Hard Truths about Bird Flu

Editors’Note: August 4, 2017
Legitimateobjections have been raised about the independence and integrity of thecommentaries that Henry Miller has written for Project Syndicate and other outlets, inparticular that Monsanto, rather than Miller, drafted some of them. Readersshould be aware of this potential conflict of interest, which, had it beenknown at the time Miller’s commentaries were accepted, would have constitutedgrounds for rejecting them.

The issues surrounding the possibility of a pandemic of the H5N1 strain of avian flu are extraordinarily complex, encompassing medicine, epidemiology, virology, and even politics and ethics. Moreover, there is tremendous uncertainty about exactly when H5N1, which now primarily affects birds, might mutate into a form that is transmissible between humans, and how infectious and lethal it might be.

It is thus hardly surprising that commentaries about avian flu often miss the mark. A recent New York Times editorial, for example, decried wealthy countries’ “me first” attitude toward a possible H5N1 pandemic, because “[t]he best hope of stopping a pandemic, or at least buying time to respond, is to improve surveillance and health practices in East Africa and Asia, where one would probably begin.”

To be sure, good surveillance is needed in order to obtain early warning that a strain of H5N1 flu transmissible between humans has been detected, so that nations around the world can rapidly initiate a variety of public health measures, including a program to produce large amounts of vaccine against that strain. But the massive undertaking required to “improve health practices in the poorest countries of the world” plays better on the editorial page than on the ground.

Intensive animal husbandry procedures that place billions of poultry and swine in close proximity to humans, combined with unsanitary conditions, poverty, and grossly inadequate public health infrastructure of all kinds, make it unlikely that a pandemic can be prevented or contained at the source. It is noteworthy that China’s chaotic effort to vaccinate 14 billion chickens has been compromised by counterfeit vaccines and the absence of protective gear for vaccination teams, which might actually spread disease by carrying fecal material on their shoes from one farm to another.

In theory, it is possible to contain a flu pandemic in its early stages by performing “ring prophylaxis” – using anti-flu drugs and quarantine aggressively to isolate relatively small outbreaks of a human-to-human transmissible strain of H5N1. According to Johns Hopkins University virologist Donald S. Burke, “it may be possible to identify a human outbreak at the earliest stage, while there are fewer than 100 cases, and deploy international resources – such as a WHO stockpile of antiviral drugs – to rapidly quench it. This ‘tipping point’ strategy is highly cost-effective.”

However, a strategy can be “cost-effective” only if it is feasible. Although ring prophylaxis might work in Minneapolis, Toronto, or Zurich, in the parts of the world where flu pandemics begin, the probability of success approaches zero. In places like Vietnam, Indonesia, and China – where the pandemic strain will likely originate – expertise, coordination, discipline, and infrastructure are lacking.