Because everybody should be.
You can't swing a sick chicken these days without hitting a pundit pontificating about bird flu. After nearly two years of sporadic news coverage, the media woke up to the threat in late September when George W Bush spoke about the potential pandemic; now, the topic is regular fodder on the nightly news, the weekend shows, the daily papers and the popular newsweeklies.
Everyone is having their say and, unremarkably, everyone seems to view it through their own lenses. Thomas Friedman opined on the Don Imus show that bird flu demonstrates the "flat-world" hypothesis of his latest best-selling book. Apocalyptic evangelicals cite it as a sign of the impending End Days. George Bush wants to invoke his administration's handling of it, post-Katrina, as an example of their competence. Democrats say that Bush's approach to the problem represents the exact opposite, as Sen. Edward Kennedy, D-Mass., recently argued in a Boston Globe op-ed.
In fact, the danger of an influenza pandemic is real and serious. It is almost certain that the current H5N1 strain, which has thus far killed more than 60 people, all in Southeast Asia, will spread to poultry in most or all of the world. So far, almost all cases in humans have resulted from contact with live infected birds. And the virus could remain in its current form, which does not seem to spread easily from human to human (as a common cold would). In that case, it will have a massive economic effect, but relatively few fatalities. Or, it may well mutate, as past viruses have, to a person-to-person disease, in which case millions, or tens of millions, will perish.
Even if we luck out with this version of the disease, we are only buying time. The consensus is that the big one is coming; we just don't know when and how bad it's going to be.
It is unsurprising that the US and the world in general have been
slow to take the threat seriously. Governments are not so different from mainstream media-only so many things occupy the high-priority bin at any given time, and bird flu hadn't made it there until just recently. Yes, it should have; the warning signs have been flashing for at least eight years, if not longer. But it has not until just recently.
What is disconcerting-in addition to the basic problem of infrastructure readiness laid bare by the Gulf Coast hurricanes-is that the US is facing the threat with a perspective no less slanted than those of Friedman or the apocalyptic preachers.
In the case of Bush and the rest of the administration, that slant is primarily capitalistic and secondarily militaristic. These are, in fact, the only two types of solutions the Bushies seem to know. Name any problem of the past five years, and the administration's proposal has been either to provide financial incentives to big business-remember that they have touted corporate and high-income tax cuts as the proper response to both recession and growth-or to roll out the armed forces.
Bush's recent proposal to use the US military to impose quarantines has drawn considerable attention and justified criticism. But that is merely a sideline. The primary bird flu strategy Bush unveiled at the beginning of the month involves giving as many concessions as necessary to prompt the pharmaceutical industry to make the drugs we'll need. There are arguments to be made for that approach, but stronger arguments against it-including, most noticeably, that it has failed miserably before.
Bush has said that his thinking about bird flu was shaped by a book on the 1918 pandemic. There is surely much to learn from that horrific episode, which killed somewhere between 20 and 80 million people worldwide, depending on whose estimates you use.
But while the current version of the virus is similar to that one-making it fully appropriate for scientists to study it for clues to a potential medical solution-the world it comes into is a vastly different place. Of course the world's response in 1918 was inadequate: understanding of viral disease was in its infancy, infrastructure for global co-operative efforts was practically nonexistent, and the world was distracted by the largest war it had ever known.
In fact, more relevant lessons can be learned from virus-pandemic scares of the last half-century when knowledge, resources and infrastructure were at hand. Unfortunately, those lessons are cautionary since, in every case, presidents have handled the threat poorly. Bush appears well on his way to sustaining that track record.
In 1957, Dwight D Eisenhower refused to order mass production of vaccines, relying instead on the market, and 80,000 Americans died. Another 34,000 died in the 1968 outbreak when again Lyndon B Johnson failed to prompt pharmaceutical companies to produce sufficient vaccine quantities. The swine flu scare of 1976 led Gerald Ford to hand over the farm to the drug manufacturers and the casualty-insurance industry, forking over large sums of money, granting indemnification against claims and allowing proprietary-secret concerns to trump government oversight. The result was an expensive fiasco, particularly when the flu strain proved relatively mild. Finally Ronald Reagan dismantled Jimmy Carter's attempts to create ongoing vaccine-development programs, and, of course, failed to marshal the power of the US government to stem the HIV/AIDS epidemic.
There is a common theme here: reliance on free-market forces, which proved woefully unsuitable.
Bush is not reading about these historical episodes, nor is he learning their lessons. Quite the opposite. Bush and his team have made explicitly clear that the plan is to take every pro-business measure they have ever supported and apply them to the vaccine industry.
This strategy dates back at least a year, to the policy of former Health and Human Services secretary Tommy Thompson, but it has been re-emphasized repeatedly in the past two weeks by HHS Secretary Michael Leavitt, the country's de facto avian flu czar.
After a bird flu meeting between Bush and pharmaceutical executives on Oct. 7, Leavitt spoke to the press about the need to pass medical-liability reform, to indemnify drug makers from litigation, and to "create a streamlined regulatory process" for those companies. Indeed, when he announced his plan in November, Bush called on Congress to "pass liability protection for the makers of lifesaving vaccines," and called civil litigation "one of the greatest obstacles to domestic vaccine production."
The Bush administration also has voiced its opposition to a plan, floated by UN Secretary General Kofi Annan, to suspend patent rules in the event of an outbreak. Annan's plan would allow more drug companies to manufacture their own versions of drugs like Tamiflu-the flu drug made by Roche Holding of Switzerland-or a future anti-flu drug. To the Bushies, intellectual-property protection is sacrosanct, so the US stood firmly with Roche when it announced in October that it would not relinquish its Tamiflu patent. (Roche subsequently said it might be open to the idea, but there has been no such change of heart by the Bush administration.)
