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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—Lee Jong-wook, the late WHO Director-General595
Dr. Lee Jong-Wook

The National Academy of Science’s Institute of Medicine now describes a pandemic as “not only inevitable, but overdue.”596 This is based in part on the understanding that there have been ten pandemics recorded since global travelers embarked approximately three centuries ago.597 Pandemics average every 27.5 years,598 with 39 years presented as the longest known interval between pandemics.599 2006 places us at year 37 since the pandemic of 1968. According to the director of the CDC, “It doesn’t take a scientist to appreciate that the clock is ticking, and that another pandemic is due.”600

Said a WHO spokesperson, “All the indications are that we are living on borrowed time….”601 A senior associate at the Center for Biosecurity lists the indications: “The lethality of the virus is unprecedented for influenza, the scope of the bird outbreak is completely unprecedented and the change that needs to happen to create a pandemic is such a small change—it could literally happen any day.”602

Never before has bird flu spread so far, so fast,603 and the longer the virus circulates in poultry production systems, the higher the likelihood of additional human exposure.604 Virology professor John Oxford explains:
The problem is one chicken can contain hundreds of thousands of strains of H5N1. Let’s say there are a billion chickens in Asia and 10% are infected—that’s a vast population of viruses, more than the entire human population of the planet. Now let’s further suppose some of these strains have mutated so they can latch not only onto a chicken but onto you or me, but they cannot do it very efficiently. That’s the position we appear to be in. If a child catches the virus from a chicken they may transmit it to their mother, but the mother won’t be able to go out and infect the grocer. At the moment it’s a slow greyhound of a virus. It’s when it develops into a normal greyhound that we’re in for it.605
But there are more than a billion chickens in Asia. In 1968, the year of the last pandemic, there were 13 million chickens in China. Now, there are more than 13 billion in mainland China alone. And since the time from hatching to slaughter is only a matter of weeks or months, depending on whether the chicken is raised for meat or eggs, there are multiple cycles of these billions passing through the system in the course of the year. Back then, there were 5 million pigs in China; now there are 500 million.606 “High concentrations of animals,” concluded the International Food Policy Research Institute, “can become breeding grounds for disease.”607

H5N1 may be here to stay. “This virus cannot now be eradicated from the planet,” said Center for Biosecurity director O’Toole. “It is in too many birds in too many places.”608 On the contrary, the virus seems to be getting more entrenched. “If you described it as a war, we’ve been losing more battles than we’ve won,” a WHO spokesman told the Financial Times. “From a public health point of view, and an animal health point of view, this virus is just getting a stronger and stronger grip on the region.”609 “That’s why every virologist in the world is flying around with his hair on fire,” says O’Toole.610

In a tone uncharacteristic of international policy institutions, the UN’s Food and Agriculture Organization writes: “Over this bleak landscape sits a black cloud of fear that the virus might become adapted to enable human-to-human transmission and then spread around the globe.”611 The urgency and alarm among those tracking H5N1’s building momentum is palpable.612 “I feel it every day, and my staff feels it every day,” describes NIH’s Fauci.613 “It’s like watching a volcano getting ready to erupt,” described a spokesperson of the World Organization for Animal Health (known as OIE, for Office Internationale des Epizooties).614 Helen Branswell of the Canadian Press, considered to be the world’s leading journalist on bird flu,615 has spent years researching pandemic influenza and has likely interviewed nearly everyone in the field. “A number, including leading influenza experts,” she reported, “told me they all suffer sleepless nights.”616 “We’re all holding our breath,” said Julie Gerberding, head of the CDC.617