[I]n the current models in how pandemic flu might spread, most of the research has been on influenza in rural regions and at rural densities. The missing link in all of this is the fact that there are now, according to the United Nations, a billion people living in slums in the mega-cities of the third world. This is, of course, an exponentially larger slum population than existed in 1918. Of course, a large portion of the population of poor, urban people live in appalling conditions of public sanitation. They live with medical and public health infrastructures that have been in many cases devastated by debt and by structural adjustment in the 1980s.
So this actually offers the absolute optimum situation not only for the rapid spread of an avian flu epidemic or other potential epidemics, pandemics, but also it preserves its virulence. If a virulent virus can easily jump from one host to another and has a large enough supply of hosts, there's no reason for its virulence to be attenuated. In 1918 the influenza pandemic of that time had had to cross a number of fire breaks and gradually lost its virulence, eventually becoming one of the flus that we now get every year. And some researchers fear that because of concentrated urban poverty across the world, combined with rapid air travel, you're treating conditions that would preserve the virulence, that is, the killing power, of pandemic flu. So, in this aspect it might even be worse than 1918.
[E]ven in a rich country like the United States, but a country with devastated public health infrastructures with shortages of hospital beds and intensive care facilities would be overwhelmed with the huge number of cases of pneumonia, both bacterial and viral pneumonia. And even more important than possessing stocks of anti-virals or potential flu vaccine really is the basic health of our local hospital system and our public health responders.
[W]hat's important to grasp is that this isn't just the return of an old monster, but it is a new disease threat that we've partially attended the birth of. That is, the ecology of influenza, like other diseases, has changed dramatically in the last 10 or 15 years because of economic globalization, because of the breakdown of biological barriers between animal and human populations, because of air travel, because of urbanization, but in this case, above all, because of something called the “livestock revolution.” And that's been the generalization around the world of the American model of poultry production, the Tyson model. Tyson is the giant poultry producer, one of the most exploitative corporations in the United States with just an appalling record of working conditions. Tyson kills several billion chickens a year. It's created huge conurbations of chickens, unprecedented concentrations of chickens.
Now this model has spread to East Asia. China has become the biggest consumer of poultry in the world, and the leading company involved in China is a Thai-based firm called C.P., which has used the Tyson model, a vertical integration of concentrating poultry in enormous warehouses. And it was directly involved in the Thai government's cover-up of the initial outbreak of avian flu in Thailand last year. That is, the government gave the corporate poultry producers in Thailand time to clear their inventories to slaughter sick chickens to send them to Europe before it notified or was forced to notify the rest of the world that avian flu existed. It also failed to notify the peasant backyard poultry producers whose children then began to die from the avian flu. So the outbreak of avian flu -- and H5N1 is only one of several subtypes that have managed to jump to human beings. There are other cases in Holland two years ago and even in British Columbia last year. All this indicates that human intervention, the industrialization of poultry, above all, has sped up the evolution of influenza. It’s changed the nature of disease by changing its ecology.
[T]he people in the greatest danger, of course, poultry workers themselves. The corporate poultry industries have undertaken an international offensive, claiming that the fault resides entirely with the backyard producers, the tens of millions of small farmers across the world who have free-range chickens in constant contact with ducks and wild birds and children playing amongst them. And although this is part of the ecology of avian flu, the thing that has changed the way that flu emerges, that has amplified, I think, the danger and the speed with which it evolves, are these huge industrialized concentrations. Having said all of that, avian flu at this point is still relatively difficult to get. Some people pick it up. Other people can have intense contact with infected birds, don’t seem to get it. Nobody understands exactly why. Pandemic flu would mean a genetic modification or even just the mutation of a few shifts of a few amino acids that would give it the ability to spread as a normal seasonal flu, able to infect, for instance, up to one-third of Americans in a single season.
[R]ight now and for the next several years at the very least, where the real attention has to go, and I totally support the generic manufacture of Tamiflu and breaking Roche's monopoly, but where the greatest priority must be is on the detection and monitoring of influenza in countries that presently don't have that ability and directing resources to the grassroots in poor countries to give them just even the most basic means to deal with large numbers of cases of pneumonia and to know what they're fighting.
