E-Mail This Article to a Friend Yes, you should be afraid As avian flu threatens to kill millions, Bush bets our lives on the free market BY DAVID S. BERNSTEIN
	Will you die? What happens if it comes to Massachusetts? Admit it: you’re thinking, "Hey, I’m young, I’m healthy, I wash my hands regularly, I live in the medical capital of the US — I’m not at risk for bird flu." Well, think again. Past flu pandemics have often proved most lethal to young adults, including the potent 1918 avian influenza that scientists say closely resembles the current threat, known as the H5N1 strain. Early evidence suggests that H5N1 may replicate that pattern. Of the first 38 documented cases of lethal bird flu in Vietnam and Thailand, a third were between the ages of 18 and 35. The average age was 15 in Vietnam, 20 in Thailand. If the H5N1 strain of avian influenza does reach pandemic proportions, it will surely find its way to Massachusetts, despite our relative paucity of poultry farms (12) and live-bird markets (six) compared with many other states. Don’t worry, you can’t get it from eating your Thanksgiving turkey or walking through a pigeon-infested park. But if it mutates, it will come down from the north, in the bellies of infected migrating birds. Their droppings will spread it to more fowl and game birds and ultimately to humans, as sometimes happens with ordinary flu. No one at this point knows exactly how much contact with the droppings is required to get infected. Then, the person-to-person transmission can begin, just as ordinary flu is passed on. The Bay State lies in the migratory path of birds that could carry it south, as they have brought viruses here in the past. We have active ports that made Boston one of the hardest-hit cities during the 1918 pandemic. And we have an actively migratory human population of business travelers, tourists, college students, and conventioneers coming and going constantly — with their diseases. The good news is that the Bay State has an influenza-pandemic-preparedness plan, created in 2001 and just updated in July. The bad news is that many critical elements of that plan, for detecting and reporting an outbreak, and for distributing, storing, and administering vaccines, are glaringly incomplete. Bear in mind, too, that the last to receive the very limited amounts of vaccine will be otherwise healthy adults aged two to 65. So if and when the crisis hits, don’t expect to get vaccinated. "Vaccine shortages are likely to exist, especially early during a pandemic," the preparedness plan warns. That’s an understatement. The plan assumes, as the US government does, that it will take at least six to eight months after the outbreak for a vaccine to be developed and ready for manufacture. That’s an entire flu season right there. When the vaccine does start moving, Massachusetts expects to receive 460,000 doses per month throughout the pandemic. Assuming two doses per patient, that means another 12 months to vaccinate the "priority groups": health-care workers, first responders, and high-risk populations. That’s another flu season come and gone before the general population gets in line. At that point, roughly six percent of the citizenry will get vaccinated each month. In other words, even if all goes well, the pandemic will likely have run its course before your turn in line comes up. And that’s if all goes well, which is unlikely. Among the items not ready as of the July report: • There is no plan for obtaining the syringes, containers, and other supplies needed by vaccination clinics. "It is unclear who is responsible" for this, the report says. • The state has no automated mortality-information reporting. Under the current system, a coded, searchable file of influenza deaths would not be available until at least three to four months after deaths occur. • There is no plan for providing security for the vaccines during their transportation from the central facility in Jamaica Plain to other parts of the state. • Many large parts of the state have little or no available excess storage space for those vaccines. • Many sites that would store the vaccines have little or no security. For example, Western Massachusetts’s vaccine would be stored at a UMass Amherst facility, where the only protection is the school’s campus security. Central Massachusetts’s supply office in West Boylston currently has no alarms or security personnel. • The state has no legal authority to enforce mandatory vaccination. — DSB

You can’t swing a sick chicken these days without hitting a pundit pontificating about bird flu. After nearly two years of sporadic news coverage, the media woke up to the threat in late September when George W. Bush spoke about the potential pandemic; now, the topic is regular fodder on the nightly news, the weekend shows, the daily papers, and the popular newsweeklies.

Everyone is having their say and, unremarkably, everyone seems to view it through their own lenses. Thomas Friedman recently opined on the Don Imus show that bird flu demonstrates the "flat-world" hypothesis of his latest best-selling book. Apocalyptic evangelicals cite it as a sign of the impending End Days. George Bush wants to invoke his administration’s handling of it, post-Katrina, as an example of their competence. Democrats say that Bush’s approach to the problem represents the exact opposite, as Senator Edward Kennedy argued in a Boston Globe op-ed last Sunday.

