SINCE THE 1918-19 pandemic, which killed at least 21 million people, and as many as 100 million people, science has been aware that one of the greatest public health risks would be the reemergence of a deadly strain of flu.

The new strain of avian flu was first identified in 1997 in Hong Kong. What's so troubling about it is that in the United States in 1918 and 1919, about 2.5 percent of the people who got the flu died. That's very high--10 or 20 times higher than die from the normal flu. But the avian flu in its current form in Southeast Asia is killing fully 70 percent of the people who get it. If that virulence were preserved in a human-to-human transmissible form, it would be a public health danger of almost unimaginable magnitude.

The basic strategy for dealing with this is a containment strategy--to kill off infected poultry in Asia. It worked in Hong Kong in 1997, but it's utterly failed now. There's plentiful evidence that the avian flu is now being spread by wild birds. It's already been detected in pigs, although the Chinese didn't tell anybody about this for a while. And you've already had what seems to be the first human-to-human transmission.

It's an extraordinary public health risk for the world, and the Third World is basically unprotected against it. Once the containment strategy breaks down, if a human-to-human strain would emerge, as most medical researchers believe is virtually inevitable, there's no other line of protection for poor people.

There is a prototype vaccine, but in extremely limited quantities, and it's not even certain that enough of that would be produced to be given to public health workers in the richest countries. More likely, what you would have is a form of triage where you would have to make decisions about whether public health workers or frail, more susceptible people would get the vaccine first. So even the rich countries are unlikely to have enough of this vaccine around to do anything more than protect a small group of people.

But the Third World is utterly unprotected. And of course, the difference between 1918-1919 and today are 1 billion people living in slums in the cities of the South--unparalleled concentrations of poor people in unsanitary conditions, many of them with immune system disorders. It's hard to imagine a more nightmarish disease scenario.

Finally, to top all of this off, the research on the avian strain indicates that of the four antiviral drugs available to deal with flu, three won't work at all, and it's not clear whether the fourth and most powerful one will work. These drugs are also scarce.

So this is a massive failure of both local and international public health networks--a failure to invest in Third World public health, the reliance on a handful of companies to manufacture vaccines and antiviral drugs. You couldn't find, I think, a more classic contradiction between profit and public health than this current situation.

And what's kind of bizarre is that if you read the World Health Organization reports, or the New Scientist magazine, or elsewhere, the level of concern is almost apocalyptic. Yet this issue has been virtually absent from political debate in the U.S.--except from Ralph Nader, who's well aware of the danger. But as far as I know, no one has responded to his letters to George Bush or his calls to make this issue an emergency.

WHY IS this particular strain of the flu so deadly?

WHAT'S TROUBLING is that the people who've died in Asia have died in the hospital, under modern hospital conditions. But it seems to take the form--like 1918-1919--of an acute viral pneumonia, which is virtually unstoppable.

If you've read any of the accounts of 1918 and 1919, it was quite extraordinary--people died within an hour or two of getting it. Mortality was particularly high among healthy young adults. It's unclear yet whether that will be the pattern here. There have been relatively few human cases so far, but the virulence of it is unquestionable, and if that is preserved in a human strain, it really is the worst-case scenario.

Right now, the problem, particularly in Thailand, is a shortage of normal seasonal flu vaccine, which is why the loss of half of the flu vaccine capacity for the United States is so significant.

Right now, the major hope of stopping the evolution of this into a pandemic is to ensure that people who handle poultry in Southeast Asia are vaccinated against normal flu. It won't prevent them from getting avian flu, but if they did, it would prevent the genetic exchange that would mutate the flu. But the New Scientist published a big story on the crisis in Thailand--and this is even before the Chiron scandal--saying they simply can't get enough ordinary flu vaccine to create this firebreak around the avian flu.

WHY IS the normal flu vaccine in such short supply?

FIRST OF all, a point to reemphasize is the danger of flu. People tend to take flu for granted. Certainly, doctors, medical researchers and the pharmaceutical industry have always been fully aware that flu is among the most dangerous and lethal of epidemic diseases. There have been four identified pandemics in history, and it's been clear that a pandemic would return and probably originate in some direct transmission between birds and humans, or maybe in pigs.

The danger and the need for investment and development of flu vaccines have always been clear. But for the drug industry, it's simply more profitable to do medicines that would deal with really "important" things like erectile disorders.

