A Virus-Drinkin' Man

Because I believe devoutly in “teaching the controversy,” I thought I should call your attention to this weird article on avian flu, which is almost as rhetorically exuberant as it is factually inaccurate:

Many migratory birds are already heading for their summer homes in Russia. By the eternal laws of nature, birds are flying in large numbers to their nesting-places for the sake of raising a new generation.

Today, however, few people romanticize the spring return of birds because they have been discredited by the rise of avian flu.

Apparently, some Russian officials are demanding that these discredited birds be purged, in a sort of ornithological Yezhovshchina:

As spring arrives, there are more and more calls from various levels of Russian society to exterminate migratory birds.

The author, Tatyana Sinitsyna, tries to explain why this is a bad idea. Unfortunately, her arguments are almost as crazy as those of the people she’s attempting to educate:

[T]he massive shooting of birds would only encourage an epidemic because killed and wounded birds spread the infection.

On the other hand, she’s not nearly as crazy as Professor Yevgeny Voronin of the Skryabin Moscow Veterinary and Biotechnology Academy, who allegedly made this remarkable statement at a recent conference on H5N1:

At present, no type of animal flu is dangerous for humans….I can drink a medicine bottle of the H5N1 virus and nothing will happen to me. Students at our academy study virology and work with the live avian flu virus. I have never heard that anyone has suffered.

I’m not sure how this article made it onto the editorial page of the Belleville News-Democrat, but it’s likely to be a boon for Professor Voronin, who’ll probably be swamped in lucrative offers from conservatarian thinktanks within a day or two.

Be Prepared!

Effect Measure on the current situation with H5N1:

[C]ases are appearing in small clusters, often in areas where no sick poultry can be found, or at least where no contact can be determined. About a third of the cases are in urban areas, although many city dwellers also keep birds. the latest large cluster exhibited all the marks of spread from person to person within the unfortunate extended family decimated by the virus.

So what should we do? According to this article, we should pray that our brave scientists somehow manage to thwart the terrorists who want to weaponize the flu virus:

This week in Rochester, scientists are discussing ways to better understand the flu and also how to prevent the possibility that terrorists could somehow modify flu as a bioweapon to make it even more lethal than it is already....

"Flu viruses are deadly – witness the 1918 Spanish flu which killed millions of people – and with modification, they can be made even more deadly," said Hulin Wu, Ph.D., professor in the Department of Biostatistics and Computational Biology and director of the modeling center. Wu's colleague, Martin Zand, M.D., Ph.D., co-director of the center, added that "We don't know whether flu will be weaponized; it's crucial to ask the question and to be prepared."

Indeed. And I think we need to worry about terrorists weaponizing TB and AIDS, too. If that happened, millions could die, despite the selfless efforts of drug companies and politicians to save them.

We'd better drop another couple billion dollars on Project BioShield right away. If there's anything left over, it can go to Ray Kurzweil. (Long live the new flesh!)

After all, what's the point of funding schools if your kids are just going to get killed by weaponized flu?

A New Face In Hell

Fiscal restraint. Smaller government. Transparency and accountability. The GOP is turning its back on all these things once again, in order to create an expensive new government bureaucracy that will be exempt from oversight, cost accounting, and the Freedom of Information Act.

POGO has the details:

S. 1873, the Biodefense and Pandemic Vaccine and Drug Development Act of 2005, exempts industry from liability and a new agency within HHS, the Biomedical Advanced Research and Development Agency (BARDA) from the Freedom of Information Act (FOIA), the Federal Advisory Committee Act (FACA) and parts of the Federal Acquisition Regulations (FAR).

BARDA would have oversight of Project BioShield, and its copious funds. As regards accounting, the text of the Act specifies that:

[T]he requirement for the submission of certified cost and pricing information...shall not apply to any contract, grant, cooperative agreement, or other transaction entered into under the Project BioShield Act of 2004.

Fair enough. Who but a terrorist-appeaser of the worst sort would demand cost accounting for biodefense projects?

