http://socialistworker.org/2004-2/517/517_05_MikeDavis.shtml

Mike Davis on the looming threat of a deadly flu pandemic

"This is a time bomb"

October 22, 2004 | Page 5

THE POSSIBLE emergence of a deadly new strain of influenza is a
public health catastrophe waiting to happen, but the world's most
powerful governments, including the U.S., have no response
planned--and profit-hungry health care corporations are doing nothing
to head off the threat.

That's the case made by MIKE DAVIS, a leading left-wing voice and
author of numerous books, including Ecology of Fear and City of
Quartz. Davis' recent article, "The Monster at the Door," outlines
the threat of a global pandemic from avian, or bird, flu if a strain
of the virus develops that can be passed not only from animals to
humans, but between humans. The article appeared shortly before a new
factor emerged--the British government's announcement that it was
shutting down a factory run by Chiron Corp. that produces flu
vaccine, including about half of the annual U.S. supply.

Here, Davis talks to Socialist Worker's ALAN MAASS about the new flu threat.

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WHY DO you think the danger of a flu pandemic is so severe today?

SINCE THE 1918-19 pandemic, which killed at least 21 million people,
and as many as 100 million people, science has been aware that one of
the greatest public health risks would be the reemergence of a deadly
strain of flu.

The new strain of avian flu was first identified in 1997 in Hong
Kong. What's so troubling about it is that in the United States in
1918 and 1919, about 2.5 percent of the people who got the flu died.
That's very high--10 or 20 times higher than die from the normal flu.
But the avian flu in its current form in Southeast Asia is killing
fully 70 percent of the people who get it. If that virulence were
preserved in a human-to-human transmissible form, it would be a
public health danger of almost unimaginable magnitude.

The basic strategy for dealing with this is a containment
strategy--to kill off infected poultry in Asia. It worked in Hong
Kong in 1997, but it's utterly failed now. There's plentiful evidence
that the avian flu is now being spread by wild birds. It's already
been detected in pigs, although the Chinese didn't tell anybody about
this for a while. And you've already had what seems to be the first
human-to-human transmission.

It's an extraordinary public health risk for the world, and the Third
World is basically unprotected against it. Once the containment
strategy breaks down, if a human-to-human strain would emerge, as
most medical researchers believe is virtually inevitable, there's no
other line of protection for poor people.

There is a prototype vaccine, but in extremely limited quantities,
and it's not even certain that enough of that would be produced to be
given to public health workers in the richest countries. More likely,
what you would have is a form of triage where you would have to make
decisions about whether public health workers or frail, more
susceptible people would get the vaccine first. So even the rich
countries are unlikely to have enough of this vaccine around to do
anything more than protect a small group of people.

But the Third World is utterly unprotected. And of course, the
difference between 1918-1919 and today are 1 billion people living in
slums in the cities of the South--unparalleled concentrations of poor
people in unsanitary conditions, many of them with immune system
disorders. It's hard to imagine a more nightmarish disease scenario.

Finally, to top all of this off, the research on the avian strain
indicates that of the four antiviral drugs available to deal with
flu, three won't work at all, and it's not clear whether the fourth
and most powerful one will work. These drugs are also scarce.

So this is a massive failure of both local and international public
health networks--a failure to invest in Third World public health,
the reliance on a handful of companies to manufacture vaccines and
antiviral drugs. You couldn't find, I think, a more classic
contradiction between profit and public health than this current
situation.

And what's kind of bizarre is that if you read the World Health
Organization reports, or the New Scientist magazine, or elsewhere,
the level of concern is almost apocalyptic. Yet this issue has been
virtually absent from political debate in the U.S.--except from Ralph
Nader, who's well aware of the danger. But as far as I know, no one
has responded to his letters to George Bush or his calls to make this
issue an emergency.

WHY IS this particular strain of the flu so deadly?

WHAT'S TROUBLING is that the people who've died in Asia have died in
the hospital, under modern hospital conditions. But it seems to take
the form--like 1918-1919--of an acute viral pneumonia, which is
virtually unstoppable.

If you've read any of the accounts of 1918 and 1919, it was quite
extraordinary--people died within an hour or two of getting it.
Mortality was particularly high among healthy young adults. It's
unclear yet whether that will be the pattern here. There have been
relatively few human cases so far, but the virulence of it is
unquestionable, and if that is preserved in a human strain, it really
is the worst-case scenario.

Right now, the problem, particularly in Thailand, is a shortage of
normal seasonal flu vaccine, which is why the loss of half of the flu
vaccine capacity for the United States is so significant.

Right now, the major hope of stopping the evolution of this into a
pandemic is to ensure that people who handle poultry in Southeast
Asia are vaccinated against normal flu. It won't prevent them from
getting avian flu, but if they did, it would prevent the genetic
exchange that would mutate the flu. But the New Scientist published a
big story on the crisis in Thailand--and this is even before the
Chiron scandal--saying they simply can't get enough ordinary flu
vaccine to create this firebreak around the avian flu.

