In blatant defiance of the White House Press Corps tradition of asking nothing but questions which they ought to already know the answer to over and over again, one reporter at yesterday’s press conference actually brought up a timely and important topic, the threat of Avian Flu.
President Bush was ready with an exhaustive answer – he’s just finished meetings with the United Nations and World Health Organizations on this issue, and has been extensively briefed on the subject. He’s also preparing to host an international conference on the Avian Flu crisis later this year, so the subject is very much on his mind.
The specifics of the president’s response to the question have led to some negative reaction because he suggested the use of the US Military to impose a quarantine within our borders in violation of Posse Comitatus. This has raised concerns for some, but it does seem to be a logical outgrowth of the inability of local authorities to respond to recent major crises like hurricane Katrina, a situation which would be accentuated by the interstate character of the outbreak of a major flu epidemic.
For years concerned commentators like Ralph Nader have been complaining that the administration was not taking the threat of Avian Flu seriously enough. Now that they are apparently taking it seriously, the proposed solutions are stirring up accusations of fearmongering.
Yet the more we learn about the threat of Avian Flu the more alarming it seems. The context in which all epidemics are assessed is the Spanish Flu of 1918, which is now believed to have originated as a bird flu. That virus infected about 25% of the population of the world and had a fatality rate of about 20%, ultimately killing millions of people world wide – about 3% of the total world population or 50 million people. In comparison the Avian Flu has yet to spread far, but it has a fatality rate of as high as 70%. All it would require would be for the virus to break out of the areas in Asia where it is currently contained and begin to pass from one human host to another and it would become an epidemic of unprecedented proportions. The World Health Organization has estimated a potential death toll of as many as 150 million people.
The good news is that so far Avian Flu has not been clearly identified in a form which can be transmitted from human to human. All of the 108 identified cases have been direct transmissions from poultry to people. This has resulted in the extermination of millions of chickens and ducks in Asia in an attempt to control infection of humans, but they keep finding more infected birds.
The danger is that once the flu gets into a human host it tends to mutate rapidly. It’s sort of fortunate that most people exposed to the virus so far have died fairly quickly, because if they lived and carried the virus for an extensive period as is the case with more benign forms of flu, the virus would have time to mutate into a form where it could be transmitted directly to other humans, and they would have time to infect other people.
The development of a human born form of Avian Flu is almost inevitable as more people get exposed to the virus. Other forms of flu mutate seasonally so that eventually vaccines developed for them no longer work, and with time Avian Flu will become an active threat just as Swine Flu did when it jumped from the pig population to humans and became an epidemic in 1976. Since that time it has probably killed 100 million people world wide, and it kills about 30,000 a year in the US alone. Because Avian FLu has a much higher fatality rate than Swine Flu the impact of an epidemic outbreak would be unprecedented.
Another problem has been the difficulty of producing a vaccine for Avian Flu. A vaccine developed to treat it in poultry has proven to be ineffective, and because the exact form it will take in humans during an epidemic is not known, no one has been successful in developing a human vaccine yet. And as has been demonstrated with past flu vaccines, they are not entirely effective, can be dangerous themselves, and become less and less effective as the virus mutates as it passes from host to host.
The World Health Organization and the US Centers for Disease Control have made Avian Flu their highest priority, and the president is clearly very aware of the issue, but as a whole people aren’t taking the threat seriously, largely because they aren’t aware of the scale of past Flu outbreaks and the potential of this virus. People tend to think of Influenza as an irritating virus which lays you up for a couple of days of misery. What they don’t realize is that even this mild form of flu kills hundreds of thousands world wide every year. Avian Flu is so much more virulent that the potential impact is almost inconceivable, dwarfing recent natural disasters like hurricanes and tsunamis.
Proposals to deal with the virus once it breaks out here in the US are inefficient and ineffective. Some, like Senator Tom Harkin, have suggested stockpiling vaccine in preparation for the outbreak, but the fact is that we don’t have a vaccine which we can count on to work at all against this strain of Flu, so such efforts may be wasted. Even the president’s plan for extreme quarantine measures might not work at all because of the likely scale of an outbreak and the difficulties of controlling the movement of population in modern society.
The only viable way to really address this threat is at the source, before it takes a communicable form in humans and begins to spread as an epidemic. That’s what the internatonal Avian Flu conference which begins tomorrow in Washington DC will address. 65 countries are expected to attend, but it’s unlikely that any immediate solution will come from it, because the countries where the disease currently exists like Laos, Thailand and Vietnam are poorly equipped to deal with an emergent epidemic and difficult to work with. The conference is an essential step in the right direction, because it is going to take the full participation of the international community and the cooperation of the problem countries to solve this problem before what is seen by experts as its inevitable outbreak as a pandemic among humans.
For a detailed video report on Avian Flu, see CNN
To read the full transcript of the president’s Press Conference with his proposals on this subject, check out the State Department website.
For additional useful information see the report on the European Health Alliance website.