Needless to say, the centerpiece of the Act comprises the "incentives" it provides to the pharmaceutical industry. The most obvious of these is all-but-total protection from liability of any kind, ever. Another is exclusivity:

[T]he bill would allow Health and Human Services to sign exclusive sales contracts with particular manufacturers for a particular product. It would forbid government purchases of generic versions of such new drugs or vaccines as well as public sales of the products for use as countermeasures.

Behold the miracle of the Invisible Hand! All it takes is an offer of exemption from antitrust laws - along with a few other anti-transparency, anti-consumer, anti-democratic provisions - and we've got a readymade free-market solution to the problem of pandemic disease.

Or maybe we don't. Senator Tom Harkin has complained that the Act doesn't sufficiently address the threat of an H5N1 pandemic:

"We need emergency funding right now, probably to the tune of several billion dollars to begin to get grants out there right now...to build the vaccine manufacturing facilities for flu vaccines....We need to get these facilities built in the next six or seven months."

The Act's author, Richard Burr (R-NC), is unimpressed with this line of reasoning:

Burr said including such provisions in the bill would have greatly delayed the measure. He said there is "ample time" to prepare such legislation and that the committee would soon begin work on it for passage next year.

Hear, hear! God forbid that a pressing need for specific anti-pandemic measures should delay the passage of anti-pandemic legislation.

The Boston Phoenix has a good article on the pursuit of "free market" solutions to previous pandemics, and their less than satisfactory results. The article also discusses a report that found some interesting lacunae in Massachussett's pandemic plan:

There is no plan for obtaining the syringes, containers, and other supplies needed by vaccination clinics. "It is unclear who is responsible" for this, the report says.

The state has no automated mortality-information reporting. Under the current system, a coded, searchable file of influenza deaths would not be available until at least three to four months after deaths occur.

There is no plan for providing security for the vaccines during their transportation from the central facility in Jamaica Plain to other parts of the state. Many large parts of the state have little or no available excess storage space for those vaccines.

Many sites that would store the vaccines have little or no security. For example, Western Massachusetts's vaccine would be stored at a UMass Amherst facility, where the only protection is the school's campus security. Central Massachusetts's supply office in West Boylston currently has no alarms or security personnel.

The state has no legal authority to enforce mandatory vaccination.

It's comforting to imagine that we have "ample time" to solve these problems, which I suspect bedevil other states than Massachusetts. How much of that time will be squandered by ideologically motivated attacks on consumer protection and government accountability remains to be seen.

UPDATE: Cervantes has more on the Massachusetts "plan." It's a must-read piece, as per usual.

The Worst That May Befall

I've argued consistently that BushCo's response to a flu pandemic will focus on repressive social control and extraconstitutional maneuvering. Now that Bush himself has more or less confirmed my fears, I want to discuss a possible pandemic scenario, in light of what increasingly looks like a policy of planned chaos in New Orleans.

My assumption here is that planned chaos is the ideal environment for BushCo, and that even a relatively mild pandemic will thus be milked for as much panic and unrest as possible. Quarantines will be imposed selectively, with low-income and high-density areas coming in for especially vigorous enforcement. People will not legally be able to leave these areas, and I suspect that services (e.g., garbage collection) will be curtailed. The unrest that will logically result will be met with the sort of brutal measures previously called for by conservatives in the wake of the mythical violence in New Orleans. And as in New Orleans, violence - or the mere rumor of it - will be used as an excuse to hold up or cancel delivery of life-sustaining necessities to poor areas.

The role of hard-right fundamentalism, as usual, will be to sanctify violence and repression on the one hand, and to ridicule compassion and leniency on the other. Bush's pseudoreligious surrogates will explain that the areas hardest hit - not just by the virus, mind you, but by consciously planned official neglect - were singled out by God for their sinfulness. Among other things, this will serve to assure Bush's increasingly restless base that God has taken matters into His own hands. The spectacle of a rampant and ululant God - who has finally gotten around to kicking ass and taking names - will be as balm in Gilead to the fundamentalist hordes that Bush has repeatedly, cynically jilted. Fatalities that don't fit this narrative will be ignored or downplayed by fundamentalists, perhaps with a remark about how God sees secret vice where the world sees naught but pomp and glory.

