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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Unused swine flu vaccine

Another impediment to progress may have been the reluctance of authorities to appear as though they were sowing undue panic among the populace. The U.S. government has not yet involved the public to any significant degree.2250 Many of the Congressional briefings on H5N1 and pandemic preparedness have been classified as “Top Secret/Sensitive Compartmented Information.” This does not sit well with Columbia University’s Irwin Redlener. “This is old-fashioned cold war secrecy being applied to a public-health issue,” he said, “a very bad idea.”2251

Bureaucratic tendencies toward condescension are not limited to the United States. The London Times ran a story describing an emergency meeting of 25 European states to deal with the threat of H5N1 at which they urged citizens not to be panicked by bird flu.2252 In response, Effect Measure, the leading public health blog dealing with avian influenza, wrote, “I don’t know about you, but the one thing that makes me want to panic is when the leaders of 25 countries meet in emergency session and tell me not to panic.”2253 Similar attempts to placate the public were made 88 years ago.

A year after California Senator Hiram Johnson coined the famous phrase, “The first casualty when war comes is truth,”2254 public officials were publicly lying to downplay the 1918 pandemic so as not to undermine the war effort.2255 One of the leading pandemic historians notes how this resulted in a public backlash:
People could see while they were being told on the one hand that it’s ordinary influenza, on the other hand they are seeing their spouse die in 24 hours or less, bleeding from their eyes, ears, nose and mouth, turning so dark that people thought it was the black death. People knew that they were being lied to; they knew that this was not ordinary influenza.2256
According to historians, the first reaction of most authorities during the 1918 pandemic was “just flat-out denial.”2257 The Chief Health Officer of New Zealand told the papers to “tell your readers not to get upset.” Rome’s Chief Sanitation Officer belittled the flu as a “transitory miniscule phenomenon.” Poland’s Public Health Commission and Rhodesia’s Medical Director issued the identical bromide: “There is no cause for alarm.”2258 Toronto’s Medical Officer was saying, “There is absolutely no necessity for anxiety,” even as the plague arrived on their doorsteps,2259 echoing the Health Commissioner of New York City: “The city is in no danger of an epidemic. No need for our people to worry.”2260 The resulting mistrust of government officials only added to the climate of fear, a scenario modern-day officials are in danger of repeating.2261 “That men do not learn very much from the lessons of history,” Aldous Huxley once said, “is the most important of all the lessons that history has to teach.”2262

One factor that may be affecting U.S. officials in particular is memories of the so-called “swine flu debacle” of 1976, in which tens of millions of Americans were vaccinated against a supposed pandemic strain of influenza that never materialized. Not only was the CDC left with 90 million useless doses of vaccine,2263 but several of those vaccinated suffered life-threatening side effects2264 resulting in thousands of lawsuits being filed, hundreds of which were settled for a total of millions of dollars.2265 The resulting political fiasco led to the firing of the heads of the CDC and the Department of Health.2266

What makes the threat of H5N1 different from the presumed threat of swine flu in 1976? How can U.S. officials be certain that bird flu is not another Chicken Little scenario? The critical difference is the current global scientific consensus that H5N1 may represent a genuine pandemic threat. Back in 1976, authorities throughout the world—including the World Health Organization—disagreed with the United States that the death of a single soldier from a swine influenza virus warranted universal vaccination. They thought America was overreacting.2267 But now the world’s authorities are in agreement. As summarized by Lee Jong-wook, the late Director-General of the World Health Organization, H5N1 is a “grave danger for all people in all countries.”2268

This is a role public health officials don’t relish. “I do not want to be right,” said the WHO’s Lee Jong-wook. “I do not want to be seen as a prophet of doom,” said the European Commissioner for Health and Consumer Protection. “But I am obliged to ring the alarm bell….”2269 “We’re not scare-mongering here,” avowed Canada’s top expert, head of the national microbiology lab. “We’re not crying wolf,” he said. “There is a wolf. We just don’t know when it’s coming.”2270 In reference to public health officials who fear they will be accused of alarming people unnecessarily, one risk communications expert reminded a reporter, “They forget that in the actual Boy Who Cried Wolf story, the wolf finally showed up.”2271

Lee Jong-wook insisted that every country must have not only a national pandemic response plan, but also a communications strategy to keep the public informed as to what is happening and what they can do without causing panic.2272 Communicating public health risks, though, Osterholm says, is like driving with both feet. “You’re putting one foot on the gas and the other on the brake. You want to motivate on the one hand, and not cause panic on the other.”2273

