Guest Commentator

Avian Flu Pandemic Threatens World

Stephen Mikesell

Revolution #023, November 20, 2005, posted at revcom.us

aStephen Mikesell is an anthropologist who has worked in the western United States, Nepal and Southwest China. He has been grappling with issues of the nature of the state, grassroots democracy, and class struggle. He also has been involved in community radio and biointensive agriculture.

According to health experts, a new influenza-A pandemic is looming, possibly within the next 3 months, with predictions of worldwide deaths ranging from 2-8 million people on the low end to 1.5 billion on the high end. The virus is being portrayed as part of the natural cycle that is inevitable and long overdue. However, the flu virus is opportunistic - it interacts with and takes advantage of human social interaction as well. Like the recent hurricanes, the extent of its impact on the world's population will depend not just on the matter that it manifests itself but on environmental, social, and political-economic factors.

Although different types of the influenza A virus can infect mammals, wild birds are the natural hosts. The current type, designated H5N1 according to the specific combination of two different proteins on the surface of the influenza virus, is causing particularly high rates of mortality, not only among bird populations but among humans and other mammals as well.

Currently, humans seem only to contract it through contact with bird secretions or poultry products. However, as an RNA virus with a gene consisting of 8 segments, an influenza type found in one population can exchange or "reallocate" one or another of its 8 segments with an existing flu virus in a new host population, allowing it to spread into the new population using the genetic material of flu strains endemic to that population. (There is one report of a case of what seems to be human-to-human transfer in Vietnam in September 2004; and the possibility of similar transfer to two people in Hong Kong in 1999.)

That the H5N1 influenza is reported to have already spread to both pigs and felines indicates that it is prone to the reallocation needed to spread to the human population. And because it has never infected humans before, the human immune system is unable to recognize and attack it, making it extremely lethal to the people who contract it.

How many people it will actually kill depends in part on its rate of mortality and in part on how easily it will spread between humans once this reallocation comes about.

The high rates of mortality experienced by people contracting the virus from birds has health experts extremely worried. Its initial mortality rate was 50 percent, but in recent months it seems to have been becoming more lethal with a rate of 70 percent. In comparison, the 1917-1918 influenza pandemic, a bird flu which killed 40 million people worldwide, had a mortality rate of just 5 percent.

Acquisition of the ability to spread between people will depend on the H5N1 virus finding human hosts simultaneously infected with strains of human influenza with which they can exchange genetic material. Health experts say from previous experience this is likely to occur within the next three months. How quickly it subsequently spreads within human populations will depend upon the character of the specific kinds of reallocation that take place.

Social and Environmental Aspects Important

As mentioned above, viruses are opportunistic and their careers do not depend just on clinical factors. World war, which moved large numbers of soldiers and refugees all across the face of the earth and put millions of men in cold, muddy trenches along the battle fronts of Europe facilitated the swath of death left by the 1917-1918 influenza epidemic. The epidemic of the much less contagious AIDS virus, which probably similarly originated from a virus jumping species, has been facilitated by the international regimes of debt and exploitation, the breakdown of communities and cultures, the dislocation of populations, and the scattering of families throughout the world.

In a manner analogous to soldiers in trenches, the recent Asian Tsunami, the American hurricanes, and the recent earthquakes have uprooted and weakened people across whole regions, making large numbers of people even more vulnerable and giving the virus potential weak points to attack.

In addition to this more obvious environmental factor, however, is the havoc wreaked over the last two decades by neo-conservative economic polices promoted by the World Bank and IMF in which communities have been opened up to trade regimes which have led to a well-documented increased inequality and breakup of communities, alongside of the dismantling of national health and other social support systems.

In a sort of positive feedback loop, pandemics, by disabling and killing large numbers of people on top of such economic, environmental and military disabilities can open the way to a systemic collapse, further exacerbating the purely clinical mortality of the disease. A good example of this is what happened to the 100 million original residents of North America when confronted by European diseases on top of the devastation of lifetimes of war and displacement. Within 400 years the original North American population had crashed by 99.7 percent. In the 1917-18 flu epidemic, hospitals were often forced to closed and local governments were overwhelmed and paralyzed. Many people subsequently died for lack of care.

As documented by the anthropologist John Bodley, furthermore, the extreme centralization of state and corporate bureaucracies and of the regimes of distribution and control, and the general environmental degradation of the entire biosphere makes today's global society more vulnerable than ever to systemic collapse, as most communities are no longer able to exist autonomously.