We know that medical supplies and hospital beds are insufficient to handle even a relatively mild pandemic. Far from being a problem, this is a requisite for the Right, which treats public health as a deadly game of musical chairs. Those who fail to secure a seat when the music stops are deservedly out of the game. Social Darwinism, not opposed to but buttressed by fundamentalism, will be invoked to explain why those who died in the greatest numbers were "life unworthy of life."

Corpse collection will undoubtedly be handled by Kenyon International, who are longtime cronies of the Bush family. In all likelihood, they'll simply ignore bodies festering in low-income, high-density areas; after all, they'll be paid handsomely from the public coffers whether they do the job or not. And if anyone complains about dereliction of duty in the inner cities, it's always possible to float the rumor that workers were chased away from half-eaten bodies by deranged cannibalistic blacks with assault weapons.

Having written out a death warrant for an unspecified number of undesirables, and forged God's signature on it, BushCo will turn to the far more important issue of removing constitutional obstacles to perennial one-party rule.

When considering these possibilities, it's worthwhile - and increasingly customary - to invoke the ideas of Carl Schmitt, an authoritarian legal theorist who questioned the viability of liberal constitutional government (and, for a time, threw in his lot with the Nazis). He claimed that such governments enable those who are enemies of the constitution to gain tyrannical power legally, by exploiting pluralism and tolerance; thus, the "open society" sows the seeds of its own destruction:

As soon as the assumption so essential for the system of legality collapses, specifically, that of legal disposition held equally on all sides, then there is no longer a remedy. The majority power in legal control of the means of state power must assume that the opposing party, when it achieves power legally, will use legal means to ensconce itself in power and to close the door behind it, hence, legally eliminating the principle of legality itself.

Under such circumstances, Schmitt argued, legality has no meaning: "there is no norm that is applicable to chaos."

In a "state of exception" - which might be caused by a terrorist attack, a pandemic, political unrest, or any number of other things - the sovereign must go beyond the legal system in order to preserve (one hopes) the preconstitutional spirit of the law; this dictatorial figure assesses the law from a point outside its boundaries, and modifies or annuls it as necessary. Schmitt says that "all significant concepts of the modern theory of the state are secularized theological concepts"; accordingly, "the exception in jurisprudence is analogous to the miracle in theology."

Schmitt argues that the possibility - or rather, inevitability - of the state of exception can best be addressed by a quasi-divine sovereign with broad extralegal powers, which must be available whenever the sovereign deems them necessary: "the law cannot protect itself." Legislative and executive functions coincide in the person of this sovereign, whose decisions have the force of law inasmuch as they reflect a homogenous popular will.

The potential for abuse of this concept by corporate and authoritarian elites - who have the means not just to represent and enforce, but to invent the "popular will" - must have been glaringly obvious in 1932, and is even more obvious today; we understand very well that once a ruler has declared a state of exception, under which unilateral executive decisions suspend or overturn existing laws, there may be no nonviolent incentive for the ruler to rescind it. Whether such decisions can be legitimated by popular acclaim and consent, or simply by popular failure to resist, is a question worth considering.

With all that said, my guess is that an H5N1 pandemic, so long as it's severe enough - or represented as severe enough - to cause public panic will bring issues like these ever more explicitly to the fore, as Bush arrogates an increasing number of "necessary" extralegal powers to himself, in order to confront a state of emergency that his actions will probably intensify, if not actually cause.

This scenario is speculative and limited in scope; it describes what I believe Bush would like to see happen, and thus it consciously ignores possibilities that I suspect Bush and his creatures are, themselves, choosing to ignore. What will actually happen depends on any number of factors that are partially or completely beyond BushCo's control. What's most worrisome to me - and at the same time, most heartening - is that BushCo itself probably doesn't realize this.

The Mind Reels

As if we didn't have enough problems with H5N1 avian flu and the Marburg virus, it seems that the College of American Pathologists included the A/H2N2 virus - which caused the deadly 1957 Asian flu pandemic - in a testing kit for distribution to laboratories around the world.

Samples of this sort are used as unknowns, to test labs on their ability to identify pathogens. In this case, vials of the virus were sent to 5000 labs in 18 countries. The problem was noticed after the virus escaped from a kit at a high-containment Canadian lab.

