Mike Davis: Are We in for Another Pandemic Like 1918?

Mike Davis, writing on www.tomdispatch.com, a weblog of the Nation Institute (Feb. 2, 2004):

Mass death soon may be coming to a neighborhood near you, and
the Department of Homeland Security will be helpless to prevent it. 
The terrorist in this case will be a mutant offspring of influenza A
subtype H5N1: the explosively spreading avian virus that the World
Health Organization (WHO) worries will be the progenitor of a
deadly global plague.  

The most lethal massacre in human history was the 1918-19
influenza pandemic that culled more than 2 percent of humanity
(40-50 million people) in a single winter.  Although never proven,
many researchers believe that the pandemic was caused by a bird
virus that exchanged genes with a human strain and thus
acquired the ability to spread easily from person to person. 
Humans have little immune protection against such species'
jumps.

The biological reservoir of influenza is the mixed agriculture of
southern China where wild and domestic fowl, pigs (another
influenza vector) and humans are brought into intense ecological
contact in farms and markets. 

Breakneck urbanization, a soaring demand for poultry and pork,
and what Science magazine recently characterized as"denser
concentrations of larger poultry farms without appropriate
biological safeguards" create optimum conditions for the rapid
evolution of viruses and their promiscuous passage from one
species to another.

Influenza, indeed, is like a viral fashion industry: every winter
changing styles (glycoprotein coats) to create new strains, but
then, perhaps every 30 years, undergoing a revolution (species
jump) that unleashes a virulent pandemic.

The last pandemic killed half a million people in 1968, but
scientists interviewed by Nature and Science expressed fears that
H5N1 might be on the verge of evolving into something more like
the 1918-19 monster.  Although so far we have confirmation only
that it has been transmitted by direct contact with birds and especially
their droppings, the current strain is far more lethal than last year's
SARs epidemic that caused so much international havoc. As a result,
a top researcher told Nature ,"Everyone's preparing for the worst-case
scenario."  At this moment, WHO investigators are checking on the
terrifying possibility that the first human-to-human transmission has
already occurred in Vietnam.

Moreover H5N1 is spreading at a much higher velocity than
previous avian flus.  There have been outbreaks annually since
1997 -- a phenomenon that puzzled WHO researchers until they
discovered that migratory birds are dying in large numbers across
Asia.  (It is chastening to recall that West Nile virus, also a bird
disease, was able to"fly" across the Atlantic.)

H5N1's progress has also been abetted by poor monitoring and
government secrecy in half a dozen countries, but especially in
Thailand, Indonesia, and China.   The Chinese staunchly deny
covering up an avian epidemic as they did SARs, but the eminent
virologist Kenneth Shortridge, interviewed by Science , 
said all evidence points to"natural reservoirs in southern China"
where the disease might have emerged as early as last October.

This winter's moderate flu epidemic, which overwhelmed
emergency rooms and quickly used up supplies of vaccine, vividly
demonstrated how ill-prepared even the richest countries are to
deal with an imminent pandemic.  Current vaccine production
lines, which depend upon a limited supply of fertile hen eggs,
couldn't meet even a fraction of potential demand.

But a true pandemic would probably overwhelm the world long
before a vaccine could be developed and produced in large
quantities.  The potential accelerators of a new plague are the
huge slums of Asia and Africa.  Concentrated poverty, indeed, is
one of the most important variables in any model of how a
pandemic might grow.

The bustees of Kolkata, the chawls of Mumbai, the kampungs of
Jakarta, or the katchi abadis of Karachi are, from an
epidemiological standpoint, landscapes saturated in gasoline,
only awaiting an errant spark like H5N1.  (Twenty million or more
of the deaths in 1918-19 were in poor, congested and recently
famished parts of British India.)           

Last fall the United Nations Human Settlements Program
published a historic report, The Challenge of Slums , warning
that slums across the world were growing in their own hothouse,
viral fashion.  One billion people, mainly uprooted rural migrants,
are currently warehoused in shantytowns and squatters' camps,
and the number will double in the next generation.

The authors of the report broke with traditional UN circumspection
to squarely blame the International Monetary Fund (IMF) and its
neocolonial 'conditionalities' for spawning slums by decimating
public-sector spending and local manufacturing throughout the
developing world.

During the debt crisis of the 1980s, the IMF, backed by the Reagan
and Bush administrations, forced most of the third world to
downsize public employment, devalue currencies and open their
domestic markets to imports.  The results everywhere were an
explosion of urban poverty and sharp fall-offs in public services.

A principal target of IMF austerity programs has been urban public
health.  In Zaire and Ghana, for instance,"structural adjustment"
meant the laying off of tens of thousands of public health workers
and doctors.  Similarly in Kenya and Zimbabwe, implementation of
IMF demands led to huge fall-offs in healthcare coverage and
spending.

In South Asia, likewise, investment in public health has lagged far
behind the growth of slums.  The five largest cities of the region
alone have a total slum population of more than 20 million, and
standards of sanitation are symbolized by ratios of one toilet seat
per 2000 residents in the poorest parts of Bombay and Dhaka. 

Thanks to global neo-liberalism, then, disease surveillance and
epidemic response are weakest precisely where they are most
important: in the mega-slums of Asia and Africa.  That's where the
brushfire of H5N1 could turn into a deadly biological firestorm. 

In that event, it would consume more than just the poor.  Once a
new pandemic had acquired the momentum of mass mortality in
Asia it would inexorably spread to North America and Europe.  It
would easily climb the walls of gated communities and other
fortresses of privilege.

Here, of course, is the rub.  In the past, the rich countries, with few
exceptions, have shown callous indifference to the monstrous
human toll of AIDs in Africa or of the two million poor children
annually claimed by malaria.   H5N1 may be our unexpected
reward.

This article first appeared on www.tomdispatch.com, a weblog of the Nation Institute, which offers a steady flow of alternate sources, news and opinion from Tom Engelhardt, a long time editor in publishing, the author of The End of Victory Culture, and a fellow of the Nation Institute.