The United States and other rich countries have been just scandalously selfish and neglectful in refusing to fund the modest request of Vietnam or the U.N.'s Food and Agricultural Organization, just asking basically for a few tens of millions of dollars to reinforce surveillance efforts and to compensate poor peasant farmers for the killing of their flocks. But we've refused to do this. And this is just another one of these, you know, pennywise, pound foolish measures. The Bush administration, where it's proposing to spend billions on buying anti-virals for Americans, but it won't give the aid to Vietnam, a country to which we have the greatest moral debt, which is actually on the front line of avian flu and still the country that I would think that the W.H.O. and the other international organizations must worry about, in terms of the possible center for the emergence of a pandemic variety.
Right now, Tamiflu is the major frontline weapon of choice. There's another anti-viral which works on the same principles as Tamiflu called Relenza, which might even be better, but it's a flu, and it’s very difficult to store and use. But we can expect that Tamiflu will work forever. Right now, it is a sensible investment to build strategic stockpiles of it, but somehow the illusion has been created that Tamiflu is really the difference of life and death in case of a pandemic. And the far more important variable here is local public health, is hospital surge capacity, the ability to cope with large numbers of cases of pneumonia.
And here's where the United States really joins the third world, rather than Europe, because we have lost that capacity. And in city after city simulations or the experience with just even normal seasonable heights and influenza or other respiratory diseases has shown that that capacity doesn't exist. We don't have the hospital beds. We don't have the intensive care facilities. And in large part this is the byproduct, not only of federal and state neglect, but the H.M.O. revolution which works on the principle of increasing bottom lines by reducing the number of hospitals, reducing the number of hospital beds, leaving Americans incredibly vulnerable in the face of any kind of epidemic or pandemic disease.
[W]e should begin with the 40 or 50 million Americans who lack health coverage, per se. And my believe is, of course, that there is no fix for this problem within the current market economy and depending on the private provision of medicine, particularly when you read in today’s paper about how yesterday's most powerful unionized workers in America, the auto workers, are now forced to suffer swinging cutbacks in medical coverage. The whole system of workplace-provided, contractually provided medicine and healthcare in America has broken down. We must have some kind of national health system.
Secondly, we must have adequate, proactive preventative public health, a priority that's consistently neglected despite the fact that administrations, including the Bush administration, has actually thrown billions of dollars in infectious disease but in the wrong places -- hypothetical or imaginary diseases -- and a lot of the money going to big corporate contractors or large labs, big pharma, and not enough of it percolating down to where it's absolutely essential at the local level.
And thirdly we must increase the surge capacity of medicine at the local levels. We need more hospital beds, more intensive care facilities. This is the only wealthy country I know of where during a pregnancy a woman is sent home within 24 hours of delivering a baby. And we will pay a terrible price for this in the event of a pandemic or an epidemic. What will happen in many American cities, will look more like what's happening in the third world than, for instance, to our neighbor north of us, Canada, which probably has right now the best planning, the most adequate preparation to deal with avian influenza or, for that matter, almost any pandemic.
[A]s Laurie Garrett and others have been pointing out for years, the combination of economic globalization and a changing world environment demand that preventative medicine and world-scale public health infrastructure must be the number one priority. But, of course, what's happened along with economic globalization is in so many countries been actually the dismantling of the ability to respond to epidemic diseases. The immigration of doctors and nurses. The closure of local public health clinics. This is one of the things, of course, responsible for the human holocaust of H.I.V.-AIDS in Africa.
So one of the most effective steps you could take immediately in fighting disease and increasing the health of the world would simply to end the debt payments, the tribute paid from poor countries to rich. But it is a global problem. And one of the great illusions that now exists around avian flu is that you can build a national fortress. You can build fortress Britain or fortress America, stockpile anti-virals, work on your own vaccine and not worry about the public health of the rest of the world. This is a total illusion. We may be two humanities, in terms of income and power, but biologically we remain one humanity. And avian flu will be a great equalizer.