Table of Contents:

Foreword

Introduction

I. Storm Gathering

1. 1918

2. Master of Metamorphosis

3. H5N1

4. Playing Chicken

5. Worse Than 1918?

6. When, Not If

II. When Animal Viruses Attack

1. The Third Age

2. Man Made

3. Livestock Revolution

4. Tracing the Flight Path

5. One Flu Over the Chicken's Nest

6. Coming Home to Roost

7. Guarding the Henhouse

III. Pandemic Preparedness

1. Cooping Up Bird Flu

2. Race Against Time

3. Tamiflu

IV. Surviving the Pandemic

1. Don't Wing It

2. Our Health in Our Hands

3. Be Prepared

V. Preventing Future Pandemics

1. Tinderbox

2. Reining in the Pale Horse

Topics

References 1-3,199

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Culling in Indonesia

The killing of all the chickens in Hong Kong in 1997 stopped H5N1, but not for long. The same underlying conditions that originally led to its emergence were still in place; it was just a matter of time.

Experts think human influenza started about 4,500 years ago with the domestication of waterfowl like ducks, the original source of all influenza viruses.308 According to the University of Hong Kong’s Kennedy Shortridge, this “brought influenza viruses into the ‘farmyard,’ leading to the emergence of epidemics and pandemics.”309 Before 2500 B.C.E., likely nobody ever got the flu.

Duck farming dramatically spread and intensified over the last 500 years, beginning during the Ching Dynasty in China in 1644 A.D.310 Farmers moved ducks from the rivers and tributaries onto flooded rice fields to be used as an adjunct to rice farming. This led to a permanent year-round gene pool of avian influenza viruses in East Asia in close proximity to humans.311 The domestic duck of southern China is now considered the principal host of all influenza viruses with pandemic potential.312

This is probably why the last two pandemics started in China.313 According to the UN Food and Agriculture Organization (FAO), China is the largest producer of chicken, duck, and goose meat for human consumption.314 It accounts for 70% of the world’s tonnage of duck meat and more than 90% of global goose meat.315 China has more than two dozen species of waterfowl.316 As Osterholm has said, “China represents the most incredible reassortment laboratory for influenza viruses that anyone could ever imagine.”317

Extensive sampling of Asian waterfowl in the years following the Hong Kong outbreak seems to have tracked H5N1 to a farmed goose outbreak in 1996, the year the number of waterfowl raised in China exceeded 2 billion birds.318 The virus seemed to have been playing a game of Duck, Duck, Goose…then Chicken.

In 2001, the virus arose again from the primordial reservoir of waterfowl to make a comeback among chickens in Hong Kong.319 Once again, all of the chickens were destroyed—this time before anyone fell ill.320 Sporadic outbreaks continued through 2002, but people didn’t start dying again in Hong Kong until 2003.321 By the end of that year, the virus would escape China and start its rampage across the continent.

As revelers got ready to ring in 2004, the FAO and other international organizations began to hear rumors of widespread outbreaks of a virulent disease obliterating chicken flocks across Southeast Asia.322 Reports were coming from so many directions at the same time that authorities didn’t know which to believe. Within a month, though, they were all confirmed. H5N1 had burst forth from China, erupting nearly simultaneously across eight countries. It quickly became the greatest outbreak of avian influenza in history.323

Given the pattern and timing of outbreaks, trade in live birds was blamed for the spread throughout Southeast Asia.324 For example, chickens made nearly a thousand-mile jump from the Ganzu province in China to Tibet via truck.325 The Vietnamese Prime Minister quickly imposed a ban on all transport of chickens,326 but the widespread smuggling of birds is thought to have continued the viral spread throughout the region.327 It would be another year before the virus would learn how to hitch rides on migratory waterfowl to wing its way westward,328 although a Lancet editorial notes that the poultry trade may also have played a role in the spread of H5N1 to the Middle East, Europe, and Africa.329 Even in the United States, a shipment of chicken parts marked “jellyfish” was allegedly smuggled in from Thailand and distributed to ten states before it was confiscated.330 At a single port in California, customs agents intercepted illegal shipments of nearly 75 tons of poultry smuggled in from Asia and about 100,000 eggs within a three-month period in 2005.331 One biologist remarked that the reason why the focus has remained on wild birds is that “[c]orporations pay more taxes than migratory birds do….”332

Within a few months, more than 100 million chickens across Asia were killed by the disease or culled.333 They were buried alive by the millions in Thailand and burned alive in China.334 Birds were stomped to death in Taiwan and beaten to death in Vietnam.335 The French media reported: “Soldiers stripped to the waist pound terrified ducks with bloody sticks; farmers dressed in grubby clothes grab chickens squawking from their cages to wring their necks, and twitching bags stuffed with live birds are tossed into a ditch and covered in dirt.”336 Lest Westerners judge, the U.S. egg industry has thrown live hens with waning egg productivity into wood chippers337 and continues to drop living male baby chicks of egg-laying breeds into high-speed grinders.338 Humane considerations aside, the World Health Organization is concerned that the methods of culling and disposal could increase the risk of human exposure. “If [the killing of birds] is done in such a way that exposes more people [to the virus],” said one WHO spokesperson, “then this…could be increasing the risk of developing a strain that you would not want to see.”339

Despite the culling, the virus came back strong in the fall of 2004, spreading its wings throughout Southeast Asia, and hasn’t left since.340 As 2004 came to an end, former U.S. Secretary of Health and Human Services Tommy G. Thompson told reporters in his farewell news conference that H5N1 was his greatest fear, eclipsing bioterrorism. Bird flu, he said, was a “really huge bomb.”341