Test kits for flu are not handled at a high level of biological containment as it is generally assumed they do not carry unusually dangerous viruses. But its escape in the Winnipeg lab is worrying, as the lab contains facilities with the highest level of containment and its staff is expected to maintain high levels of lab hygiene. Its most probable route of escape into the outside world would be if a lab worker catches the Asian flu, then passes it on.

Unfortunately, this is a strain to which no one born after 1968 has any immunity.

Effect Measure, as usual, explains the situation in terms that the layperson can understand; Revere calls this a major fuck-up.

For some reason, this seems like a good time to mention the global campaign to "prohibit the genetic engineering of smallpox, the insertion of smallpox genes in other poxviruses, and any further distribution of smallpox genetic material for non-diagnostic purposes."

UPDATE: I almost forgot about the recent spate of tularemia infections, which I discussed here.

The War On Birds

Hedwig at Living the Scientific Life has written an extremely important post on the central role of factory farming in the H5N1 crisis:

[W}ild birds have been vilified for a problem that primarily stems from human-based activities. In fact, the widely sanctioned practice of harassing and killing wild birds only makes the problem worse by distracting public attention and energy from the real problem, poultry farming methods....

It is short sighted, ineffective and potentially dangerous to exterminate wild, migratory and exotic pet birds when the real problem can be found in how people raise and market domestic poultry. The way to deal with this problem and to prevent a pandemic is by educating the populace about safe poultry husbandry, slaughter and meat-handling practices and also by investing money, materials and personnel into improving poultry farming methods in the region.

I couldn't agree more. Factory farms are a ghastly embodiment of the worst - and most cherished - falsehoods of our economic, political, and ethical thinking. They're bad neighbors, brutal employers, incorrigible polluters, false advertisers, and careless incubators for diseases old and new. And of course, the "low" price of meat from these farms is an utter delusion. The actual cost of factory farming includes astronomical external costs; if we factored the total social cost of factory farming into the price of meat - instead of passing it on surreptitiously to citizens - a hamburger from McDonald's would be a luxury item.

It's really shameful that governments would persecute wild birds, instead of addressing the stupidity and stubbornness of this short-sighted, dangerous industry.

Influenza and Bioterror Revisited

I'd intended to append this to my earlier post on the subject, but as usual, Blogger won't let me open my archives.

Anyway, Effect Measure has a very important post on this subject, which really must be read in full:

Before this topic goes much further, let me sound a note of caution. Bioterrorism is an issue in this instance only because it shows that the huge amount of time, effort and money fed willy-nilly into the bioterrorism maw has bought us little of real substance. But it is not the main issue or even close to it, as I shall argue below. I have real discomfort raising the flag of bioterrorism whenever it suits us to raise the visibility of a problem. If we are going to beat up on public health officials and their political bosses (and we should when we see the need) it should be for the right reasons. This was an alarming episode, not because it revealed a chink in our bioterrorism armor (armor which doesn't exist and probably cannot exist), but because it raises the alarm about surveillance and our preparedness for influenza and other emerging infectious diseases.

I couldn't agree more, and I hope my post didn't give anyone any other impression. The best defense against bioterrorism is an efficient, fully staffed, well-funded public-health system, preferably with a high degree of international cooperation. Just to make it perfectly clear where I stand on this issue, here's something I said back in October of last year:

The classic libertarian line is that the only business of government is to protect the public from attack. If that applies to bioterrorism, it applies to epidemic disease generally; no one dying of smallpox or cholera is going to be comforted by the fact that it occurred naturally, especially in this day and age....An H5N1 epidemic could kill 25 million Americans in a matter of months; it worries me more than terrorism does, and I'd rather have more money going to prevent that (not that Bush is actually doing anything to prevent terrorism).

My nightmare scenario is one in which "bioterrorism defense" becomes something along the lines of "missile defense": a bottomless hole for public money, which gives the false impression that serious people are addressing a problem in a serious way, and siphons money and attention away from more important security threats, and - as a punchline - never delivers a working product.

A million thanks to Revere for reminding me of the need for cautious, effective framing of this (and every other) issue.

