Global Pandemics: Not If, But When
The deadly influenza virus H7N9 was first detected in China this March. “When we look at influenza viruses, this is an unusually dangerous virus for humans,” said Keiji Fukuda, the World Health Organization’s (WHO) assistant director-general for health security.
The new H7N9 avian influenza has infected more than 120 Chinese and taken nearly 30 lives, so far as is known. This strain of the flu has never been detected in humans before. Although Chinese health officials have not located the virus’s origins, they have determined that it comes from an assortment of birds – including domesticated ducks and chickens and migratory wild birds.
What is unique about H7N9 is that it does not seem to make the birds sick, so it is hard to track, unlike the 2003 H5N1 outbreak that killed chickens quickly and led investigators to the sources of the virus.
Another unsolved puzzle is why dead pigs and dead ducks in the thousands suddenly were seen floating down some of China’s rivers in March. Historically, influenza viruses that have spread around the world have started with Chinese chickens, spread to pigs, and then, due in part to the close living proximity of humans with their farm animals, spread to humans in China and then spread to other parts of the world.
The U.S. Centers for Disease Control and Prevention (CDC) is on high alert, receiving samples of the virus and beginning the process of preparing a vaccine. The CDC says that “influenza viruses constantly change and it’s possible that this virus could become able to easily and sustainably spread between people, triggering a pandemic.”
So far H7N9 has only spread to one case in Taiwan – a man who returned from a trip to China.
The problem with the reported numbers of cases is that the Chinese government often delays reports and does not have sufficient experts all over the country to test and provide full and timely information to the world.
Nor does the U.S. have adequate numbers of CDC specialists in China for early detection. The CDC informed us this month that they have “one U.S. direct hire and 3 local employees dedicated to the influenza program in China.” The agency added that it has a total of 54 staff members including one secunded to WHO, adding that “apart from the influenza team, others on the staff have supported the H7N9 outbreak efforts in their area of expertise such as lab, epidemiology, communications and assisting with the embassy’s committee tracking the outbreak.”
Given the immense stakes to the health of the American people, this is a tiny staff allocation – smaller than a normal Obama assassination team in a foreign country. The Influenza Epidemic of 1918-1919, involving the H1N1 virus, took 1.9 million lives in the U.S. and, like many recurrent avian flu epidemics since then that experts believed started in China, the total loss of American life exceeds the loss of lives in all of America’s wars.
Clearly we are now better prepared scientifically and logistically for such epidemics, but the facility of international travel is much greater now as well. Yet, the budgets for detection and prevention of epidemics are much smaller than the bloated cost of a few F-35 fighter planes that Lockheed-Martin is still mired in producing.
What has got some leading U.S. health officials properly worried, such as Dr. Anthony Fauci, the great communicator and director of the National Institute of Allergy and Infectious Diseases, is that H7N9 is showing some adaptation to humans, but doesn’t kill the birds. Though it could mutate further, Dr. Daniel Jernigan, deputy director of CDC’s influenza division, says the virus is presently “somewhere in that middle ground between purely avian and purely human,” which Dr. Fauci calls a red flag.
As if the looming presence of the H7N9 virus from China is not troubling enough, a deadly coronavirus has infected at least 23 people in Saudi Arabia, resulting in 13 Saudi deaths and five more in neighboring countries – a high-fatality ratio. Earlier this year two cases were documented in the U.K. of people who were recent arrivals from Saudi Arabia. This week, a patient, exposed to this coronavirus, suffering from acute respiratory illness has been reported in France.
WHO officials are urging all countries to report faster and more fully what they know about the spread of this virus in order to comply with international health regulations.
When all is said and done, the world is not devoting anywhere near enough resources to combat these viral and bacterial “terrorists.” Governments are far more frightful of sporadic, anthropomorphic, human-based physical terror – whether stateless or state-sponsored – than the grim annual toll of epidemics and the informed warnings by infectious disease specialists of a potential pandemic. They all agree; it is not a matter of if, it is only a matter of when!
For many years, I have urged the White House to take greater action and make more substantial preparations regarding infectious diseases. President Bill Clinton declined to speak to the annual meeting of the American Society of Tropical Medicine and Hygiene in Philadelphia in 1998 when alarms over malaria and tuberculosis were rising. At the time, a traveling associate with Hillary Clinton told me that being at-risk from such infections on the First Lady’s journeys to developing countries was always foremost on their minds. Such concern did not materially change her husband’s public health priorities while in office.
To get President Obama’s attention, I sent him a letter from E.coli 0104:H4 warning about the “invisible terrorism from bacterium and viruses.” He and his assistants never responded.
In many areas, our country needs to reset its priorities. Both the White House and the Congress need more maturity regarding pandemic risks before it is too late.