"The Monster at the Door"

Mike Davis

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

The monster, of course, is H5N1, the lethal avian flu that first emerged
in 1997 in Hong Kong and is now entrenched — in an even more lethal
strain — in a half dozen Southeast 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 sick person (or
possibly a pig) and produce a mutant offspring that could travel at
pandemic velocity from human to human.

The media episodically gives page fifteen coverage to these warnings,
which, at most, cause a small shudder before readers turn the page to
more important stories about Paris Hilton's sex video or John Kerry's
war record.

Ironically, in our 'culture of fear' — with Ashcroft and Ridge
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, the World Health Organization's (WHO)
regional director for the western Pacific, tried to shake complacency
with an urgent warning that human-to-human transmission of avian flu was
a "high possibility."

Two weeks later (28 September), grim-faced Thai officials revealed that
the dreaded viral leap had already occurred. A young mother, who had
died on 20 September, most likely had contracted 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 from 2 to 5
per cent of humanity (50 to 100 million people — including 675,000
Americans) from the Aleutians to Patagonia.

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 per cent of infected Americans
died. In contrast, more than 70 per cent of this year's H5N1 cases (30
out of 42) have perished: a lethality comparable to ebola fever and
other nightmare emergent diseases.

The Center for Disease Control has estimated that a new pandemic would
infect 40 to 100 million Americans. Multiply that by a 70 per cent kill
rate and ponder your family's future.

Secondly, as the WHO has repeatedly emphasized, 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 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 West Nile, it has wings with
which 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 gasoline awaiting the spark of H5N1. Third World
urbanization has created unparalleled high-density concentrations of
poor people in ill health, ripe for viral slaughter.

What are the frontlines of defense against such an unthinkable
catastrophe?

One of the most urgent tasks is to ensure that poultry workers in
Southeast Asia receive ordinary flu vaccinations in order to prevent
possible mixing of human and avian genes. But current production of
seasonal flu vaccine is mostly consigned to the richer countries, and
Thai officials have complained that they cannot obtain enough donated
doses to conduct a systematic vaccination.

Meanwhile a prototype H5N1 vaccine is under development, but only in
quantities to safeguard frontline public health and safety workers in
the United States, Europe and Japan.

Pharmaceutal companies to date have not found sufficient profit
incentives to increase their output of vaccines and virals. As the New
York Times emphasized last Thursday (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
defenses 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."

"Limited production capacity largely concentrated in Europe and North
America," the WHO report continues,"would exacerbate the problem of
inequitable access."

"Inequitable access,' of course, is 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 pubic health.

This is the moral context of the deafening silence about the H5N1 threat
in the current presidential debate. Although the General Accounting
Office recently concluded that "no state is fully prepared to respond to
major public health threat," the Kerry camp has failed to sound the
tocsin about the Bush administration's lethargic preparations.

Only Ralph Nader appears to be fully 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 is warning us about the Monster at the door?

[Mike Davis is the author of Dead Cities: And Other Tales as well as
Ecology of Fear, and co-author of Under the Perfect Sun: The San Diego
Tourists Never See, among other books.]