Although no social class will be immune from the upcoming pandemic, the experience of New Orleans taught that disasters, natural or unnatural, don't necessarily effect the rich and the poor equally. Furthermore, as they are unable to defend themselves the poor often are blamed for the problems that ensue. With the current bird flu, small farmers are being accused by large-scale poultry factories for running their poultry freely in farm yards, when it was very likely the large chicken houses squishing hundreds of thousands of chickens together in unnatural conditions which provided the conditions for initial mutation and spread of the current virus.

H5N1 has shown itself responsive to only two of the four available anti-viral drugs. However, the regime of patent laws have restricted production to one company, leading to extreme limitations on quantities and high prices. While many North European countries, anticipating the 35 percent infection rate of the routine yearly flu epidemics, have been building stockpiles for between a quarter and 100% of their citizens, until recently the United States had only stockpiled one of them, Tamiflu, in a quantity sufficient only for its military. Government websites now admitting that they have learned a lesson from New Orleans are saying the U.S. government has now set out to stockpile 20 million dosages of Tamiflu, which will be enough for about 7 percent of the population. Unfortunately, due to widespread use of Tamiflu in Japan for treating common influenza, there are reports that an H5N1 strain has appeared in Korea which is resistant to Tamiflu, leaving only one alternative antiviral Relenza (zanamivir). Public health experts are now calling for revving up its production.

Even if we had enough stockpiles of the right kind of anti-viral drug, the United States’ private-insurer for-profit health system introduces another major weakness. The anti-viral drugs must be used at the onset of the illness to be effective, but the 40 percent uninsured proportion of the U.S. population hesitates to seek medical care until symptoms are well developed, for fear of large hospital bills. The wealthy, on the other hand, can bid for the limited stocks and can get access to the limited number of high-priced hospital beds. From the experience of hurricane, thus, we can imagine who will benefit from the limited supply of viral drugs and who won't. There is already talk of turning stadiums into hospitals.

The world has changed greatly from the time of the 1917-1918 pandemic. Not only like World War I are there the above-mentioned conditions that make the world's population vulnerable to a new pandemic of the same order of magnitude as the 1917-1918 pandemic, there are also new factors in play. The industrialization of agriculture has removed the major portion of the world's population into densely packed urban areas. It also has concentrated large numbers of chickens into giant chicken factories in Southeast Asia on the U.S. factory-farming model which as mentioned above have provided perfect breeding grounds for new forms of avian flu. There is much greater mobility of the population which allows the virus to radiate out into the different populations of the world much quicker. Like the destruction of wetlands that once protected New Orleans, the natural environment worldwide had been greatly impoverished, removing a source of natural elasticity.

Under pressure from the U.S. government and international organizations, the new director of the Bird Influenza Program at the World Health Organization had to hastily retreat from his initial assessment that 150 million will die from the influenza virus and give instead an estimate in the hundreds of thousands. Taking the 1917-1918 influenza as a guide, it could be much more than that, even though it could be much less, depending upon the manner that the H5N1 reassorts itself. However, it is possible that he was forced to back away from his initial statement due to the United States' and other corporate elite's lack of commitment to the world's working classes and poor, like the way that New Orleans' African Americans were abandoned by their local, state and national governments.

What Can We Do?

Finally, it might be smart for localities to act quickly to protect themselves and the less advantaged among them. In 1917-18 government in the United States, at least, failed people at all levels. Effective attacks on the virus were only mounted when citizens shoved aside government took things into their own hands. Overstretched state, county and city health budgets cannot handle the additional burden that protection would entail, and probably there is not enough time to go through the political process of allocating money, even though ideally we should be trying to make our government at various levels responsive to us.

Local wards or neighborhoods might to set up teams that would train themselves for dealing with all the possible fallout that can come from such an emergency. After all, health care providers being on the front line are expected to suffer disproportionate casualties. In many countries, such as Japan or Cuba, wards are organized with well-supplied teams of people who make sure everyone is cared for in tsunamis, typhoons and other disasters. Considering the failure of our governments at all levels to take care of us in the most recent disasters, and given the corporate carpet baggers who subsequently descended on the communities in their aftermath, it might do us well to prepare our communities to pool resources, talent and training to take care of our own members, the least among them, and make sure nobody is abandoned this time.