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Deadly avian flu on the wing
By Mike Davis
The first bar-headed geese have already arrived at their wintering grounds near
the Cauvery River in the southern Indian state of Karnataka. Over the next 10
weeks, 100,000 more geese, gulls and cormorants will leave their summer home at
Lake Qinghai in 
western China, headed for India, Bangladesh, Myanmar, and, eventually,
Australia.
An unknown number of these beautiful migrating birds will carry H5N1, the avian
flu sub-type that has killed 61 people in Southeast Asia and which the World
Health Organization (WHO) fears is on the verge of mutating into a pandemic
form like that which killed 50 to 100 million people in the fall of 1918.
As the birds arrive in the wetlands of South Asia, they will excrete the virus
into the water, where it risks spreading to migrating waterfowl from Europe, as
well as to domestic poultry. In the worst-case scenario, this will bring avian
flu to the doorstep of the dense slums of Dhaka, Kolkata, Karachi and Mumbai.
The avian flu outbreak at Lake Qinghai was first identified by Chinese wildlife
officials at the end of April. Initially it was confined to a small islet in
the huge salt lake, where geese suddenly began to act spasmodically, then to
collapse and die. By mid-May it had spread through the lake's entire avian
population, killing thousands of birds. An ornithologist called it "the biggest
and most extensively mortal avian influenza event ever seen in wild birds".
Chinese scientists, meanwhile, were horrified by the virulence of the new
strain: when mice were infected they died even quicker than when injected with
"genotype Z", the fearsome H5N1 variant currently killing farmers and their
children in Vietnam.
Yi Guan, leader of a famed team of avian flu researchers who have been fighting
the pandemic menace since 1997, complained to the British Guardian newspaper in
July about the lackadaisical response of Chinese authorities to the
unprecedented biological conflagration at Lake Qinghai.
"They have taken almost no action to control this outbreak. They should have
asked for international support. These birds will go to India and Bangladesh
and there they will meet birds that come from Europe." Yi Guan called for the
creation of an international task force to monitor the wild bird pandemic, as
well as the relaxation of rules that prevent the free movement of foreign
scientists to outbreak zones in China.
In a paper published in the British science magazine Nature, Yi Guan and his
associates also revealed that the Lake Qinghai strain was related to officially
unreported recent outbreaks of H5N1 among birds in southern China. This would
not be the first time that Chinese authorities have been charged with covering
up an outbreak. They also lied about the nature and extent of the 2003 SARS
epidemic, which originated in Guangdong but quickly spread to 25 other
countries. As in the case of SARS' whistleblowers, the Chinese bureaucracy is
now trying to gag avian-flu scientists, shutting down one of Yi Guan's
laboratories at Shantou University and arming the conservative Agriculture
Ministry with new powers over research.
Meanwhile, as anxious Indian scientists monitor bird sanctuaries throughout the
sub-continent, H5N1 has spread to the outskirts of Lhasa, the capital of Tibet;
to western Mongolia; and, most disturbingly, to chickens and wildfowl near the
Siberian capital of Novosibirsk.
Despite frantic efforts to cull local poultry, Russian Health Ministry experts
have expressed pessimism that the outbreak can be contained on the Asian side
of the Urals. Siberian wildfowl migrate every fall to the Black Sea and
southern Europe; another flyway leads from Siberia to Alaska and Canada.
In anticipation of this next, and perhaps inevitable, stage in the world
journey of avian flu, poultry populations are being tracked in Moscow; Alaskan
scientists are studying birds migrating across the Bering Straits, and even the
Swiss are looking over their shoulders at the tufted ducks and pochards
arriving from Eurasia.
H5N1's human epicenter is also expanding: in mid-July Indonesian authorities
confirmed that a father and his two young daughters had died of avian flu in a
wealthy suburb of Jakarta. Disturbingly, the family had no known contact with
poultry and near panic ensued in the neighborhood as the media speculated about
possible human-to-human transmission.
At the same time, five new outbreaks among poultry were reported in Thailand,
dealing a terrible blow to the nation's extensive and highly publicized
campaign to eradicate the disease. Meanwhile, as Vietnamese officials renewed
their appeal for more international aid, H5N1 was claiming new victims in the
country that remains of chief concern to the WHO.
The bottom line is that avian influenza is endemic and probably ineradicable
among poultry in Southeast Asia, and now seems to be spreading at pandemic
velocity among migratory birds, with the potential to reach most of the earth
in the next year.
Each new outpost of H5N1 - whether among ducks in Siberia, pigs in Indonesia or
humans in Vietnam - is a further opportunity for the rapidly evolving virus to
acquire the gene or even simply the protein mutation that it needs to become a
mass-killer of humans.
This exponential multiplication of hot spots and silent reservoirs (as among
infected but asymptomatic ducks) is why the chorus of warnings from scientists,
public-health officials, and finally, governments has become so plangently
insistent in recent months.
The new US Health and Human Services Secretary Mike Leavitt told the Associated
Press in early August that an influenza pandemic was now an "absolute
certainty", echoing repeated warnings from the WHO that it was "inevitable".