Not wanting to cause panic is admirable, but in a country not infrequently alerted in response to formless terrorist threats, it would seem appropriate to inform about threats that are considered both real and imminent.2274 The CDC’s National Immunization Program associate director for communications doesn’t believe it possible to effectively motivate people to take appropriate precautions against health risks without making them feel at least some level of concern or anxiety. “This is like breaking up with your boyfriend without hurting his feelings,” the director said. “It can’t be done.”2275

“Don’t be afraid to frighten people” is considered by WHO risk communication specialists to be a key principle in communicating risks such as H5N1 with integrity.2276 The director of the Canadian Centre for Health Care Ethics wrote, “A concern that public discussion of a probable flu pandemic will cause alarm among the public is not sufficient justification for non-communication, just as concern for a patient’s anxiety would not justify not warning him of an impending stroke.”2277 UN Secretary-General Kofi Annan has counseled, “If other pandemics have taught us anything, it is that silence is deadly.”2278

It is true that when people are already terrified, scaring them further may push them into denial. In general, however, public opinion polls show that the population remains too apathetic about the threat of bird flu.2279 A poll in Europe showed that the majority of the population believes that their governments could somehow protect them in the event of a pandemic.2280 In a WHO publication, the communication experts conclude, “We can’t scare people enough about H5N1.”2281

One reason bird flu may sound apocryphal is that we don’t want to believe there’s something that modern medical science can’t handle.2282 Alberta’s Health Minister is concerned that people don’t understand how overwhelmed the health-care system will become. “What worries me most is the ignorance of people in the public who assume that if they get sick there’ll be something there for them, and they don’t realize the devastation this could be.”2283

The prospect of a pandemic might also just be too disturbing to consciously consider. The same disbelief existed in 1918. From fancy dress balls in the Johannesburg City Hall in Spanish costume emblazoned with “Spanish flu” to Londoners holding “sneezing parties” with a bottle of champagne given as prize to the lustiest sneeze, the citizens of the world in early 1918 ridiculed as a joke the threat of “Spanish Influenza.”2284 They were not laughing for long.

Media messages about H5N1 have been mixed. Until fall 2005, news of the impending pandemic was practically nonexistent in North America.2285 Editorial pages slowly started to take notice of the gravity of the situation. The Philadelphia Inquirer editorialized in August that “the U.S. policymakers remain amazingly passive about pandemic preparations.”2286 In September 2005, though, bird flu hit prime time. The ABC News Primetime special started with the words, “It could kill a billion people worldwide, make ghost towns out of parts of major cities, and there is not enough medicine to fight it. It is called the avian flu.”2287 Finally, the issue was starting to get the coverage it deserved.

Then, the media backlash began. Headlines like “No Local Threat from Avian Flu”2288 or “Bird Flu Not Expected to Affect Arkansas”2289 downplayed the global reach by misunderstanding the capacity of the virus to mutate into a human transmissible form. It was framed as strictly a threat to chickens and a few peasant farmers. Meat industry officials the world over said things like, “We care about a pandemic. We do care. But so far, there is no scientific evidence of human-to-human transmission.”2290 Of course, by then it will be too late. As the president of the National Academy of Sciences Institute of Medicine has said of the world’s efforts to prepare for pandemic flu, “The only reason nobody’s concerned the emperor has no clothes is that he hasn’t shown up yet.”2291

“It’s still seen by many capital cities in the West as basically a lot of chickens dying and chicken farmers, so they think, where is the urgency?” explained the FAO of the United Nations. “Our reply is, if this develops into an uncontrollable pandemic in a year, it won’t be farmers dying in the paddy-fields of Vietnam. People will be dying in Washington, New York, London and Paris.”2292 Countries continue to hide their heads in the sand.2293 The United States is no exception, claims Osterholm, who doubles in his professional life as both director of the Center for Infectious Disease Research and Epidemiology and associate director for the Department of Homeland Security’s National Center for Food Protection and Defense. “This to me is akin to living in Iowa,” Osterholm said, “and seeing the tornado 35 miles away coming. And it’s coming. And it’s coming. And it’s coming. And it keeps coming.”2294

“I worry that too many policy leaders dance around this issue fearful that somehow they will either offend or frighten the public,” Osterholm said, answering critics who complain about his dire warnings. “Our job is not to upset people or to calm people. Our job is to tell the truth.”2295 “I am not trying to scare people out of their wits,” he said. “I am trying to scare them into their wits.”2296