An Alien Threat

Those of you who are sufficiently long in the tooth may remember Ronald Reagan's frequent remarks on extraterrestrials, as thus:

"[I]n our obsession with antagonisms of the moment, we often forget how much unites all the members of humanity. Perhaps we need some outside, universal threat to make us recognize this common bond. I occasionally think, how quickly our differences worldwide would vanish if we were facing an alien threat from outside this world.

Isn't it pretty to think so? Obviously, the "universal threat" of the H5N1 virus is far too mundane to make the world's nation's act sensibly, let alone to unite them.

Dr. Henry Niman at Recombinomics reports that governments are underreporting H5N1 fatalities:

:The active exclusion of these obvious cases diminishes the utility of the fatality tallies and now the deficient database is being used to make comments and comparisons that are simply not supported by the facts. The faulty database covers up the clear deficiencies in the monitoring of the disease and the artificially low numbers are faithfully cited in media reports on a daily basis.

It's hard not to be reminded of the Chinese government's attempt to cover up SARS cases a couple of years back, or San Francisco's attempt to cover up the presence of bubonic plague in the early 1900s. It never works, but that doesn't seem to stop people from trying.

Whether this underreporting is purposeful, or simply a matter of incompetence, it's totally unacceptable. Granted, countries like Vietnam and Laos lack money and equipment to do proper epidemiological work. But that's as much our fault as theirs; these countries constitute the rest of the world's first line of defense against H5N1. Vietnam has asked the West for help, and its plea has been rather stingily answered:

The European Commission in Vietnam says it will provide $782,100 to buy laboratory equipment and emergency preparedness kits for patient care and to assist health care workers.

That's an astonishingly small amount of money, I'd say.

Here in the United States:

President Bush's budget for 2006 cuts spending for a wide range of public health programs, including several to protect the nation against bioterrorist attacks and to respond to medical emergencies, budget documents show.

Meanwhile, in Oregon, geese are falling out of the sky. All in all, it's the perfect time to cut public-health funding.

The Greatest Country On Earth

Effect Measure continues to do a terrific job of reporting on H5N1 avian flu, which increasingly seems pertinent to just about everything. Bookmark them now, under pain of my displeasure.

I know I said I was giving the subject up, but as I was saying the other day chez Echidne, it presents a perfect example of why the Republicans are wrong about their concepts of individualism and patriotism. If I make sure that everyone in my community is vaccinated against a viral disease, then I'm safer even if I'm not vaccinated myself; that's the basic epidemiological concept of herd immunity. But if I am vaccinated, I'm still safer if everyone else is vaccinated. For one thing, vaccines aren't 100-percent effective, so one can't simply say "I got mine, the hell with you." And even if the vaccine does protect me, a hospital that's not overwhelmed by flu cases will be much better able to meet my needs if I have a different ailment.

With all that in mind, here's a quote from the new Effect Measure post:

Japan is stockpiling the antiviral oseltamavir (Tamiflu) sufficient to treat 20 million of their population of 127 million people. The US reportedly has a total of 6 million doses for our 300 million people....

This raises an interesting question: if the United States is really the greatest country on earth, why is it so unwilling to protect its citizens from sickness and death? If American lives are the most important ones in the world, as current conservative thought asserts, then why do we hold those lives so cheap as a matter of principle? Kill a few thousand Americans in a terrorist attack, and it means war for the foreseeable future; kill a few thousand with substandard or unavailable health care, and it's sound public policy.

Republicans have steadfastly ignored the remarkable extent to which individual safety depends on group safety. If you want to protect a country's population, you can't do it by apportioning medical care to the economically "worthy"; a country in which fifty percent or less of the people "deserve" health care is an insecure country, a country divided against itself. If you worry about war and invasion and "defending freedom at home and abroad," as Republicans claim to do, then you have to accept that your country is only as strong as its weakest links. That may sound like "collectivism," but a country is nothing if not a collective. Universal health care is literally a national security issue; free-market dogma that denies this fact endangers us all, as I argued here:

As influential as game theory is supposed to be among the economic elite - and as well known as the Prisoner's Dilemma is - the basic lessons don't seem to have taken hold. You cannot allow the Invisible Hand to make public-health decisions; it doesn't work, and it never will. The temptation to cut costs and corners in public health, and to take huge risks in order to maintain the bottom line, is a recipe for disaster, but it's a course the free market tends to favor strongly.

