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May 28, 2005

Hen-nyPenny, The Bird Flu Over the Cuckoo's Nest

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If, by nature, you are drawn towards gloom and doom, these days you may have begun to believe that you've died and gone to henny-penny heaven. On your checklist you've no doubt got at least the following scenarios: Dirty Bomb, it goes, there's little in the way of stopping someone with knowledge from gathering together from multiple available sources enough radioactive material to create a rather rudimentary "dirty bomb" that could turn any major US city into a Chernobyl like ghost town; Military Quagmire, i.e.; the war in Iraq drags on and as it more fully morphs into a "quagmire" (a winless war of long duration) US military vulnerability becomes more apparent to the rest of the world even as we face potential nuclear threats from Iran and North Korea; Economic Stagnancy, the US and world economies remain stagnant even at the point in which the housing bubble that was created to mitigate the collapse of the stock bubble enters into its own final days, having failed to stimulate jobs and a real recovery; Monetary Collapse, the twin US deficits that keep interest rates artificially low continue to grow resulting in a major sell-off of paper currencies; Jihad, anti-American sentiment spreads and magnifies throughout the Muslim world toppling governments in Saudi Arabia, Egypt and Pakistan (1/4th of the world's population) then spreads to the other 3/4's of the world; Global Climate Change, the global environment relentlessly continues down its path of accelerating climate change within a failed countervailing political system; AIDS?, Genocide in Africa? etc., take you pick!

But according to the World Health Organization, the NIH and other authorities, perhaps none of these match the imminent disaster that awaits us from what appears to be the inevitable spread of the Bird Flu or Avian Virus. In sheer terms of gloom, the facts are staggering. In 1918 right after World War I, the world suffered the worst flu epidemic in modern history. It is estimated that by the time the virus called the Spanish Flu had done its deadly work more people had died from it than had died in history's bloodiest war up to that time. In fact, it's possible to argue that more people died from the Spanish Flu in the course of less than two years than had died in all of the world's wars up to that time. Nobody knows what the mortality figures might be from the coming outbreak of the Bird Flu but it's sobering to note that so far, for known cases where the disease has passed from the poultry host to humans, there has been a death rate of nearly 50%. In contrast, the Spanish Flu killed about 30% of its victims..

In 1918 there were roughly 2 billion people living on Earth. Of those, roughly 22 million died from the great epidemic. Should the Avian Flu have only the same potency as the earlier highly virus, that would mean in today's world of over 6 billion a death toll of some 66 million people. But according to many epidemiologists the death toll this time around will go much higher. This is because of the speed in which the disease will be propelled from country to country and continent to continent via air travel. At any rate, public health resources even in the richest countries will be totally overwhelmed whereas in the poor countries where population density is often the highest, the speed of transmission will completely overrun already frayed civil societies.  In many countries we can expect total collapse as the scourge races through populations

In the looming Avian Flu outbreak scenario, which many of the most credible experts believe is not a question of if but of when (see this month's issue of Nature Magazine), the deaths and ensuing panic will only be the beginning of the suffering. A lasting result of a serious pandemic, will be the kind of economic devastation never before experienced on a worldwide scale. We have to think that in a global economy, many, if not most, of our consumer goods are manufactured in Asia, where the disease is spawning; conversely, we in North America supply many parts of the world with critical food supplies. An attempt to seal our borders from the flow of people and goods in this globally interdependent world, might provide short-term protection  but would lead to unparalleled disruptions in fuel and goods supplies. Massive segments of the US population would be thrown out of work and it's likely that civic disorders would erupt around the country, as shortages and rumors spread even faster than the disease. More than likely, the quarantine would not work for long as the pressures for contraband grew and threatened populations pushed across the border.  For the amount of economic dislocation spawned by a narrow quarantine, we only have to look as far as Toronto during the SARS outbreak there a couple of years ago, which directly affected no more than 500 patients but which brought the city to a standstill.

If you've read this far, you are more than likely to be asking yourself what flavor tobacco we have been smoking here at DW HQ. Surely, this is an overly bleak picture of what such a pandemic can do to a modern society with advanced medical, pharmaceutical and public health capabilities. You may be imagining that in the face of a certain danger, the advanced countries like the US are feverishly building up supplies of vaccines or virus killing drugs.. The picture, unfortunately, harkens back to last year's Asian Flu vaccine shortage. At the time, we all learned a little about the problems associated with vaccine production. It seems, however, that although we can try to get a jump on what we think the virus may look like,  efficient vaccines can be developed only after the precise virus configuration has been determined And that will not happen until the virus that now mainly spreads from bird to bird finds a way not only to leap over to humans and other mammals but mutates in such a way that it can spread directly from human to human. Only then will scientists know the final form. The other piece of the vaccine puzzle is the technique in which vaccines are produced. We also learned last year that flu vaccines require eggs in the production process and that the process itself is highly tricky. Normally, it takes months to get up to full production speed and even then rigorous testing is needed to ensure the vaccine doesn't become just another facet of the problem. Worldwide, there are very few licensed production facilities.

It's clear to us that this peril is as great as humanity has faced in our lifetime including MAD (Mutual Assured Destruction) and the neutron bomb. In perspective, it turns the relatively limited capabilities of the ""terrorists" --as in War on Terrorism-- into a minor diversion. Billions of dollars now being earmarked for military threats that may someday appear on the horizon should be immediately diverted from the Pentagon's budget to that of the Department of Health and Human Services. It would probably take an effort like that of  the Manhattan Project in WWII as the editorial in Nature puts it:

if the next pandemic were to arise five years from now, there would have been breathing space to stimulate our drug and vaccine industries to limit the damage it would cause. But that requires urgent action now. As matters stand, a vaccine against a pandemic flu would not be ready until at least six months after a pandemic starts. Too late: by then the worst of the pandemic would already have happened.

We here at DW, of course, wouldn't know a virus from a spore under a microscope, so we have to take the word of people like Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases but what we do know a little about are the ways of Washington and, sadly, our democracy; The chances of money for true national defense moving from DOD, or any other pocket of the Budget, to HHS or the UN's WHO in time to truly mitigate the crisis are about as big as that virus, or was it a spore?

Posted by dymaxion at 01:28 PM


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