WHY IS the normal flu vaccine in such short supply?

FIRST OF all, a point to reemphasize is the danger of flu. People
tend to take flu for granted. Certainly, doctors, medical researchers
and the pharmaceutical industry have always been fully aware that flu
is among the most dangerous and lethal of epidemic diseases. There
have been four identified pandemics in history, and it's been clear
that a pandemic would return and probably originate in some direct
transmission between birds and humans, or maybe in pigs.

The danger and the need for investment and development of flu
vaccines have always been clear. But for the drug industry, it's
simply more profitable to do medicines that would deal with really
"important" things like erectile disorders.

Flu vaccine is produced in one huge batch. You only sell it once. If
the flu doesn't turn out to be as bad as expected, you may have
millions of doses unsold. The profit margin is relatively small
compared to other kinds of medicines. So the reliance on the
marketplace to generate flu vaccines and antivirals has been a
disaster.

But of course, it's part of the larger problem that the corporate
drug industry simply doesn't develop the medicine and vaccines that
are most needed by people--they're not profitable enough.

I should also point out that the avian flu is so virulent that a
vaccine can't be produced in the way normal flu vaccines are--which
are cultured in fertile eggs. The avian flu simply kills the fertile
eggs. It's a much more complicated and expensive method of
cultivating the vaccine in live cells, which also limits the
production of it.

Right now, if you log on to the Centers for Disease Control or the
Department of Health and Human Services Web sites, the national
pandemic plan that the Bush administration has is to repeat 1918 and
1919--to shut the whole country down, everybody will wear a mask, and
we'll stay at home for a few months.

BUT IF governments like the U.S. have known about the threat, why
have they been so slow to act?

THE FOCUS of the existing system has been on monitoring--particularly
the monitoring of human cases. It's now clear that veterinary
monitoring is incredibly important, too, and that doesn't work very
well in a lot of countries.

Understanding this epidemic, like any epidemic, means first of all to
understand its ecology. The reservoir of influenza is the mixed
agriculture of southern China--of birds and pigs and humans in
intense contact. But that's been radically modified by the factory
poultry industry that's emerged in the last decade or so in a number
of countries. There's lots of evidence that factory agriculture
absolutely increases the danger of the epidemic.

The other factor that's so radical and so essentially important is
the huge underinvestment and neglect of public health, particularly
in the cities of the Third World--which creates, literally, wildfire
conditions for the emergence of diseases and epidemics.

If you point to any single factor, the neglect of public health is
the most important. Second is the total reliance on the marketplace
to generate vaccines and medicines. And third would be the capitalist
mode of factory agriculture. This pandemic flu threat grows directly
out of capitalist transformations of agriculture, capitalist
urbanization and the hegemony of the drug industry.

Of course, Ralph Nader has been calling for a national emergency
summit to deal with the problem. It is a very serious public health
risk in rich countries, but it is an almost apocalyptic threat to
poor people, who simply don't have access to the vaccines, to the
antivirals, to any of the things that would be required to manage the
acute pneumonia that typically is what kills people.

WHEN WE think about the threat of disease or other disasters like
hurricanes and earthquakes, we're taught to believe that these are
"natural" disasters that can't be stopped. But the way you describe
it, there are so many social factors involved--especially the way
capitalist society is organized, and what it prioritizes.

THERE ARE hardly ever--if any--natural disasters or completely
natural pandemics. Mortality is determined as much or more by social
conditions--the nature of the housing supply in the case of
earthquakes, or land use in the case of hurricanes, or sanitation
conditions. The social conditions are paramount.

We now see on a world scale unparalleled vulnerability and
unparalleled hazards. The single biggest problem is simply urban
poverty, on an almost unimaginable and ever-increasing scale. In most
of the urban growth that's occurring around the world, people are
building their own houses. We see cities modifying their
environmental conditions or resources and making themselves
extraordinarily vulnerable.

So the perception that people have of an increasingly hazardous
world, with an increasing frequency of disaster, is absolutely true.
But this is rooted in the mode of urbanization and the kind of
agriculture and farming we're dependent on. AIDS and HIV should have
been the wake-up call about epidemic disease--particularly where it
would take its greatest toll.

One of the illusions of the era, of course, has been that rich people
or rich countries could wall themselves off from the diseases and
disasters of the poor. And that simply isn't true. Public health came
about in the first place in the mid-19th century, when the middle
class started getting cholera--and realized that the slum conditions
in the great cities threatened them as well.

But now we live as though rich Americans can be protected by vaccines
and antivirals and wonder medicine--and the health of other people
can be totally ignored or neglected. It can't. It's essentially a
time bomb.

What's really important for socialists to point out is not only the
capitalist origins of this crisis, but the question of priorities.
Because if this were to suddenly become a big public issue in the
U.S., there would be a panic, and it would all center on protecting
ourselves and protecting the American middle classes. One issue that
has to be hammered on is that the greatest threat is to poor
people--and particularly poor people in city slums.