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07/28/2005
The Coming Pandemic?
With all the talk of bird flu and other diseases emanating out of
Asia these days, including a scary episode this week where 19
died from a variant of streptococcus, it’s a good time to
summarize a piece written by Laurie Garrett, Senior Fellow for
Global Health at the Council on Foreign Relations.
Below are excerpts from Ms. Garrett’s work in the July / August
issue of Foreign Affairs. She is also the author of “The Coming
Plague” and “Betrayal of Trust.”
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--The next pandemic could infect 40 percent of the world’s
population.
--“The havoc such a disease could wreak is commonly compared
to the devastation of the 1918-19 Spanish flu, which killed 50
million people in 18 months. But avian flu is far more
dangerous. It kills 100 percent of the domesticated chickens it
infects, and among humans the disease is also lethal; as of May
1, about 109 people were known to have contracted it, and it
killed 54 percent.”
--“According to the Centers for Disease Control and Prevention
(CDC), in a normal flu season about 200,000 Americans are
hospitalized, 38,000 of whom die from the disease, with an
overall mortality rate of .008 percent for those infected. Most of
those deaths occur among people older than 65; on average, 98
of every 100,000 seniors with the flu die. Influenza costs the
U.S. economy about $12 billion annually in direct medical costs
and loss of productivity .
But, in a severe flu pandemic, the CDC predicts “that a ‘medium-
level epidemic’ could kill up to 207,000 Americans, hospitalize
734,000, and sicken about a third of the U.S. population.”
Medical costs alone would top $166 billion. However, if the
H5N1 influenza was transmittable from human to human, and
assuming a mortality rate of 20 percent and 80 million illnesses,
“the United States could be looking at 16 million deaths and
unimaginable economic costs.”
“The entire world would experience similar levels of viral
carnage, and those areas ravaged by HIV and home to millions of
immunocompromised individuals might witness even greater
death tolls. In response, some countries might impose useless
but highly disruptive quarantines or close borders and airports,
perhaps for months. Such closures would disrupt trade, travel,
and productivity. No doubt the world’s stock markets would
teeter and perhaps fall precipitously. Aside from economics, the
disease would likely directly affect global security, reducing
troop strength and capacity for all armed forces, UN peace-
keeping operations, and police worldwide.”
--Regarding the Spanish flu of 1918-19, when it hit North
America in the summer of 1918, the virus caused “a surge of
deaths.” Army bases were hit hard and it spread quickly to other
camps and troops ships crossing the Atlantic, killing 43,000 U.S.
military personnel in about three months. “Despite the entreaties
of the military’s surgeons general, President Woodrow Wilson
ordered continued shipments of troops aboard crowded naval
transports, which soldiers came to call ‘death ships.’ By late
September 1918, so overwhelmed was the War Department by
influenza that the military could not assist in controlling civic
disorder at home, including riots caused by epidemic hysteria.
Worse, so many doctors, scientists, and lab technicians had been
drafted into military service that civilian operations were
hamstrung.”
--“Most strains of the flu do not kill people directly; rather, death
is caused by bacteria, which surge into the embattled lungs of the
victim. But the Spanish flu that circulated in 1918-19 was a
direct killer. Victims suffered from acute cyanosis, a blue
discoloration of the skin and mucous membranes. They vomited
and coughed up blood, which also poured uncontrollably from
their noses and, in the case of women, from their genitals. The
highest death toll occurred among pregnant women; as many as
71 percent of those infected died. If the women survived, the
fetus invariably did not. Many young people suffered from
encephalitis, as the virus chewed away at their brains and spinal
cords. And millions experienced acute respiratory distress
syndrome, an immunological condition in which disease-fighting
cells so overwhelm the lungs in their battle against the invaders
that the lung cells themselves become collateral damage, and the
victims suffocate. Had antibiotics existed, they may not have
been much help.”
--Devolution: “Understanding the risks requires understanding
the nature of H5N1 avian flu specifically and influenza in
general. Influenza originates with aquatic birds and is normally
carried by migratory ducks, geese, and herons, usually without
harm to them. As the birds migrate, they can pass the viruses on
to domesticated birds – chickens, for example – via feces or
during competitions over food, territory, and water. Throughout
history, this connection between birds and the flu has spawned
epidemics in Asia, especially southern China. Aquatic flu
viruses are more likely to pass into domestic animals – and then
into humans – in China than anywhere else in the world. Dense
concentrations of humans and livestock have left little of China’s
original migratory route for birds intact. Birds that annually
travel from Indonesia to Siberia and back are forced to land and
search for sustenance in farms, city parks, and industrial sites.