So there's one implication of H5N1 for domestic policy. Arms Control Wonk recently wrote an excellent piece on its implications for foreign policy, which everyone ought to read in full:

Arms control is founded on the idea that the preoccupation with deliberate aggression leads goverments to jealously guard their soveriegnty, eschew cooperation and obssess about the balance of power, often at the expense of coordinating international responses to more dangerous threats to human security.

Deliberate aggression does occur. But other threats to human security, like deaths from natural disasters, too often get short shrift. Nothing demonstrates the declining relevance of sovereignty and the need for greater international cooperation than the HN51 virus.

A truly great country, I think, would be one whose leaders understand these basic concepts, and act on them.

H5N1 Follies

I've tried to stay abreast of the H5N1 avian flu situation ever since starting this blog. Now, we seem to be close enough to zero hour that I don't really see the point of blogging about it anymore. Accordingly, I'm turning things over to the experts; anyone who's interested in keeping tabs on this approaching disaster can bookmark these sites:

Effect Measure offers frequent updates on the situation, from the point of view of public-health professionals. Their latest comments are fairly blunt:

Somebody needs to tell President Bush that it's not democracy and freedom that is likely to spread around the world under his "leadership." Instead of cavorting at obscenely costly inaugural events he should be instructing his public health establishment to sound the alarm that we may soon come under attack by a Virus of Mass Destruction.

Unfortunately the response to the Viet Nam wake-up call seems to be to hit the snooze alarm once again. Just a few more minutes sleep, please.

Many people voted for Bush because they thought he would "keep us safe." Now that's irony.

Recombinomics has daily updates by Dr. Henry Niman, the virologist who developed the flu monoclonal antibody. Here's a recent comment from him:

This season, the case fatality rate is running at 90% assuming the earlier reports of confirmation of the 8th and 9th fatalities are accurate and the middle (42M) brother in the north continues to recover. So far this season, no confirmed case of avian influenza in Vietnam has been discharged from the hospital, so technically the case fatality rate for confirmed cases with outcomes remains at 100%.

So far, the words "flu pandemic" have not crossed George W. Bush's lips. It'll be interesting to see how many people die before he holds a press conference. Anyone want to make a prediction?

Evolution in Action

While America settles down for another nice long argument about whether evolution should be taught in schools, the continuing evolution of the H5N1 avian flu virus brings the world ever closer to an unprecedented public-health disaster in which millions of people could die:

H5N1 has been evolving much more rapidly than H3N2. This is due in part to the extreme genetic instability of H5N1 in Asia. H5N1 evolves via recombination, and each year new sequences fly into the region via migrating birds.

In Viet Nam, the situation is getting very bad indeed. As Effect Measure notes,

The Viet Namese report that after its initial appearance in early December, the spread began to accelerate in the first nine days of January. We are thus entering the exponential growth phase of the epidemic curve.

Meanwhile, in the Philippines, a disease resembling meningococcemia, but with a fatality rate much more comparable to that of avian flu, is claiming victims through human-to-human transmission.

Both stories are virtually absent from the U.S. media; the situation in the Philippines, in particular, has been completely ignored.

A Modest Proposal

Rationing of flu shots has apparently left the United States with a large surplus of vaccine. What's to be done? Here's one opinion:

[A] federal advisory panel Friday recommended the government ease restrictions on the nation's supply and make shots available to everyone 50 and older. The move was prompted by worries all of a sudden that tens of thousands of doses of flu vaccine might go to waste.

I have a better idea. Let's donate surplus vaccine to Asian countries where H5N1 avian flu is rampant, and distribute it to people who work with poultry (as Canada did back in January). Doing so could lessen the chances of human coinfection with H5N1 and this season's flu strain, and could thus postpone or prevent a deadly flu pandemic. Sounds like rational self-interest to me!

