The Monster at our Door: The Global Threat of Bird Flu
By Mike Davis
The New Press, 2006
216 pages, $22 (pb)
Epidemic alarm bells pealed loudly in 2005 with the first case of human-to-human transmission of avian influenza when a Thai mother died after contracting the lethal H5N1 virus from her daughter. Poultry-to-human transmission of avian flu had already made its mark in 1997, but this new mutation of H5N1 that could potentially spread with lightning rapidity from human to human threatened to turn avian influenza into a ruinous global pandemic. Mike Davis's superb book on avian influenza will help with a scientific and political understanding of, and solution to, this new "monster at our door".
There are three major genera of influenza. Influenza C (which causes the common cold) and Influenza B (the classic winter flu villain) both diverged from Influenza A (avian influenza) many centuries ago. Influenza A is "wild and dangerous", its primary reservoir or safe harbour the intestines of ducks and other waterfowl. It occupies an evolutionary fast lane, with new strains and mutations producing a fast-changing crop of viruses that can vault over the species barrier.
The avian flu virus (H5N1), first isolated as a subtype in 1959, had shifted up a species-jumping gear with its human debut in Hong Kong in 1997. It has since repeatedly revisited China and South-East Asia (and Turkey), discovering new ways to unpick the chemical and biological "lock and key" configurations of virus and host that had previously provided a barrier to avian flus from circulating among mammals.
The immediate official response to an avian flu epidemic of continent-wide scope in China, Thailand and Indonesia was the erection of a wall of silence by bureaucrats and agribusiness. The hotspot of Guangdong province in China was inoculated from reality under the "semantic Maoism" of press releases that read, "Thanks to the correct line of the Chinese Communist Party there is no avian flu in Guangdong". The Thai government of mobile-telephone billionaire Thaksin Shinawatra also went into concealment mode and, as Thaksin ate Thai-style chicken dishes on national television to assuage alarm, his government colluded with poultry mega-companies to allow them to go into overtime to process diseased birds before sales could be harmed.
Davis argues that the avian flu crisis is not just another "natural disaster", but a demonstration of the disaster of the private profit principle in health. The New York Times, "in a moment of almost Marxist revelation", writes Davis, identified the underlying problem as the "chronic mismatch of public health needs and private control of the production of vaccines and drugs". Waiting until demand peaks (at the height of a flu outbreak) means a supply lag as too little vaccine is manufactured too late by a pharmaceutical industry that finds curative and preventative drugs for infectious diseases far less profitable than drugs that manage but don't cure chronic diseases or "lifestyle" drugs like Viagra. The flu medicines that are produced fail to reach the most vulnerable (who are mostly poor).
The obvious solution, says the genuinely Marxist Davis, is socialisation of vaccine production, for government itself to "undertake the non-profit development and manufacture of lifeline medications" such as preventative vaccines and the avian flu treatment medication, Tamiflu.
All capitalist governments, however, says Davis, dance to the political contributions and economic clout of the pharmaceutical industry, the most profitable in the world. They are "more concerned to protect pharmaceutical industry profits than to increase availability of vaccines and antivirals". At a World Health Organisation meeting in January 2005, a proposal that poor countries on the avian flu frontline be allowed to override drug patents to produce affordable quantities of Tamiflu was stifled by US and French delegates.
So, with a limited supply of anti-flu drugs, the prickly issue of rationing is raised. With limited stockpiles, asks Davis, who would come first? Health workers or their most vulnerable patients? Elderly people or babies? Pregnant mothers or police? Or "perhaps the imperial legions should be protected first"? Given the political ethics of capitalist governments, it is not too hard to predict the winners and losers.
The poor-rich divide is global. The world's wealthiest countries already consume 95% of flu vaccines and a stockpile buying spree by governments in these countries — especially Canada, Australia, New Zealand, Singapore and Japan — has locked up the potential supply of avian flu drugs, leaving the death traps of Asia (and Africa) essentially unprotected. The global aid effort has also been a disgrace with poor countries starved of international aid from richer countries for whom they are expected to build an epidemic firewall.
Yet it is the poor world where most effort needs to be made to address the root cause of avian flu pandemics. The most fertile breeding grounds for viral evolution, says Davis, include dense, intermingled human and animal populations — particularly poultry and swine — in conditions of economic deprivation with a high prevalence of respiratory or immune disorders.
Guangdong in south China, home to an extraordinary 700 million chickens, has all this in intensified form, making it an export leader in flu viruses as well as sports shoes, clothing and cheap electronics. It has become "something of a dogma", however, to fix south China as the epicentre of all flu outbreaks. The environmental preconditions for the rapid inter-species evolution of influenza have spread far wider, including the developed world, in the wake of the rise of the intensive, factory-line industrialisation of poultry and pork production. The "viral food supply" has dramatically enlarged, especially in the "disease factories" of the massive slum peripheries, home to 1 billion people, in the poor world's mega-cities.
But is the sky really falling? After all, influenza experts have been warning of a viral apocalypse since the original outbreak in Hong Kong in 1997. With under 200 people dead 10 years later, the avian flu pandemic is still just a prediction. Reflecting a near universal scientific consensus, however, Davis argues that this favourable outcome to date may only be "a bullet dodged", and that an evolutionary viral twist in H5N1, or other candidate subtypes, could see avian flu find its human mark.
If it does, H5N1's current virulence (killing over half those people it infects compared to a mortality rate of less than 5% for the terrible 1918-19 "Spanish flu" pandemic) means it would be incredibly dangerous if it acquired the mutations necessary for sustained human-to-human transmissibility. As with all flus, it would be discerning in respect of social class with the poor the viral cannon fodder.
"The essence of the avian flu threat", Davis concludes, "is that a mutant influenza of a nightmarish virulence is searching for the new gene or two that will enable it to travel at pandemic velocity through a densely urbanised and mostly poor humanity". Global capitalism has forced the evolutionary pace through a corporate "livestock revolution" and Third World urban poverty, turning the avian flu virus's "extraordinary Darwinian mutability into one of the most dangerous biological forces on the planet".
Our vulnerability to this disease is increased through the neglect of vaccine development by a profit-driven pharmaceutical industry, the collapse of public health infrastructures in the Third World, and the bizarre skewing of public health priorities in the rich world under the "war on terror", which throws billions at fanciful scenarios of smallpox and anthrax attacks while a genuine bioterrorist, the avian flu virus, is swiftly taking wing.
Avian flu is "a fundamental test of human solidarity", says Davis, one which the capitalist market and its business-friendly governments have failed. Many millions could yet pay with their lives for this failure.