developing nations prepare for future outbreaks of avian influenza and other diseases, according to The Nation newspaper in Thailand. That money would be used to build infrastructure, help countries monitor for bird flu in poultry, and create an incentive for farmers to report disease.
But a deeper consideration of the problem would show that figure to be drastically low, in face of a pandemic that could quickly shut down world trade, force people into starvation, and eliminate 20% of the population of a country.
Peter Davis, a veterinary public health specialist in Malaysia, is organizing an Emergency Food Committee to help plan measures for that nation of 23 million to deal with the pandemic. His proposals give an idea of how the flu might affect developing nations, and others, and what might be done about it.
Davis notes that 65% of the protein intake in Malaysia is from chicken and eggs, and much of the feed is imported. The country is only 60% self-sufficient in food overall. His emergency plans anticipate a period in which most of the chicken supply will be lost and the country might be cut off entirely from outside trade. He believes the cities would be quickly depopulated, as food shortages arise. Much of the population would go to the countryside to try to subsist on family farms held by the older generations.
To avoid starvation and anarchy, the government must be prepared to take immediate control of food supplies, Davis says. The black market must be fully suppressed. There must be free but rationed food, under a government policy of food for all, Davis proposes, citing his boyhood experience in wartime and immediate postwar England. To increase the total supply of food, Davis is investigating the stockpiling of seeds for crops such as beans, which can supply protein and are easily grown. The younger generations in the city have lost agricultural knowledge, but a reservoir of experience will exist among the older generations. Although there is much complacency now, he thinks the country will mobilize quickly with a spirit of cooperation once disaster strikes. Davis is most concerned to have emergency capabilities put in place now.
A growing awareness on the part of public officials around the world is showing itself. In the United States, leading epidemiologists and public health officials have begun to mobilize, drawing up emergency plans and demands for funding and action for Federal, state, and local officials. If we are to succeed, a call for the swift replacement of the Cheney-Bush team must, in all seriousness, be the first item on the list of avian flu emergency preparedness. For lacking competent Executive leadership, as we now do in the world's leading superpower, it is certain that the effects of this looming human catastrophe will be grossly magnified.
Let us act now, that we do not later have to deliver Horatio's oration in the closing scene of Hamlet, the corpses of his fellow Danes piled high upon the stage.
