Avian flu is demanding admission to the European Union and it will not be refused. Despite brave promises by veterinary and public health officials to seal borders and quash new outbreaks, H5N1 is an almost irresistible force.
Already last year, veteran researchers were warning that avian flu had become ineradicable among wild birds and domestic poultry. Previous hopes that it was not easily transmissible among wild birds were dashed this spring when Chinese researchers discovered a huge epidemic at Lake Qinghai in western China. Initially the outbreak was confined to a small islet in the huge salt lake where geese suddenly began to act spasmodically, then to collapse and die. By mid-May, however, the lake’s entire avian population was infected and thousands of birds were dying. An ornithologist called it ‘the biggest and most extensively mortal avian influenza event ever seen in wild birds’.
Chinese virologists, meanwhile, were shocked by the virulence of the new strain. When mice were infected with the Qinghai virus they died even more quickly than when injected with ‘genotype Z’, the fearsome N5N1 variant currently killing people in Vietnam and Indonesia. (Both strains, incidentally, are 100 per cent lethal to mice.)
Yi Guan, leader of the world-famous team of avian flu researchers in Hong Kong, who have been fighting the pandemic menace since 1997, complained to the Guardian in July about the lackadaisical response of Chinese authorities to the biological conflagration at Lake Qinghai. ‘They have taken almost no action to control this outbreak,’ he said. ‘They should have asked for international support. These birds will go to India and Bangladesh and then they will meet birds that come from Europe.’
In a paper published in Nature, Yi Guan and his associates also revealed that the Qinghai strain was probably derived from officially unreported recent incidences of avian flu among birds in southern China. This confirmed suspicions that Chinese authorities were continuing to conceal disease outbreaks from the rest of the world – just as they had also lied previously about the nature and extent of the 2003 SARS (severe acute respiratory syndrome) epidemic.
As in the case of earlier SARS’ whistleblowers, the bureaucracy immediately retaliated against Yi Guan for his scientific honesty, shutting down one of his laboratories at Shantou University and arming the conservative agriculture ministry with new powers to vet basic research. And while Beijing was censoring research, avian flu’s human epicentre was expanding. In mid-July Indonesian health officials confirmed that a father and his young daughters had died of avian flu in a wealthy suburb of Jakarta. At the same time, five new outbreaks amongst poultry were reported in Thailand, dealing an embarrassing blow to the nation’s extensive and highly-publicised campaign to eradicate the disease. Vietnamese officials, for their part, renewed appeals for international aid as H5N1 claimed new victims in the country that remains the outbreak centre of highest concern to the
World Health Organisation.
Meanwhile, the birds at Lake Qinghai were taking flight toward their wintering grounds on five continents. H5N1 punctually arrived at the outskirts of Lhasa, the capital of Tibet; it was detected in western Mongolia and Kazakhstan; and, most disturbingly, it began to kill chickens and wildfowl near the Siberian capital of Novosibirsk – a halfway point along flightways to the Black Sea and southern Europe.
The arrival of avian flu in Iran, Turkey and Romania was no surprise, therefore. Its next destinations may include the Nile Valley, southern India, Bangladesh, Australia, Alaska, northern Canada and eventually the whole world. Even if avian flu posed no human health threat, it is already a global ecological cataclysm that threatens incalculable devastation to wild birds as well as to the billions of chickens that now constitute our second largest source of animal protein (pigs, also now succumbing to avian flu, are the largest).
Robert Wallace, a University of California scientist who is studying how pandemic influenza might spread, told me that H5N1 is a ‘more sophisticated Darwinian search engine than Google’. He says that it is outsmarting us in four decisive ways.
First, ‘H5N1 is flying underneath the social radar: few humans yet infected, but the strain is seeding broad regions. It is changing not only at the molecular level but at the epidemiological level as well.’ Second, ‘In spreading geographically, and infecting more chickens, H5N1 broadens the base of operations from which it can begin a pandemic.’
