The Moneymaker on the Bookshelf – endorsed by panic-monger Laurie Garrett
A year ago in these pages I clucked at all this, laying out the evidence that the alarmists were wrong, that avian influenza type H5N1 would not become readily transmissible from human to human and therefore not become pandemic – meaning a global epidemic. (See "Fuss and Feathers: Pandemic Panic over the Avian Flu," November 21, 2005.) Some of the arguments I made have quietly caught on. For instance, health officials, including National Institute of Allergy and Infectious Diseases director Dr. Anthony Fauci, no longer talk about an "overdue pandemic" (because there is no pattern to when pandemics occur; they are never "due" or "overdue"). But the damage has been done. A Harvard School of Public Health survey of adults who have children revealed that 44 percent think it "likely" or "somewhat likely" there will be "cases of bird flu among humans in the U.S. during the next 12 months." Less than a fifth of respondents considered it "not at all" likely.
Not coincidentally, an avian flu bureaucracy has become entrenched. Like all bureaucracies, it will fight to survive and thrive, egging on governments to provide ever more money. The alarmingly titled 2006 Guide to Surviving Bird Flu is published by no less than the Department of Health and Human Services. Never mind that no one in this country has yet even contracted bird flu. Congress last year allocated $3.8 billion to prevent the ballyhooed catastrophe (Bush requested almost twice that amount). The latest "scary news," promulgated in the November 23 issue of the New England Journal of Medicine by über-alarmist Robert Webster of St. Jude Memorial Childrens Hospital, is that human cases of H5N1 contracted from birds are continuing to increase. Indeed, confirmed cases for 2006 are running ahead of those for last year. But the difference is slight; 97 worldwide for all of last year versus 111 through the end of November 2006. This difference could be entirely explained by better surveillance. Moreover, the real concern is not sporadic bird-to-human transmission, but human-to-human transmission. Far more people die of tuberculosis in an hour than all those known to have died from H5N1.
So its time to revisit the allegations and show that as small as the risk was a year ago, its nevertheless dropped considerably since.
Mutation and Reassortment
A flu pandemic can come about in two ways. One way is for the virus to randomly mutate to become easily transmissible between humans. "Randomly" is the key word here. There are no evolutionary pressures to make H5N1 adapt better to humans. Given enough time, H5N1 might mutate so that it could under the right conditions become pandemic. But that could take millions of years, during which time it would be more likely to mutate itself out of existence. H5N1 was first identified in Scottish chickens in 1959. It has been flying around the globe for close to half a century and hasnt done a number on us yet. Theres absolutely no reason to think it will pick this year or next to do so.
Another scenario is that somebody with human flu could contract avian flu at the same time and the two flus could "reassort" into hybrid avian-human flu. The last two flu epidemics in the 20th century – 1957-58 and 1968-69 – were caused by such hybrids. We can help reduce this possibility by vaccinating as many people as possible (especially Southeast Asian poultry farmers) against human flu, thus reducing the potential number of "mixing vessels." Programs underway to keep farmers away from poultry droppings and spittle (birds dont sneeze or cough) will also help.
Ferreting Out the Truth
Ferret studies show H5N1 avian flu doesnt readily take wing outside of birds.
The research showed that the H3N2 virus passed easily by droplets (ferrets do sneeze and do not use handkerchiefs) but the H5N1 virus did not spread – the same thing were seeing in humans infected with H5N1 from birds.
Separately, the scientists used gene splicing to create a hybrid H5N1/H3N2 virus. In other words, rather than letting nature take its course and seeing if the viruses would reassort, they guaranteed that reassortment occurred. They found these hybrids also did not pass easily between the animals. Moreover, ferrets injected with the reassorted virus showed symptoms less severe than those with the pure avian flu. Reassortment appears to have weakened the virus.
In a final study, CDC researchers passed a hybrid virus through a series of ferrets to see if it would accumulate genetic changes necessary to transmit more easily. This tested the mutation factor. The scientists found this introduced only one genetic change in the virus but didnt enhance its transmissibility.
