By Merrill Goozner,
author of "The $800 Million Pill," who directs the Integrity in Science project at the Center for Science in the Public Interest
Wednesday, November 23, 2005
THE MONSTER AT OUR DOOR
The Global Threat of Avian Flu
By Mike Davis
New Press. 212 pp. $21.95
The Truth About the Epidemic of Fear
By Marc Siegel
Wiley. 246 pp. $24.95
Four years ago, an administration on high alert after 9/11 responded to anthrax attacks in Washington and New York by mobilizing scientists for a War on Bioterror. As we now know, Iraq, the one nation we most feared might use such weapons, didn't have them. Meanwhile, investigators' best leads in the still-unsolved crime point to someone who had access to our government's stockpiles of the deadly pathogen.
Last month, the Bush administration enlisted fighters of infectious diseases in another war -- this time against the threat of an avian flu pandemic. Are the billions of dollars recently pledged for flu drugs and vaccines a long overdue response to an imminent peril? Or will this turn out to be the latest in a long line of bugs du jour, destined to briefly threaten our sang-froid (and drain the Treasury) before fading like anthrax, smallpox, Ebola and SARS?
Mike Davis, an author better known for his dissection of the diseases of Southern California urbanism, spent a year immersed in the science of Southeast Asia's avian flu outbreak and came away convinced that "a flu pandemic is not a fate we can avoid." In "The Monster at Our Door," he argues that it is only a matter of time before the H5N1 flu virus or some other deadly variant hatched in the sprawling city-slums of Asia mutates into a grim reaper capable of culling the human herd by tens of millions.
Davis's claim for inevitability hinges on the nature of the rapidly mutating influenza virus, which incubates in birds and migrates to animals and humans wherever they live in close proximity (that's why most flu strains start in South China and Southeast Asia). This chameleon-like virus usually sends a fairly benign illness coursing through humanity. Benignity, however, is in the eye of the beholder, since flu carries off 30,000 to 50,000 Americans every year, mostly among the very young or very old.
But every few decades an especially deadly mutation escapes to wreak havoc. It happened most famously in 1918, when a frightful epidemic killed tens of millions around the globe, many in the prime of life. Less well known are the 1957 and 1968 pandemics, with the former killing an estimated 2 million globally, including 80,000 Americans. What's different now, Davis argues, is that economic globalization has created an ideal laboratory for hatching an especially deadly strain. In South China, Vietnam, Thailand and Indonesia, urbanized peasants have brought their traditional livestock practices into overcrowded shantytowns that lie cheek-by-fowl with Western-style industrial chicken farms, whose owners have a strong incentive to hide flu outbreaks among their flocks. Davis scarily recounts how the Thai government, closely allied with one of the largest chicken farm operators, dithered for months when H5N1 reappeared in late 2003.
Davis has plenty of scientific help in sounding the alarm. Infectious-disease specialists have openly worried about the particularly deadly H5N1 strain since 1997, when it first appeared in Hong Kong. Robert Webster of St. Jude Children's Research Hospital in Memphis emerges as something of a hero in this account for his early calls for a massive public health response to the emerging threat.
But history got in the way. The October 2001 anthrax attack diverted resources from infectious diseases that naturally threaten mankind, such as tuberculosis, malaria and influenza (full disclosure: Davis quotes an article I wrote on this subject in 2003). The result: Pharmacies ran short of seasonal flu vaccine last year while warehouses bulged with vaccines against smallpox and anthrax, which from a public health perspective are laboratory curiosities.
Davis concludes his jeremiad by castigating the Bush administration for its misplaced priorities. The United States "lags shockingly far behind its peers" in stockpiling the new antiviral drug Tamiflu and in building vaccine capacity, he notes. But he neglects to mention that Tamiflu reduces flu symptoms by only a day and that the experimental vaccine now being rushed into production may not be effective against the strain that eventually emerges. Though his story finishes in mid-2005, he would probably endorse the Bush administration's recently announced plan to spend $7 billion on avian flu, largely on stockpiling vaccines and pharmaceuticals.
To which Marc Siegel, a practicing physician on the faculty of New York University School of Medicine, would reply, "You're wasting our money." In "False Alarm," Siegel weaves his personal experiences with patients who want to hoard drugs for use against various health scares into a story line that essentially accuses public health officials of acting like Chicken Little. He repeatedly castigates Julie Gerberding, director of the Centers for Disease Control and Prevention, for "public displays of worrying [that] always made us worry more."
He also heaps scorn on the media, which gladly race from one disease "outbreak" to another in search of readers and ratings without evaluating the actual risk faced by individuals or society. In 2002, for instance, the nation was gripped by media-driven fear of West Nile virus, which took fewer than three dozen lives. The next year, the disease killed four times as many people with scarcely a mention in the nation's press or, for that matter, pronouncements from leading public health officials. What changed? The focus had shifted to SARS, even though that disease never killed a single American.
Siegel sees bird flu as being no different from previous alarms. While a pandemic is always possible, he admits, the chances are remote, and public health authorities should work to dampen concern while monitoring the threat. "An epidemiological need to track an emerging disease before it gets out of hand," he writes, "is not the same thing as saying the entire public is already at risk."
Missing from both these accounts is a full realization that the world has become smaller since the last influenza pandemic. Although Davis sees that as a breeding ground for disease, instant communication into the far corners of the globe also gives international authorities the capacity to quickly isolate and stamp out outbreaks of fast-spreading infectious diseases. It happened with SARS, and avian flu is down sharply in Thailand this year after its government became fully committed to the fight.
Siegel is convinced that institutions such as the World Health Organization and the CDC already have the tools to keep emerging diseases in check. Alas, a public that just watched our government's response to Hurricane Katrina has good reason to question that judgment.
It takes resources to beef up and empower our public health infrastructure. The issue isn't whether we should be investing more in the fight against emerging disease threats, but how best to spend the money. Neither of these books provides much insight into that critical question.