H5N1 Mortality: A Minor Discrepancy

What's the human mortality rate of the H5N1 influenza virus? Here's one guess:

The WHO estimated that it would take three to six months for a mutated virus to travel around the world, with 25 to 30 percent of the world's population likely to be infected. About one percent of those who fell ill were likely to die, Stoehr said.

Here's another:

Allison McGeer, an infectious-diseases expert at Toronto's Mount Sinai Hospital...noted that the Asian bird flu has triggered so much concern because it...has an apparent mortality rate of 70 per cent....

For what it's worth (a lot), observed H5N1 mortality to date is indeed at about 70 percent, as The Globe and Mail reports. Where the one-percent figure in the AFP story comes from is anybody's guess.

Sorry to be a bore...I just like to keep track of these things.

A Coincidence? Surely Not!

I'd like to demonstrate the awesome power I wield as the author of a several-week-old blog that virtually no one reads.

Less than 24 hours after my alarmist post on the H5N1 virus, the WHO sprang into action (or, if you prefer, sidled into mobility) and arranged a conference on the matter.

The World Health Organization has called an unprecedented summit meeting next week of flu vaccine makers and nations to expand plans for dealing with the growing threat of a flu pandemic.

Sixteen vaccine companies and health officials from the United States and other large countries already have agreed to attend the summit in Geneva, Switzerland, on Nov. 11, said Klaus Stohr, influenza chief of the United Nations' health agency.

Isn't it altogether wonderful that I choose to use my power for good? Lucky thing for all of you that the coin I tossed came up heads, eh?

Hold on, there's more. The WHO is also trying to stir the world from its privatization-mad, neoliberal torpor by explaining that international and domestic public-health systems need to be strengthened in the 21st century.

The World Health Organisation (WHO) began a final drive to convince governments to update rules for stopping the spread of infectious diseases across borders, amid fears that the measures cannot tackle new threats such as SARS, the Ebola virus or bird flu.

Talks on new regulations have over the past decade become bogged down by concerns over their potential economic impact, but recent outbreaks of previously unknown diseases like SARS and bird flu in Asia have forced governments back to the negotiating table, health officials said Monday.

Yes, it's a real problem, the "potential economic impact" of necessary public-health measures. However, the economic impact of epidemic disease can be equally inconvenient. I don't want to seem shrill, but let me say it again: free-market capitalism discourages responsible, long-term planning on issues of public health and safety. Economists who advance the notion that the free market can solve these problems are in the position of Medieval scholastics who believed that all planetary motion must be circular, on account of Aristotle said so.

I don't know if anything will come of this conference, or of the WHO's "final drive" (and isn't that an ominous phrase?), but I'm glad an effort's being made. And I think we can remain certain that the Kerry administration will be far more responsive to the group's long-term recommendations than BushCo would be.

Another Reason Bush Must Go

One of the reasons I'm desperate to have a president who believes in science is the ongoing situation with the H5N1 strain of avian flu (see my archives for several other posts on this).

Though a recent case that was thought to be the result of human-to-human transmission turned out not to be, there's an ever-increasing danger of the virus mutating in that direction. The H5N1 death rate in humans is currently at staggering 70 percent (by contrast, the 1918 pandemic killed only about five percent of the people it infected). Even allowing for a somewhat lower death rate in first-world countries, we're facing a disease with the potential to be both as contagious and as deadly as smallpox. This is a danger that dwarfs any conceivable terrorist threat, with the possible (though far less likely) exception of an attack with bioengineered pathogens.

If the Bush administration has lifted a finger to deal with H5N1, it's news to me. The WHO and governments around the world are calling for a massive stockpiling of H5N1 vaccine, but BushCo's response - if it exists - is very low-key indeed. I find no evidence that the administration has addressed the problem at all.

The current US vaccine shortage directly affects the likelihood of H5N1 mutation. While spontaneous mutation is always possible, there's an additional danger of mutation from human co-infection with human and avian flu viruses. That means that it's essential to inoculate poultry workers in poorer countries like Vietnam, where birds and people are crowded together in filthy conditions. But such countries have almost no human flu vaccines available. And with flu season beginning in the US and Europe, and huge shortfalls in vaccine production, there's none to spare for them.

