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.
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.
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.
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.