In fact, the danger of an influenza pandemic is real and serious. It is almost certain that the current H5N1 strain, which has thus far killed more than 60 people, all in Southeast Asia, will spread to poultry in most or all of the world. So far, almost all cases in humans have resulted from contact with live infected birds. And the virus could remain in its current form, which does not seem to spread easily from human to human (as a common cold would). In that case, it will have a massive economic effect, but relatively few fatalities. Or, it may well mutate, as past viruses have, to a person-to-person disease, in which case millions, or tens of millions, will perish.

Even if we luck out with this version of the disease, we are only buying time. The consensus is that the big one is coming; we just don’t know when and how bad it’s going to be.

It is unsurprising that the US and the world in general have been slow to take the threat seriously. Governments are not so different from mainstream media — only so many things occupy the high-priority bin at any given time, and bird flu hadn’t made it there until just recently. Yes, it should have; the warning signs have been flashing for at least eight years, if not longer. But it has not until just recently.

What is disconcerting — in addition to the basic problem of infrastructure readiness laid bare by the Gulf Coast hurricanes — is that the US is facing the threat with a perspective no less slanted than those of Friedman or the apocalyptic preachers.

In the case of Bush and the rest of the administration, that slant is primarily capitalistic and secondarily militaristic. These are, in fact, the only two types of solutions the Bushies seem to know. Name any problem of the past five years, and the administration’s proposal has been either to provide financial incentives to big business — remember that they have touted corporate and high-income tax cuts as the proper response to both recession and growth — or to roll out the armed forces.

Bush’s recent proposal to use the US military to impose quarantines has drawn considerable attention and justified criticism. But that is merely a sideline. The primary bird-flu strategy involves giving as many concessions as necessary to prompt the pharmaceutical industry to make the drugs we’ll need. There are arguments to be made for that approach, but stronger arguments against it — including, most noticeably, that it has failed miserably before.

FREE-MARKET FOLLY

Bush has said that his thinking about bird flu was shaped by a book on the 1918 pandemic. There is surely much to learn from that horrific episode, which killed somewhere between 20 and 80 million people worldwide, depending on whose estimates you use.

But while the current version of the virus is similar to that one — making it fully appropriate for scientists to study it for clues to a potential medical solution — the world it comes into is a vastly different place. Of course the world’s response in 1918 was inadequate: understanding of viral disease was in its infancy, infrastructure for global cooperative efforts was practically nonexistent, and the world was distracted by the largest war it had ever known.

In fact, more-relevant lessons can be learned from virus-pandemic scares of the last half-century, when knowledge, resources, and infrastructure were at hand. Unfortunately, those lessons are cautionary since, in every case, presidents have handled the threat poorly. Bush appears well on his way to sustaining that track record.

In 1957, Dwight D. Eisenhower refused to order mass production of vaccines, relying instead on the market, and 80,000 Americans died. Another 34,000 died in the 1968 outbreak, when again Lyndon B. Johnson failed to prompt pharmaceutical companies to produce sufficient vaccine quantities. The swine-flu scare of 1976 led Gerald Ford to hand over the farm to the drug manufacturers and the casualty-insurance industry, forking over large sums of money, granting indemnification against claims, and allowing proprietary-secret concerns to trump government oversight. The result was an expensive fiasco, particularly when the flu strain proved relatively mild. Finally Ronald Reagan dismantled Jimmy Carter’s attempts to create ongoing vaccine-development programs, and, of course, failed to marshal the power of the US government to stem the HIV/AIDS epidemic.

There is a common theme here: reliance on free-market forces, which proved woefully unsuitable.

Bush is not reading about these historical episodes, nor is he learning their lessons. Quite the opposite. Bush and his team have made explicitly clear that the plan is to take every pro-business measure they have ever supported, and apply them to the vaccine industry.

This strategy dates back at least a year, to the policy of former Health and Human Services secretary Tommy Thompson, but it has been re-emphasized repeatedly in the past two weeks by HHS secretary Michael Leavitt, the country’s de facto avian-flu czar.

After a bird flu meeting between Bush and pharmaceutical executives on October 7, Leavitt spoke to the press about the need to pass medical-liability reform, to indemnify drug makers from litigation, and to "create a streamlined regulatory process" for those companies.