Scott McPherson's Web Presence

This week has marked an escalation of sorts -- not regarding bird flu, but regarding the emergence of stories on bird flu, some of them second-guessing whether or not there will ever be a bird flu pandemic.  From blogger Orange and the site The Coming Influenza Pandemic?,  a link to the Cosmos story asking loudly if everyone overdid it when H5N1 was on everyone's lips from 2004 to 2006.  Orange also links to a Nature story via Effect Measure, written by the veteran Nature bird flu journalist Declan Butler.  Effect Measure's thoughtful analysis is here.

Allow me to weigh in on this topic.

Science has only recently been able to peek into the fascinating genetic makeup of influenza viruses.  The ability of scientists to unwrap and decode the actual genetic code of this viral killer has been prodigious over the past three or four years.  We all know the statements that knowledge will double every so many years, based on the accumulation of new knowledge and the ability of the Internet to make that knowledge available to yet even more scientists.

The one thing we cannot do except in very rare, Hultin-Taubenberg -esque circumstances, is to reconcile history with science.  On this score, we are as much in the dark as we have ever been.

Here's what I mean:  From an epizootic standpoint, our real, hardcore, boots-on-the-ground knowledge of past pandemic incubation is very, very limited.  We just don't have the data.  We still don't know how exactly how the 1918 Spanish Flu pandemic really started, although the evidence now points to Kansas, and not China, as the point of insertion.  Or maybe both:  Science is still debating whether or not Hope-Simpson's theory of a kind of viral spontaneous worldwide reveal is what actually happens.  Researching centuries-old historical accounts of viral activity flaring up pretty much simultaneously aboard ships at sea for weeks, all over the globe, simply does not match up with what science has uncovered about the virus thus far.

Want further proof?  Where is the thoughtful, detailed historical analysis of the 1957 Asian Flu pandemic?  It was not the killer 1918 was, but it nonetheless wrought economic calamity and did kill between one and two million people globally. Yet we know virtually nothing about where it came from, or what the spark was that sent the virus on its way across the planet.  We don't know how long it incubated, or where it made the species jump.  We can only guess.

So we think we know how the influenza virus evolves.  But we are far from certain about how it can do this within a limited time frame in various places, all at the same time.

Likewise, we do not know how long it takes for a virus to evolve to the point where it can make a major species jump.  Dr. Mike Osterholm recently made a huge point when he spoke of equine influenza.  Dr. Osterholm reminds us that it took forty years -- forty years! -- for equine influenza to make the species jump and show up in dogs in Florida.  That's forty years from when H3N8 was first typed.  Who knows how long it really took?  And it apparently accomplished this species jump without any major structural change in the virus' genetic footprint, according to a recent study I read.

So how did H3N8 equine influenza jump to, and kill, dogs in Florida and elsewhere without sacrificing a major change in its viral DNA?  Science has no answer.

Naysayers and critics point to the noticeable drop in the number of human deaths from H5N1.  And we all can certainly say that this is both welcome and unexpected news.  Surely we can chalk this up to better coordination, a Return on Investment of American and WHO dollars toward education of agrarian populations, poultry culling and other eradication efforts, and possibly (and I think in a very minor way) rudimentary poultry vaccination efforts.

For example: The minute India began experiencing its worst and massive H5N1 infestation in poultry last year, I said "Game over!" and refreshed my personal inventories of stuff.  I was more than surprised at the subsequent and apparent lack of human victims of H5N1 among cullers. I was downright shocked that a major outbreak of human H5N1 did not occur.  This prompted me to blog my speculation that Qinghai H5N1, as it exists today, might not be the pandemic strain after all, and wrote that the Fujian clade should get more attention.

We need to think more like the virus thinks and respect its patience.  H5N1 is now endemic in many areas and regions of the world.  Things may be calm now, but they can change with one day's notice.

As the Reveres did, let's turn to the topic of pandemic planning.  I believe we are worse off now than we were two years ago.  Why?  First, because pandemic fatigue has hit everyone, especially in the private sector.   Not to toot my own horn, but I am considered an expert in pandemic planning, and I am one of less than a handful of global IT pandemic planning experts.  I used to get several calls a day to lecture on panflu from all over the world.  

I have not gotten a call to do a bird flu lecture in months. 

Second, everyone has less money to devote toward pandemic preparedness.  Governments are broke all over the nation, and anyone who thinks things in the economy will be getting better anytime soon is living in a fool's paradise.  So no government has the money to buy antivirals, masks, hand sanitizer or anything else helpful.  This probably is why Roche decided to change its strategy with Tamiflu and sell it directly to businesses and corporations.  They realized governments were no longer able to spend taxpayer money on antivirals, and needed to change their business model to move product languishing in warehouses all over the planet.  Or to "lease" product, based on the releases I have read.  Kind of like buying gold stocks as a hedge against inflation.  Corporations would "reserve" their right to get Tamiflu in exchange for Roche warehousing the drugs and distributing them at a different pricepoint if the excrement hit the fan.

Likewise, knowledge will be much harder to impart.  Many governments have laid off their training departments or have made major cuts in personnel.  The focus of training will turn toward events that must be planned for, such as hurricane preparedness and the mitigation of other risks.  People in the Midwest, especially along the Mississippi River, have much more important things to attend to than pandemic planning.  And their real-time, immediate health care needs more closely resemble the health care needs of Indonesia than they do Indiana. 

Viruses have a tendency to kick humanity when it is down.  Bird flu has already deprived millions and millions of people worldwide of a primary and essential protein source.  The madness that is ethanol production from corn has raised food prices to an unconscionable level worldwide.  The combined loss of poultry to H5N1 eradication efforts, coupled with the increase in the price of everything, will reduce the quality of life for many poor nations and their residents.   Sick people get sicker; the pace accelerates.  This puts heavy pressure on the world's "haves" to help resupply starving people and offer compensation for culled birds, as well as putting enormous pressure on poor farmers to cover up their diseased flocks and keep their mouths shut if they don't get compensation.

Peering into this malestrom of uncertainty, protein deprivation, starvation, economic and political instability sits the H5N1 virus, along with many, many other "emerging" diseases.  Aided by these factors and the globalization and "flattening" of everything, these diseases bide their time, enduring setbacks here and advances there.  As Dr. Henry Niman says, H5N1 does not read press releases.  Nor does it read scientific journals.  And if it decides it will not be the next pandemic strain, another virus will come along to take its place.

When, where, and how severe will never be known to us.  We can only do what we can to prepare in this brave new world of ours.