The Avian Flu Threat Is Real
(Mar. 16, 2006)
By Stephen Soldz
One of the many serious dangers arising
from the Bush administration's persistent record of lies and distortions
is that, for many, whatever visceral faith they had that the government
would attempt to deal sensibly with emergencies has dissipated. United
States governments are well-known to deceive when foreign policy is at
stake. But, in general, when domestic emergencies loom, we have been
able to assume a basic level of honesty and competence. But no longer.
The lies and incompetence that surrounded the Hurricane Katrina response
and reconstruction, in conjunction with the Medicare prescription drug
disaster, have focused attention on the overwhelming incompetence and
duplicitous nature of this administration in dealing with domestic
problems.
Given the administration's record, it is no surprise that cries of alarm
are met with skepticism. Thus, when President Bush finally acknowledged
the risk of an avian flu pandemic and proposed strategies to deal with
it, a certain amount of skepticism is appropriate. However, misjudging
the extent and nature of the threat can lead to bad policies and these
poor judgments can be a serious menace. Progressives must be careful not
to let their skepticism about this administration and its actions
obscure their ability to perceive real risks.
Unfortunately, a recent article by ZNet commentary by Lucinda Marshall
[The Ultimate Chicken Joke] illustrates the danger. Marshall makes four
points: 1) the occurrence of a pandemic is uncertain; 2) the main
treatment option, Tamiflu, has unknown efficacy; 3) vaccines under
development are just that, under development, and thus of unknown
efficacy; and 4) pharmaceutical companies stand to gain a lot of money
from stockpiling Tamiflu and Vaccines. She therefore concludes that the
threat of avian flu is largely bogus and is being hyped by the
administration to channel money to these companies. Let's examine these
claims.
Assessing the Danger
Marshall is, of course, correct that the occurrence of a pandemic is far
from certain. But she incorrectly minimizes the risk. She cites a
Congressional Budget Office report as stating that the probability is
only "one third of one percent." She neglects to tell the reader that
this estimate is just the historical rate of a severe influenza pandemic
[the report uses the phrase "based only on historical frequencies" to
describe the basis for this estimate], and is not based on any estimate
of the likelihood that H5N1, the current avian flu virus, will spawn a
human pandemic. Marshall neglects to mention that the report also states
that, based on history, "there is a roughly 3 percent to 4 percent
probability of a pandemic occurring in any given year" (p. 5). The
difference is between a mild pandemic (causing perhaps a hundred
thousand American deaths) and a severe pandemic, with many more victims.
The report also states, immediately after the 0.3 percent estimate, that
"given the evidence of an existing epidemic of H5N1 in fowl, and the
possibility that it might mutate to circulate efficiently in humans, the
probability may exceed the historical frequency" (p. 6). If a severe
avian flu pandemic occurs, the report estimates that 2 million Americans
will die, whereas a mild pandemic (a much more likely event) will cause
100,000 deaths. Of course, many times that would die worldwide under
either scenario.
Others, including the World Health Organization and many other
scientists and public health organizations are also warning of an avian
flu pandemic. Thus the WHO states on the avian flu FAQ "the risk of
pandemic influenza is serious". As another of myriad examples, the
mainstream Australian Lowy Institute estimates that, under a worst case
avian flu pandemic scenario, 143 million people would die worldwide
while a mild pandemic would result in 1.4 million deaths.
Additionally, many progressives who have examined the issue also warn of
the threat from avian flu. Thus, Laurie Garrett, author of the
award-winning Betrayal of Trust: The Collapse of Global Public Health,
expressed her concern in the title of a recent article: Unless We Act
Now, Bird Flu May Win [for a critique of Garrett's strategy to prevent
this occurring, see Wherein I disagree with Laurie Garrett]. And Mike
Davis, surely no friend of big pharma, expresses his view in the title
to his 2005 book: The Monster at Our Door: The Global Threat of Avian
Flu; Davis, in fact, believes that a pandemic is largely inevitable and
will occur soon. As he states in a recent article: "'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" 6.
Further, the authors of the progressive public health blog Effect
Measure [http://effectmeasure.blogspot.com/] are quite concerned about
the threat facing the human race from avian flu in the next several
months or years. While these progressive authors disagree among
themselves as to the degree of risk and what approaches should best be
used to respond to the risk, they agree that there is considerable
danger, danger that warrants major efforts now to avoid the worst.
It is important to realize that deaths (mortality in epidemiological
lingo) is not the only major risk from avian flu. Even a mild pandemic
could cause massive economic costs and dislocation, and a major pandemic
could be economically catastrophic. Imagine what would happen if
significant numbers of truck drivers or those who stock grocery stores
were to become ill, or if panic, or just sensible public health policy,
leads huge numbers of economically important personnel to stay away from
work.
The Lowy Institute, in their report Global Macroeconomic Consequences of
Pandemic Influenza, examine the economic impacts of an influenza
pandemic under different scenarios. They estimate that a mild pandemic
[similar to that which occurred in 1968-69, the mildest influenza
pandemic of the 20th century] would cost the world $330 billion. In
contrast, the worst-case scenario they investigate would result in a net
loss of $4.4 trillion to the global GDP, a whopping decline of 12.6% in
world GDP (this in addition to the 143 million deaths they estimate
would result).
Also important to note is that the Lowy Institute analysis shows that
the economic losses would be disproportionately borne by the developing
countries. They predict that a pandemic would result in "a major shift
of global capital from the affected economies to the less affected safe
haven economies of North America and Europe" (p. 26).
It should also be noted that avian flu will have major economic impacts
even if it never becomes a human pandemic. Just coping with the now
inevitable world-wide spread in birds of avian flu will not be cheap.