Third, ‘By spreading geographically H5N1 enters countries that have no experience in detecting or grappling with such outbreaks.’ And fourth, ‘If dispersal is related to increasing the number of chickens infected – and expanding the evolutionary space H5N1 has to play in – then the time of onset of an outbreak of human-to-human infection becomes compressed.’ The bottom line, in other words, is that each new outpost of H5N1, whether among chickens in Turkey, ducks in Siberia, pigs in China, or humans in Indonesia, is a further opportunity for the rapidly evolving virus to acquire the gene or even more simply, the amino acid substitutions it needs to massacre vulnerable human populations.
There are, of course, sceptics (although usually not amongst virologists) who argue that avian flu is merely a ‘theoretical threat’, and that there may be some ‘factor X’ that is preventing H5N1 from acquiring facile transmissibility amongst humans. Many researchers are indeed puzzled that a pandemic hasn’t already emerged, but there is little evidence for the existence of a ‘factor X’ structurally inhibiting H5N1’s mutation. Quite the contrary: a breathtaking (and dangerous) scientific experiment in August confirmed frightening similarities between the current avian virus and the 1918 influenza that killed 40 to 100 million people in the autumn of 1918.
After a decade of painstaking lab work using lung tissue samples retrieved from corpses of 1918 victims, a team headed by Jeffery Taubenberger at the Armed Forces Institute of Pathology, outside of Washington DC, succeeded this summer in deciphering the complete genome of the 1918 virus. In a discovery that shocked many researchers, they found that the 1918 virus was a purely avian strain that had acquired human transmissibility through a series of surprisingly simple mutations rather than through a mixing of avian and human flu genes in a co-infected pig or person. This implies that H5N1 may not, after all, have to ‘reassort’ genes with a human virus: it may acquire pandemic velocity through its own modest evolution.
So, as H5N1 – which some ducks transport without any symptoms – prowls around the edges of EU agriculture, there is little basis for discounting official warnings from the WHO and innumerable experts that a pandemic is ‘imminent’. ‘Imminent’, of course, could mean this winter or 2007. And so far, European health ministers have acted as if either the threat or the EU didn’t exist.
Each government has made an independent assessment of the peril and responded accordingly. While some have taken the flu apocalypse seriously enough to begin to stockpile millions of courses of antiviral drugs, others have barely even got around to the surveillance of poultry. None have yet got to grips with the decisive role of the huge European pharmaceutical corporations.
When, at a WHO meeting earlier in the year, Thailand and South Africa raised the question of the generic production of Tamiflu (oseltamivir) in the third world, France and the United States joined forces to quash the challenge to Roche’s current monopoly over the drug. Likewise, when I visited the WHO’s influenza programme in Geneva this August, I was told that the WHO had for the time being abandoned any hope of a ‘world vaccine’ to combat avian flu, largely because it discounted the willingness of the EU to make the necessary commitment to mobilise its vaccine production lines or of GM (genetic modification) opponents to allow the use of ‘reverse genetic engineering’ (the technology that made the recreation of the 1918 virus possible). Europeans should take little solace in the even more dreadful state of preparedness in the US, where despite throwing away billions of dollars on imaginary threats of bioterrorism, Bush’s ‘homeland security’ precautions have failed to build antiviral stockpiles or rebuild vaccine production capacity.
The most dangerous migration of H5N1 in recent weeks is not its Black Sea vacation, but its inexorable movement toward the mega-cities of Africa and south Asia. We should be most worried about the imminent explosive convergence of urban poverty and avian influenza. Even if the EU got its collective act together – as it must do, urgently – it would be to little avail if a 1918-type pandemic erupted in the vast slums of Kinshasa or Mumbai.
Neither fortress-style epidemiological nationalism nor idiot reverence for the profits of Big Pharma (and Roche in particular) should override the principle of human solidarity in the face of the coming pandemic. Our common survival demands an adequate lifeline of vaccines, antivirals and antibiotics as a human right.