Other researchers have found the explanation for a phenomenon that was already clear but unexplained--that H5N1 virtually never spreads from human to human and, if it does, its only after prolonged contact. This contrasts with human flu, which can be contracted via a single cough or sneeze. A Nature magazine study published last March found that while avian flu can infect human lungs, it cannot infect most of the cells lining the nose, throat, and sinuses. Moreover, it tends not to penetrate deeply into the lungs. "It has been an enigma why people get sick and die from H5N1 avian flu virus, but the virus does not spread well in humans," study leader and University of Wisconsin virologist Yoshihiro Kawaoka told WebMD. "Our finding explains it."
That Allegedly Horrendous Death Rate
Ersatz experts like Laurie Garrett, a renowned pandemic panic-monger, warn of a horrific mortality rate from the bird flu virus. "Right now in human beings, it kills 55 percent of the people it infects," she told ABC Newss Primetime last year. St. Judes alarmist Webster referred to a similar death rate in his New England Journal of Medicine article, and the media routinely parrot it. By comparison, the devastating 1918-1919 Spanish flu is believed to have killed 2.5 percent to 5 percent of those it infected. The death rate in a typical flu season is less than 1 percent. Its true that, of bird flu cases recorded by the World Health Organization, 59 percent have died. But this is a mere artifact with an obvious explanation: Only people with the most severe cases go to the hospital and become part of the dataset.
Research from Vietnam shows that even with inferior health care, the human death rate from H5N1 is considerably less than 1 percent, not higher than 50 percent.
More good news from Vietnam, incidentally, is that it has reported zero cases in 2006. Why? As I wrote last year, "Vietnam appears to be making a heroic effort to inoculate all of its poultry." If you can keep poultry from getting flu, youve knocked down the chance of a human pandemic from close to zero to absolute zero.
Antivirals: Preventing Infection, Preventing Spread
Another risk-reducing development over the past year is the increased availability and evident reliability of Roches Tamiflu and GlaxoSmithKlines drug Relenza. These drugs interfere with neuraminidase (the N in H5N1), a protein on the surface of the virus that must multiply in order for the virus to multiply. Research at St. Judes has shown that H5N1 appears to express the highest level of neuraminidase of any flu since 1957, and studies continue to appear showing both drugs can kill two birds with one stone. That is, they are effective both in preventing a person from getting the flu and, if they do get it, from transmitting it.
Avian flu vaccine is on its way
In fact, no human H5N1 vaccine has yet received official approval, but companies are pumping them out anyway in the confidence that their drugs will be found both safe and effective. Switzerland has ordered enough vaccine from GlaxoSmithKline for one inoculation of each of its eight million citizens if a pandemic erupts. The U.S. government has ordered 2.7 million doses from three makers, which would be enough to vaccinate first responders so they could take care of those who did become ill. Eventually the country plans to stockpile 20 million doses and then presumably will increase that as well, but since the vaccines arent yet available, even that amount is still academic.
This isnt the first time somebody has cashed in on fear of birds . . .
Newer research by Dr. John Treanor and colleagues at the University of Rochester, presented on October 13 at a meeting of the Infectious Diseases Society of America supports these findings. Treanors team studied people whod been vaccinated against the Hong Kong strain of the H5N1 virus in 1998. Each was vaccinated again this year with a booster shot to fight the strain found in Vietnam. A second test group received only shots for the Vietnam strain in 2005. Those who received shots back in 1998 developed better protection than those with just the 2005 vaccination. Thus for all the talk about how rapidly H5N1 mutates, injections from 1998 were still protective. On the other hand, a seasonal human flu injection from 1998 would be worthless.
This is both evidence that H5N1 is not mutating like gangbusters and that we can quite possibly amass enough vaccine to protect every reachable person on the planet without having to build a new stockpile each year. Hysteria over an avian flu pandemic has been very good for the Chicken Little media, authors, ambitious health officials, drug companies, and even Bush bashers. (An alarmist fantasy published by Nature magazine in May 2005 concluded by predicting a pandemic outbreak in December of last year, laying the blame entirely at the presidents feet.) But even as many of the panic-mongers have begun to lie low, the vestiges of hysteria remain – as do the misallocations of billions of dollars from more serious health problems. Too bad no one ever holds the doomsayers accountable for the damage theyve done.