Scott McPherson's Web Presence

Indonesia's Health Minister dashes the dream of Yi Guan upon the rocks of national insanity.

Recently, I wanted to write a blog titled "Found: One same Indonesian."  It was to be a profile of the Indonesian bird flu researcher (I think he is on Bali) and his belief that the Health Minister has gone the way of the rabbithole in Alice's adventures in Wonderland. 

That was a few weeks ago, and the story went stale.  But I have fused the events of the past week and a half into one crystalline structure -- a looking glass, if you will -- for you to peer into and see its many facets.

Two weeks ago, world-renowned Chinese infectious disease expert Yi Guan postulated that we could end pandemics forever if only we had the appropriate amount of surveillance.  The Reuters story included this quote:

"If proper surveillance is in place for animals and humans, yes, we can stop pandemic influenza forever. Not just for H5N1, it may also work for other subtypes of viruses," he said in an interview over the weekend.

"We have the ability to remove pandemics if we have a long-term strategy."

http://uk.reuters.com/article/homepageCrisis/idUKT16178._CH_.242020080330

An audacious dream, indeed.  And it is not outside the realm of possibility.  It is always good to hope.

But apparently the government of Indonesia believes in the words of the German philosopher Nietzsche, who is infamously quoted as writing:

In On the Genealogy of Morals, Nietzsche writes: “Hope is the worst of all evils, for it prolongs the torments of Man.”

Yi Guan speaks of a perfect world, and the global press seized upon his message with the same zeal as if we had stumbled onto a cure for cancer.  The headline trumpeted:

Proper surveillance can stop flu pandemic: expert

The headlines might have also said:  Asteroid can be stopped if we invent spaceship capable of blasting it to smithereens (not the superb band The Smithereens, of which I am obviously fond).  Or "Baldness can be cured if we ever figure out how to change the baldness gene."  Of course, I am personally counting on that one, and soon!  I have work to do in my yard and I hate wearing hats!

But I sadly digress. Yi Guan's point, I believe, is that in a perfect world, all nations would gleefully set up avian surveillance programs in every remote village and hamlet on the planet.  Poor farmers would be trained to look for avian influenza.  Payments for culling sick poultry would skyrocket.  Farmers might actually be persuaded to turn in their flocks for proper compensation at that point!

Yes, and a few poor farmers with bad luck and a bit of larceny in their minds might also try to sicken their own flocks to resemble H5N1, in order to profit monetarily.  That's the Nietzsche in me, I suppose.

Counting on surveillance to help eradicate pandemics forever is a just and righteous cause.  But at this point, it is no more than an audacious hope.  And while surveillance may very well have prevented an H5N1 pandemic from occurring, and maybe more than once, it cannot be counted upon to be infallible.  Just look at all the territory, all the customs of the villagers, all the chickens and ducks being hidden from government authorities, the huge disparity in compensation for farmers worldwide, and the endgame by large corporate farmers who are more than happy to take up the slack and provide protein when backyard farmers are cleaned out.

Now entire governments, driven by their own selfish desires, may even try to stymie the ability of scientists and public health experts to do their good work.  For confirmation of this, look no further than today's story on Indonesia's decision to shut down NAMRU-2.  Shutting down NAMRU is madness, the height of insanity.  It is the scientific equivalent of cutting off one's nose to spite one's face.  And it puts a massive dent in the ability of Indonesian and American scientists to test H5N1 samples -- and those of other viruses such as chikungunya, malaria and dengue.

Surveillance without samples accomplishes nothing, except to cause us to look on in horror as poultry writhes and dies.  Surveillance without samples is empty.  And the Indonesian government, via its decision to shut down NAMRU-2, is making it almost impossible to get quick, independent laboratory confirmation of viral changes at just the time when Indonesia needs all the help -- and all the real friends -- it can get.

Yi Guan is a great scientist and, I am sure, a great person.  He is right to hope.  But one singluar action by a national government has the effect of walking Yi's dream deep into the woods and shooting it in the head.

Call me a pessimist, which I am normally not.  I am the eternal optimist.  But on this topic, my money's on Friedrich.