Flu vaccine is produced in one huge batch. You only sell it once. If the flu doesn't turn out to be as bad as expected, you may have millions of doses unsold. The profit margin is relatively small compared to other kinds of medicines. So the reliance on the marketplace to generate flu vaccines and antivirals has been a disaster.

But of course, it's part of the larger problem that the corporate drug industry simply doesn't develop the medicine and vaccines that are most needed by people--they're not profitable enough.

I should also point out that the avian flu is so virulent that a vaccine can't be produced in the way normal flu vaccines are--which are cultured in fertile eggs. The avian flu simply kills the fertile eggs. It's a much more complicated and expensive method of cultivating the vaccine in live cells, which also limits the production of it.

Right now, if you log on to the Centers for Disease Control or the Department of Health and Human Services Web sites, the national pandemic plan that the Bush administration has is to repeat 1918 and 1919--to shut the whole country down, everybody will wear a mask, and we'll stay at home for a few months.

BUT IF governments like the U.S. have known about the threat, why have they been so slow to act?

THE FOCUS of the existing system has been on monitoring--particularly the monitoring of human cases. It's now clear that veterinary monitoring is incredibly important, too, and that doesn't work very well in a lot of countries.

Understanding this epidemic, like any epidemic, means first of all to understand its ecology. The reservoir of influenza is the mixed agriculture of southern China--of birds and pigs and humans in intense contact. But that's been radically modified by the factory poultry industry that's emerged in the last decade or so in a number of countries. There's lots of evidence that factory agriculture absolutely increases the danger of the epidemic.

The other factor that's so radical and so essentially important is the huge underinvestment and neglect of public health, particularly in the cities of the Third World--which creates, literally, wildfire conditions for the emergence of diseases and epidemics.

If you point to any single factor, the neglect of public health is the most important. Second is the total reliance on the marketplace to generate vaccines and medicines. And third would be the capitalist mode of factory agriculture. This pandemic flu threat grows directly out of capitalist transformations of agriculture, capitalist urbanization and the hegemony of the drug industry.

Of course, Ralph Nader has been calling for a national emergency summit to deal with the problem. It is a very serious public health risk in rich countries, but it is an almost apocalyptic threat to poor people, who simply don't have access to the vaccines, to the antivirals, to any of the things that would be required to manage the acute pneumonia that typically is what kills people.

WHEN WE think about the threat of disease or other disasters like hurricanes and earthquakes, we're taught to believe that these are "natural" disasters that can't be stopped. But the way you describe it, there are so many social factors involved--especially the way capitalist society is organized, and what it prioritizes.

THERE ARE hardly ever--if any--natural disasters or completely natural pandemics. Mortality is determined as much or more by social conditions--the nature of the housing supply in the case of earthquakes, or land use in the case of hurricanes, or sanitation conditions. The social conditions are paramount.

We now see on a world scale unparalleled vulnerability and unparalleled hazards. The single biggest problem is simply urban poverty, on an almost unimaginable and ever-increasing scale. In most of the urban growth that's occurring around the world, people are building their own houses. We see cities modifying their environmental conditions or resources and making themselves extraordinarily vulnerable.

So the perception that people have of an increasingly hazardous world, with an increasing frequency of disaster, is absolutely true. But this is rooted in the mode of urbanization and the kind of agriculture and farming we're dependent on. AIDS and HIV should have been the wake-up call about epidemic disease--particularly where it would take its greatest toll.

One of the illusions of the era, of course, has been that rich people or rich countries could wall themselves off from the diseases and disasters of the poor. And that simply isn't true. Public health came about in the first place in the mid-19th century, when the middle class started getting cholera--and realized that the slum conditions in the great cities threatened them as well.

But now we live as though rich Americans can be protected by vaccines and antivirals and wonder medicine--and the health of other people can be totally ignored or neglected. It can't. It's essentially a time bomb.

What's really important for socialists to point out is not only the capitalist origins of this crisis, but the question of priorities. Because if this were to suddenly become a big public issue in the U.S., there would be a panic, and it would all center on protecting ourselves and protecting the American middle classes. One issue that has to be hammered on is that the greatest threat is to poor people--and particularly poor people in city slums.

Home page | Back to the top