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What do Vietnamese chickens, the Nobel Prize in economics, and the flu vaccine
shortage have in common? They are all possible ingredients for a future influenza outbreak that
could quickly spin out of control and spread worldwide just as the “Spanish Flu” did in 1918.
Consider the current situation: Half of the U.S. influenza vaccine disappears because one
of two manufacturing plants is contaminated. The sudden shortage produces a mad scramble for
the remaining vaccine, price gouging, thefts, border-crossings to buy Canadian and Mexican
vaccines, political finger-pointing, rationing, and a general sense of chaos. All of this political
and public health confusion is over an annual event—the arrival of flu—that is as regular and
predictable as a sunset. One wonders how the U.S. would respond to an unpredictable event.
Which brings us to those chickens in Viet Nam. Over the summer, tens of thousands of
chickens and other birds have died from an avian form of influenza. In an effort to control the
spread of avian flu, the Vietnamese government killed 44 million birds. They did this to prevent
bird flu from infecting more people. So far, 27 people in Viet Nam have been infected. Twenty
Nearby Thailand is dealing with a similar situation. There, 16 people have been infected
and 11 have died. What is interesting, and worrisome, about the Thai cases is that one of them
appears to involve person-to-person transmission of the bird virus. If true, it would be very bad
news. It would mean the virus no longer needs birds to sustain itself; instead it can move among
Bird flu (known to scientists as H5N1) is like a pot of water on a slow boil. Bubbles keep
breaking to the surface, and the first bubble popped in Hong Kong in 1997. There it killed 6 of
18 infected people, and led to the wholesale slaughter of the island’s poultry. It reappeared in
2003 and killed one of two infected people. Another bird flu virus (H7N7) appeared in the
Netherlands in 2003, killing one man. Thirty million birds in the Netherlands, Belgium and
Germany were slaughtered to stop the outbreak. Hong Kong was hit with a second bird virus
(H9N2) in 1999 and 2003, but no deaths resulted. Why are we suddenly being plagued with bird
flu?
First, flu viruses are inherently unstable. Like actors changing costumes and characters
in a play, influenza viruses shift their own appearances and characteristics in regular but
unpredictable ways. That’s why a new flu vaccine has to be made each year; it has to be able to
recognize the latest viral custom change to be effective. Second, crowded Southeast Asia and
China have vast populations of poultry that live wing-to-jowl with pigs and their human keepers.
Thus, there are endless opportunities for bird viruses to mix with viruses from pigs and people.
Pigs have traditionally been thought of as “mixing vessels” for bird and human viruses to meet
But the H5N1 bird virus seems to be able to jump directly to people. The big fear is that
this virus will find its way into a person already infected with a human flu virus. There in the
warm, dark lungs of that unfortunate individual the two viruses will meet, recombine and
produce a new virus that is both deadly and highly infectious. This is the nightmare that most flu
Based on data from previous pandemics, the CDC estimates there could be 207,000
deaths in the U.S. alone. (There are 35,000 flu deaths in a typical year.) Last year the World
Health Organization raised its pandemic alert to Level 2 following the appearance of these avian
viruses that could infect people. The U.S. government has a plan for confronting a new
pandemic (www.hhs.gov/nvpo/pandemicplan), but it relies on antiviral drugs that are currently in
short supply, untested vaccines made from a process called “reverse genetics,” and an unlicensed
Which brings us to the economists who won this year’s Nobel Prize. They figured out
why “good governments do bad things to good people,” according to Charles Seife of Science
undermines their credibility and leads to unintended consequences. This may explain why the
government’s $5.6 billion Bioshield bill encouraging industries to make new bioterrorism drugs
and vaccines has fallen flat. “Fuzzy mandates,” says the Center for Biosecurity at the University
of Pittsburgh.
Thus, the Center concludes we remain vulnerable to biological attack. By the same
token, we also remain vulnerable to the shifty flu virus, and the clock is ticking.