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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—Richard Horton2347

In the months the pandemic is expected to rage before a vaccine is available, an elite segment of the privileged world will have antiviral drugs like Tamiflu, and the rest of the world will essentially have nothing. A lead article in the Medical Journal of Australia pointed out the irony that the countries in the region most likely to become sources of the pandemic strain are the ones least able afford to a national Tamiflu stockpiling strategy.2348 Webster remembers a trip he made to brief prime ministers of the Association of Southeast Asian Nations on what the rest of the world could offer them. He told them that the World Health Organization will try to help with the initial outbreak. “But if it breaks through, guys,” he said, “you’re on your own.”2349

Mike Davis in his landmark bird flu book, The Monster at Our Door, describes this as the “Titanic Paradigm.” He compares the availability of the world’s public health resources to that of lifeboats on the Titanic: “[M]any of the first-class passengers and even some of the crew will drown because of the company’s skinflint lack of foresight; the poor Paddies in steerage, however, do not even have a single lifeboat between them, and thus, they are all doomed to swim in the icy waters.”2350

Symbolic gestures are at least being made. Australia sent a stockpile of 50,000 treatments of Tamiflu to Indonesia, population 211,000,000.2351 The rest of the stockpile in the region is hidden in “secure locations,”2352 sites remaining secret “for national security.”2353 Canada has signed a pledge announced by Mexico for wealthy nations to donate 10% of their flu drug stockpile and eventual vaccines to less affluent nations.2354 “Just imagine the ethical, political and security implications of a world where only rich countries have access to lifesaving drugs or vaccines, and the rest of the world stands while [poor countries] march toward death,” Mexico’s Health Minister told the Canadian Press. “That is an unsustainable scenario.”2355 Garrett agrees that these disparities during a global crisis bring up “desperate, unbelievably enormous foreign policy issues”2356 and could turn into a “big bloody mess.”2357 The United States declined to sign onto the same pledge. Given limited U.S. supplies, it would be “unrealistic,” said a senior advisor with the U.S. Emergency Preparedness Department, “to start talking about sharing.”2358