Likewise, Science magazine observed that expert opinion held the odds of a
global outbreak as "100%".
In the same grim spirit, the British media revealed that officials were
scouring the country for suitable sites for mass mortuaries, based on official
fears that avian flu could kill as many as 700,000 Britons. The Blair
government is already conducting emergency simulations of a pandemic outbreak
("Operation Arctic Sea") and is reported to have readied "Cobra" - a
cabinet-level working group that coordinates government responses to national
emergencies, like the recent London bombings, from a secret war room in
Whitehall - to deal with an avian flu crisis.
Little of this Churchillian resolve is apparent in Washington. Although a sense
of extreme urgency is evident in the National Institutes of Health, where the
czar for pandemic planning, Dr Anthony Fauci, warns of "the mother of all
emerging infections", the White House has seemed even less perturbed by
migrating plagues than by wanton carnage in Iraq.
Prevention and cure
As the president was packing for his long holiday in Texas, the Trust for
America's Health was warning that domestic preparations for a pandemic lagged
far behind the energetic measures being undertaken in Britain and Canada, and
that the administration had failed "to establish a cohesive, rapid and
transparent US pandemic strategy".
That increasingly independent operator, Senate majority leader Bill Frist, had
already criticized the administration in an extraordinary (and under-reported)
speech at Harvard at the beginning of June. Referring to Washington's failure
to stockpile an adequate supply of the crucial antiviral oseltamivir (or
Tamiflu), Frist sarcastically noted that "to acquire more anti-viral agent, we
would need to get in line behind Britain and France and Canada and others who
have tens of millions of doses on order".
The New York Times on its July 17 editorial page, a May 26 special issue of
Nature and the July/August issue of Foreign Affairs have also hammered away at
Washington's failure to stockpile enough scarce antivirals - current
inventories cover less than 1% of the US population - and to modernize vaccine
production. Even a few prominent Senate Democrats have stirred into action,
although none as boldly as Frist at Harvard.
The Department of Health and Human Services, in response, has sought to calm
critics with recent hikes in spending on vaccine research and antiviral
stockpiles. There has also been much official and media ballyhoo about the
announcement of a series of successful tests in early August of an experimental
avian flu vaccine.
But there is no guarantee that the vaccine prototype, based on a
"reverse-genetically-engineered" strain of H5N1, will actually be effective
against a pandemic strain with different genes and proteins. Moreover, trial
success was based on the administration of two doses plus a booster. Since the
government has only ordered 2 million doses of the vaccine from pharmaceutical
giant Sanofi Pasteur, this may provide protection for only 450,000 people. As
one researcher told Science magazine, "it's a vaccine for the happy few".
At the least, gearing up for larger-scale production will take many months and
production itself is limited by the antiquated technology of vaccine
manufacture, which depends on a vulnerable and limited supply of fertile
chicken eggs. It would also likely mean the curtailment of the production of
the annual winter flu vaccine that is so often a lifesaver for many senior
citizens.
Likewise, Washington's new orders for antivirals, as Frist predicted, will have
to wait in line behind the other customers of Roche's single Tamiflu plant in
Switzerland. In short, it is good news that the vaccine tests were successful,
but that does little to change the judgment of the New York Times that "there
is not enough vaccine or antiviral medicine available to protect more than a
handful of people, and no industrial capacity to produce a lot more of these
medicines quickly".
Moreover, the majority of the world, including all the poor countries of South
Asia and Africa where, history tells us, pandemics are likely to hit especially
hard, will have no access to expensive antivirals or scarce vaccines. It is
even doubtful whether the WHO will have the minimal pharmaceuticals to respond
to an initial outbreak.
Recent theoretical studies by mathematical epidemiologists in Atlanta and
London have raised hopes that a pandemic might be stopped in its tracks if 1 to
3 million doses of oseltamivir (Tamiflu) were available to douse an outbreak in
a fail-safe radius around the early cases.
After years of effort, however, the WHO has only managed to inventory about
123,000 courses of Tamiflu. Although Roche has promised to donate more, the
desperate rush of rich countries to accumulate Tamiflu will be certain to
undercut the WHO's stockpile.
As for a universally available "world vaccine", it remains a pipe-dream without
new, billion-dollar commitments from the rich countries, above all the United
States, and even then, we are probably too late.
"People just don't get it," Dr Michael Osterholm, the outspoken director of the
Center for Infectious Disease Research and Policy at the University of
Minnesota, recently complained. "If we were to begin a Manhattan Project-type
response tonight to expand vaccine and drug production, we wouldn't have a
measurable impact on the availability of these critical products to
sufficiently address a worldwide pandemic for at least several years."
"Several years" is a luxury that Washington has already squandered. The best
guess, as the geese head west and south, is that we have almost run out of
time. As Shigeru Omi, the Western Pacific director of WHO, told a UN meeting in
Kuala Lumpur in early July: "We're at the tipping point."
Mike Davis is the author of the just-published Monster at our
Door, The Global Threat of Avian Flu (The New Press) and the forthcoming
Planet of Slums (Verso).
Buy this book
(Copyright 2005 Mike Davis)
(Used by permission Tomdispatch) |
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