The World Health Organization estimates that, already, the infection has
cost the world's farmers $10 billion and that 300 million farmers have
been affected. As the disease spreads among birds, these costs will
inevitably rise significantly.
Tamiflu Stockpiling
Marshall is correct that there are serious reservations about the
efficacy of Tamiflu for avian flu. In the last couple of months, a few
avian flu patients have unsuccessfully been treated with the drug,
leading to belief that Tamiflu-resistant strains of the H5N1 virus are
developing, potentially reducing the effectiveness of the drug should a
pandemic occur. It should also be pointed out that these reports
appeared after the President's plan to stockpile Tamiflu was prepared.
There does appear to be another drug, Relenza, which (according to the
December 22, 2005 New England Journal of Medicine) is less likely to
facilitate the development of resistant influenza strains. Relenza,
however, is currently only available in an inhaled form which can make
administration more difficult.
I am not an expert on drug treatment of influenza. However, given the
potential devastation that a pandemic would cause, stockpiling a drug
that might have some effectiveness is not irrational. If a pandemic
breaks out, there is a danger that many vital systems, such as out
health and food distribution systems could experience severe strain as
workers get sick or stay home to care for sick family members. A drug of
only limited effectiveness might make the difference between strain and
collapse of those systems.
Marshall's conspiracy view of Tamiflu stockpiling does not explain why
many other countries are taking similar steps, or why the World Health
Organization is recommending the development of Tamiflu stockpiles 3. In
fact, the world capacity to produce Tamiflu is severely limited, so that
the US, having started planning late, will probably not be able to get
much of its desired stock of the drug. Roche, the manufacturer of
Tamiflu, will not need President Bush's help to sell all the Tamiflu
they can manufacture in the foreseeable future. The manufacturer of
Relenza, GlaxoSmithKline, has recently announced plans to increase
production of the drug. No doubt, they also will not need the Bush
administration's help in selling all they can manufacture in the
foreseeable future.
Vaccines
The situation with vaccines is even murkier. Marshall is, again, correct
that currently there are no human vaccines for avian flu. Given an
illness with a potential for killing millions, I sure wish there was. It
is a technical issue to estimate the likelihood of success in rapid
development of such a vaccine. I defer to the experts on this. But if
such a vaccine was developed, given the numerous warnings of a
significant avian flu threat, it certainly would make sense to produce
and stockpile it if possible.
A major problem with the vaccine strategy for coping, assuming a vaccine
could be developed, is that the world's production capacity for
influenza vaccine is limited to perhaps 500 million doses. European
countries have already placed orders for much of the potential vaccine,
should one be developed. The United States has some production capacity
and stands a chance of getting at least some vaccine. But most of the
world, including virtually all developing countries, would obtain little
or no vaccine and be left out in the cold. It is not clear if world
production capacity could be ramped up in time, but this option should
be explored. Considerations of profit and patents should not be allowed
to stand in the way.
Who Profits
Marshall is again correct that pharmaceutical companies stand to make a
lot of money from selling Tamiflu and avian flu vaccines. The system of
private development and ownership of drugs in the world today is
irrational and immoral. But she presents no evidence that the major
motive behind the administration's plan is to enrich these companies.
Further, her theory in inconsistent with the fact that the Bush
administration has essentially ignored the avian flu threat for two
years during which public health professionals were becoming
increasingly concerned. If the goal was to enrich the pharmaceutical
companies, why waste two years of potential enrichment?
None of this is to say that the administration plan to respond to avian
flu is the best or is even adequate. [See my: Avian Flu Excuses Begin]
This plan places far too great an emphasis on Tamiflu and vaccines and
not enough on either prevention or strengthening our public health
infrastructure to cope with a potential pandemic. The plan does not
place primary responsibility for coping with a pandemic where it
belongs, with the federal government's pubic health professionals.
Rather, it places primary responsibility with state and local
governments that are ill-equipped to cope with a risk of this magnitude.
Even in the case of its centerpiece Tamiflu stockpile, the plan states
that the resource-starved states and localities are supposed to develop
the bulk of these stockpiles, not the federal government. The plan
devotes only limited resources to prevention efforts, such as
reimbursing poultry farmers in poor countries for culling their sick.
These prevention efforts may not, at this late date, prevent a pandemic,
but, as the World Health Organization points out, the efforts may buy
time for countries to prepare if a pandemic breaks out.
Most tellingly, as already mentioned, the administration's avian flu
plan was developed two years after many in the public health community
became aware of a dangerous mutation in the H5N1 virus which made it a
greater threat than had previously been the case. That is, it is too
little, too late, which is quite the opposite of what Marshall argues.
Of course, in the broader scheme of things, Marshall's comments are not
likely to significantly impact public health policy. But the attitudes
she exemplifies are no doubt held by other progressives suspicious of
anything said or done by this administration. We must be careful,
however, to not let that justified suspicion interfere with what little
is being done in this country to prepare for this potential, though not
inevitable, catastrophe. At the same time, we must, however, exercise
vigilance to identify counterproductive policies quickly and to call
public attention to them. We also must resist attempts to protect
Americans while letting the poorer parts of the world suffer the full
effects of any potential pandemic unaided. In addition to being immoral,
such a policy would be counterproductive. In a pandemic, an injury to
one will, indeed, be an injury to all.
Stephen Soldz, a researcher, psychoanalyst
and public health researcher, is Director of the Center for Research,
Evaluation, and Program Development at the Boston Graduate School of
Psychoanalysis. He is a member of Roslindale Neighbors for Peace and
Justice and founder of Psychoanalysts for Peace and Justice. He
maintains the Iraq Occupation and Resistance Report web page and the
Psyche, Science, and Society blog.
|