But the big idea, the grand strategy for boosting flu-vaccine development and production, was rolled out in a new administration code word: "certainty." Certainty, Leavitt explained at a press conference in October, refers to assurance that drug companies will have a permanent, huge, profitable market for such products.
Leavitt's idea is that the US can provide this "certainty" by "creating an ethic of vaccinations"-i.e., convincing tens of millions of Americans to regularly get flu shots they don't particularly need.
And Leavitt has thus far been doing his part to whip up demand, by scaring the bejesus out of the general populace. He has called the global spread of H5N1 virtually inevitable, and he's been quoted in major media outlets saying that "the world is woefully unprepared," "a pandemic is essentially nature's terrorist," and "there will be a pandemic, and our preparation is not adequate." And sure enough: Although Leavitt's call for panic is not the only reason, demand for avian flu drugs has leapt-Europe is now experiencing a run on Tamiflu, and there are reports that a run may be starting in the US. (Bids for a single course of treatment of Tamiflu on eBay were recently up to $175, roughly four times the normal prescription price, before the auction site pulled the plug due to its rules against selling prescription drugs.)
Much criticism has been leveled against the Bush administration for failing to stockpile Tamiflu. But stockpiling may prove to be a classic case of fighting a new war with the last war's weapons.
Any drug useful for today's virus will likely be useless against tomorrow's. Viruses evolve through mutation to survive against the immunity that humans build against earlier versions. Every year, pharmaceutical companies must create a new vaccine for regular, run-of-the-mill influenza, once they identify the new season's version of the virus.
While Tamiflu, a retroviral drug, seems promising (though far from proven) against the current strain of avian flu virus, by last weekend signs had emerged that the virus already is developing resistance to it.
Besides, Tamiflu is a treatment, not a preventive vaccine, and it must be administered within two days of contracting the disease. In fact, recent tests at the University of Minnesota suggest that it may need to be taken before exposure to the virus. As we've learned from Katrina, the US simply doesn't have the emergency-response capacity to buy, store, secure, distribute and administer enormous amounts of any needed item in that limited time frame. If anything, producing and stockpiling too much Tamiflu or other retroviral treatment drugs may actually prove counterproductive, because doing so will occupy what limited resources we have-resources we will need for making, storing and distributing an actual vaccine when the time comes.
That's why disaster-preparedness plans for virus pandemics assume a period of several months between the first identified case-and thus the first specimen for study-and the availability of a useful vaccine.
And therein lies the rub, particularly for a free-market economy
like ours. To be ready to respond to an outbreak, we need to have, at the ready, an entire infrastructure in place for the creation, manufacture and distribution of a drug that, until the time comes, does not and cannot exist.
Building and maintaining capacity for a theoretical future product is not something free markets do well. Companies do not invest millions in manufacturing facilities for non-existent products.
The Bush administration, which is full of former corporate executives, understands this problem perfectly well. For most other types of emergency threats to our population, the US government accepts this fact and takes on the job itself. We don't rely on a for-profit Coast Guard to stand ready to save flooding victims from their houses, or on a for-profit military to stand ready to protect us against attack. We are, however, counting on the for-profit pharmaceutical industry to swoop in and save us from avian flu when the time comes.
But those companies have shown no inclination to do so out of the goodness of their hearts, and they are arguably even more resistant to government persuasion now than when Eisenhower and Johnson failed to spur them to action. Thanks to mergers and consolidations, there are now just five American vaccine-making companies, compared with 25 just 30 years ago-and only two of those five make an influenza vaccine.
The pharmaceutical industry, meanwhile, has become the single largest government-influence peddler, according to the Center for Public Integrity, spending well over $100 million a year on lobbying and campaign contributions. Most of that money comes via the industry's main lobbying group, the Pharmaceutical Research and Manufacturers of America (PhRMA). Its current president is former US congressman Billy Tauzin who, just last year, was chairman of the House committee that regulates the pharmaceutical industry.
In short, judging by recent legislation and activity by agencies like the Food and Drug Administration, the US government is more likely to do big pharma's bidding than vice versa.
Indeed, right after the Oct. 7 top-level bird flu meeting with the president, executives of two of the six companies, Wyeth and Merck, announced that they do not plan to start flu-vaccine programs.
The Bush administration's only solution, then, is to continue upping the ante, guaranteeing more and more "certainty" in the form of enormous profits and minimal risk, until the drug companies deign to make a vaccine to save thousands, if not millions, of lives. In that vein, the US has already contracted to pay $62.5 million to Chiron and $100 million to French company Sanofi-Avantis for an avian flu vaccine. At the beginning of the month, as part of his proposal, Bush asked Congress to buy another $1.2 billion worth-regardless of whether it proves to be effective against any strain of virus that actually reaches the US, let alone whether it pass such trivial tests as FDA approval. (Right before Bush's announcement, Swiss drug giant Novartis paid $5.1 billion to buy the US's only flu vaccine maker: Chiron.)
When the pharmaceutical and insurance industries demanded similar concessions during the 1976 swine-flu crisis, Congressman Henry Waxman asked, "Are you in effect saying that the insurance industry is using the possibility of a swine-flu pandemic as an excuse to blackmail the American people?"
We sure could use more questions like that now.
