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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—Michael Osterholm2205
Michael Osterholm speaking with Oprah

Even assuming that countries had the resources for proper surveillance and reported outbreaks promptly, no antiviral stockpile currently exists to carry out the ring-fencing strategy. The WHO only has 120,000 courses of antivirals, whereas millions may be necessary.2206 The WHO sent 2,500 treatments to Vietnam, 500 to Cambodia,2207 and a few hundred courses divided among 44 hospitals in Indonesia; many received no more than a handful.2208 Countries at risk, like Sri Lanka, report they don’t have a single dose.2209 “I think the take-home message,” said an epidemiologist at Harvard, “is that the current stockpile is very unlikely to be adequate to stop anything.”2210

Meanwhile, the Western world is continuing in its “narcissistic planning,”2211 as described in a medical journal editorial, ignoring pleas from the World Health Organization to pour resources into Southeast Asia.2212 The United States may spend $1 billion to domestically stockpile antiviral drugs.2213 That’s more than ten times the entire health budget for Vietnam. In Cambodia, the total annual budget for a campaign to encourage citizens to report suspected cases of bird flu is about $3,000.2214 In a New Yorker interview, a senior public health official pondered the question of whether countries in the West might send their resources to combat the flu in Southeast Asia. He told the reporter, “Who are you kidding?”2215

In the end, mathematical models remain just that—mathematical models. Even assuming that the models are valid, they are so qualified with conditional assumptions as to potentially render them useless under real world conditions. Public health experts point out that the odds are vanishingly slim of early detection of a small cluster in a rural area with little public health infrastructure followed by the distribution of an antiviral stockpile that doesn’t yet exist—all within a three-week period.2216 Michael Osterholm, who was responsible for leading the single-largest containment campaign in U.S. history to control a meningitis outbreak,2217 is skeptical that influenza can be stopped: “To believe that you can contain this locally is to believe in fairy tales.”2218

Poorly executed, the strategy could even make things worse by creating Tamiflu resistance in the virus that escapes. This class of drugs represents our last remaining hedge against the pandemic.2219 “We have to be very careful right now,” warns one University of Hong Kong microbiologist. “We don’t want a lot of drug resistance for Tamiflu because if the pandemic comes, it may become useless…[and] we will then be completely disarmed. We will be finished, this is the concern.”2220

Even if the human pandemic could be successfully quashed, we might still face a “reloading” problem. Experts speculate that H5N1 could be so endemically entrenched within multiple, globe-trotting migratory species of birds that its eradication must be regarded as impossible, presenting a constant pool of mutant virus ready to pop up somewhere else. In bird populations, we are dealing with a moving target.2221 The genie cannot be put back in its bottle.

Given these considerations, a microbiologist at Chinese University sums up the bottom line: “[O]nce H5N1 becomes easily transmissible in humans, it will be the end,” he said. “We can do nothing to control this spreading.”2222