As influential as game theory is supposed to be among the economic elite - and as well known as the Prisoner's Dilemma is - the basic lessons don't seem to have taken hold. You cannot allow the Invisible Hand to make public-health decisions; it doesn't work, and it never will. The temptation to cut costs and corners in public health, and to take huge risks in order to maintain the bottom line, is a recipe for disaster, but it's a course the free market tends to favor strongly.

There still may be time to mitigate the situation by stockpiling vaccines and anti-virals, but that'd take huge amounts of money and coordination, and that would take intelligent, engaged, focused leadership by the United States. This issue alone is reason enough to vote for John Kerry, who is at least capable of understanding the issue, whether or not he does at the moment. Bush doesn't and can't understand issues like these, and neither does anyone around him. This is just one more reason why we can't afford - and might not survive - four more years of BushCo.

A Small Wager

The flu vaccine shortage demonstrates the danger of relying on the free market to look after public health; the pressing need for such vaccines demonstrates a larger flaw in capitalist thinking.

As a matter of homeland security (or, if you prefer, common sense), it's essential to monitor new flu strains. A new flu pandemic could kill millions of people worldwide, and have political and economic repercussions beyond Osama Bin Laden's wildest dreams.

The factory farms of Mainland China and Southeast Asia are a breeding ground for new flu strains; humans, pigs, and birds live together in filthy conditions, wallowing in each other's dung. This set-up is partly a matter of poor planning - with a focus on short-term benefits and achieving economies of scale - and partly a matter of tradition.

The typical right-leaning economist would argue that the factory-farm system keeps food costs low. And that's quite true...but only up until a new virus rears its head, and (as happened recently) 44 million chickens have to be culled, and killed, and burned in gigantic pyres. In any sane financial model, the cost of dealing with these outbreaks would be considered when assessing the cost/benefit ratio of factory farming; since massive contagion is inevitable under the current overcrowded system, the logical solution would be to invest in prevention, instead of letting the situation spiral out of control again and again and again.

Just as we saw with Mad Cow Disease in the UK, short-term objections to the cost of prevention turn out to be false economy; in the case of poultry-rearing, the long-term costs of a pandemic would far outstrip the cost of reducing the risk of contagion (especially interspecies contagion) on farms. To believe otherwise is to fall prey to the same irrational thinking that might make someone skimp on the cost of a filling this month, and end up paying for a root canal in a year.

The problem is, preparing for a pandemic takes a massive investment of time and money well before the pandemic starts...and if the pandemic then doesn't happen, the vaccines will probably be useless and the manufacturers take a large loss. A public-health organization can take that risk; a for-profit drug company can't, unless it's subsidized by a government. But as we all know from listening to Grover Norquist, such subsidies are evil.

The World Health Organization describes how this state of affairs affects our dealings with the deadly Avian Flu (H5N1) currently raising havoc in China, Vietnam, and Thailand:

"Vaccine manufacturers respond to market forces. Companies may be reluctant to produce a vaccine for an event, such as a pandemic, that cannot be predicted with any certainty and might not be caused by currently circulating strains. Some uncertainty has also centered on rights to use the special technique of reverse genetics, a patented procedure, that is needed to produce the prototype 'seed' vaccine against H5N1.

"At the beginning of April 2004, WHO made the prototype seed strain for an H5N1 vaccine available to manufacturers. To date, only two of the world’s roughly 12 major companies producing influenza vaccines have taken work on a pandemic vaccine significantly forward. These two companies, Aventis Pasteur Inc. and Chiron Corp., both located in the USA, have produced small batches of vaccine for use in clinical trials. These trials, which require several months for the compilation and analysis of data, are needed to fine-tune vaccine composition, test safety, and meet other licensing requirements. Trials are not expected to begin before year-end."

So there you have it. We've allowed market forces to decide who will work on an H5N1 vaccine, and they have decreed that only two companies will do the work, and that they won't exactly be knocking themselves out to get it done on time. If no H5N1 pandemic occurs, there's no harm done. The problem is, these companies will take the same gamble next year, and the next, and eventually they'll lose. Which is a shame, because they're gambling with our lives.