For centuries, Chinese farmers have raised chickens, ducks, and
pigs together, in miniscule pens surrounding their homes, greatly
increasing the chance of contamination: influenza can spread
from migrating to domestic birds and then to swine, mutating and
eventually infecting human beings.”
--“The scarcity of flu vaccine, although a serious problem, is
actually of little relevance to most of the world. Even if
pharmaceutical companies managed to produce enough effective
vaccine in time to save some privileged lives in Europe, North
America, Japan, and a few other wealthy nations, more than six
billion people in developing countries would go unvaccinated.
Stockpiles of Tamiflu and other anti-influenza drugs would also
do nothing for those six billion, at least 30 percent of whom –
and possibly half – would likely get infected in such a
pandemic.”
--“In the event of a deadly influenza pandemic, it is doubtful that
any of the world’s wealthy nations would be able to meet the
needs of their own citizenry – much less those of other countries
Every year, trusting that the flu will kill only the usual risk
groups, the United States plans for 185 million vaccine doses. If
that guess were wrong – if all Americans were at risk – the
nation would need at least 300 million doses. That is what the
entire world typically produces each year.
“There would thus be a global scramble for vaccine. Some
governments might well block foreign access to supplies
produced on their soil and bar vaccine export. Since little
vaccine is actually made in the United States, this could prove a
problem for America in particular.”
--And then you have this scenario. “In the event of a modern
pandemic, the U.S. Department of Defense, with the lessons of
World War I in mind, would undoubtedly insist that U.S. troops
in Iraq and Afghanistan be given top access to vaccines and anti-
flu drugs. About 170,000 U.S. forces are currently stationed in
Iraq and Afghanistan, while 200,000 more are permanently based
elsewhere overseas. All of them would potentially be in danger:
in late March, for example, North Korea conceded it was
suffering a large-scale H7N1 outbreak [slightly different from
H5] – taking place within miles of some 41,000 U.S. military
forces.”
--Then, consider this. As Ms. Garrett writes, “more than a
quarter of some African armies and police forces are HIV
positive, perhaps making them especially vulnerable to
influenza’s lethal impact. Social instability resulting from troop
and police losses there would likely be particularly acute.”
--A true pandemic would have a devastating impact on
international relations, let alone the global economy. “With
death tolls rising, vaccines and drugs in short supply, and the
potential for the virus to spread further, governments would feel
obliged to take drastic measures that could inhibit travel, limit
worldwide trade, and alienate their neighbors.”
--Garrett also writes of a recent near miss.
“In October 2004, the American College of Pathologists mailed a
collection of mystery microbes prepared by a private lab to
almost 5,000 labs in 18 countries for them to test as part of their
recertification. The mailing should have been routine procedure;
instead, in March 2005 a Canadian lab discovered that the test
kits included a sample of H2N2 flu – a strain that had killed four
million people worldwide in 1957. H2N2 has not been in
circulation since 1968, meaning that hundreds of millions of
people lack immunity to it. Had any of the samples leaked or
been exposed to the environment, the results could have been
devastating. On learning of the error, the WHO called for the
immediate destruction of all the test kits. Miraculously, none of
the virus managed to escape any of the labs.”
--Finally, from a separate article by Michael Osterholm in the
same issue of Foreign Affairs, we learn the following.
“The population explosion in China and other Asian countries
has created an incredible mixing vessel for the virus. Consider
this sobering information: the most recent influenza pandemic, of
1968-69, emerged in China, when its population was 790
million; today it is 1.3 billion. In 1968, the number of pigs in
China was 5.2 million; today it is 508 million. The number of
poultry in China in 1968 was 12.3 million; today it is 13 billion.
Changes in other Asian countries are similar. Given these
developments, as well as the exponential growth in foreign travel
over the past 50 years, an influenza pandemic could be more
devastating than ever before.”
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I need to take a little break from this column; a combination of
vacation and just catching up on other site work.
Hott Spotts will return August 18.
Brian Trumbore
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