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Bird Flu: Waiting in the Wings

What do Vietnamese chickens, the Nobel Prize in economics, and the flu vaccine

shortage have in common? They are all possible ingredients for a future influenza outbreak that

could quickly spin out of control and spread worldwide just as the “Spanish Flu” did in 1918.

Consider the current situation: Half of the U.S. influenza vaccine disappears because one

of two manufacturing plants is contaminated. The sudden shortage produces a mad scramble for

the remaining vaccine, price gouging, thefts, border-crossings to buy Canadian and Mexican

vaccines, political finger-pointing, rationing, and a general sense of chaos. All of this political

and public health confusion is over an annual event—the arrival of flu—that is as regular and

predictable as a sunset. One wonders how the U.S. would respond to an unpredictable event.

Which brings us to those chickens in Viet Nam. Over the summer, tens of thousands of

chickens and other birds have died from an avian form of influenza. In an effort to control the

spread of avian flu, the Vietnamese government killed 44 million birds. They did this to prevent

bird flu from infecting more people. So far, 27 people in Viet Nam have been infected. Twenty

of them have died.

Nearby Thailand is dealing with a similar situation. There, 16 people have been infected

and 11 have died. What is interesting, and worrisome, about the Thai cases is that one of them

appears to involve person-to-person transmission of the bird virus. If true, it would be very bad

news. It would mean the virus no longer needs birds to sustain itself; instead it can move among

people, leaving in its passage the sick and the dead.

Bird flu (known to scientists as H5N1) is like a pot of water on a slow boil. Bubbles keep

breaking to the surface, and the first bubble popped in Hong Kong in 1997. There it killed 6 of
18 infected people, and led to the wholesale slaughter of the island’s poultry. It reappeared in

2003 and killed one of two infected people. Another bird flu virus (H7N7) appeared in the

Netherlands in 2003, killing one man. Thirty million birds in the Netherlands, Belgium and

Germany were slaughtered to stop the outbreak. Hong Kong was hit with a second bird virus

(H9N2) in 1999 and 2003, but no deaths resulted. Why are we suddenly being plagued with bird

flu?

First, flu viruses are inherently unstable. Like actors changing costumes and characters

in a play, influenza viruses shift their own appearances and characteristics in regular but

unpredictable ways. That’s why a new flu vaccine has to be made each year; it has to be able to

recognize the latest viral custom change to be effective. Second, crowded Southeast Asia and

China have vast populations of poultry that live wing-to-jowl with pigs and their human keepers.

Thus, there are endless opportunities for bird viruses to mix with viruses from pigs and people.

Pigs have traditionally been thought of as “mixing vessels” for bird and human viruses to meet

and produce new pandemic strains of flu.

But the H5N1 bird virus seems to be able to jump directly to people. The big fear is that

this virus will find its way into a person already infected with a human flu virus. There in the

warm, dark lungs of that unfortunate individual the two viruses will meet, recombine and

produce a new virus that is both deadly and highly infectious. This is the nightmare that most flu

experts say is “inevitable.”

Based on data from previous pandemics, the CDC estimates there could be 207,000

deaths in the U.S. alone. (There are 35,000 flu deaths in a typical year.) Last year the World

Health Organization raised its pandemic alert to Level 2 following the appearance of these avian

viruses that could infect people. The U.S. government has a plan for confronting a new
pandemic (www.hhs.gov/nvpo/pandemicplan), but it relies on antiviral drugs that are currently in

short supply, untested vaccines made from a process called “reverse genetics,” and an unlicensed

production system involving cell cultures instead of chicken eggs.

Which brings us to the economists who won this year’s Nobel Prize. They figured out

why “good governments do bad things to good people,” according to Charles Seife of Science

magazine. In a nutshell, governments have trouble committing to a policy, which then

undermines their credibility and leads to unintended consequences. This may explain why the

government’s $5.6 billion Bioshield bill encouraging industries to make new bioterrorism drugs

and vaccines has fallen flat. “Fuzzy mandates,” says the Center for Biosecurity at the University

of Pittsburgh.

Thus, the Center concludes we remain vulnerable to biological attack. By the same

token, we also remain vulnerable to the shifty flu virus, and the clock is ticking.