Wednesday, June 22, 2005

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Need something more to worry about?

Foreign Affairs has a special section in their July/August 2005 issue devoted to "coping with the next pandemic." After reading Laurie Garrett's excellent introduction to the section (subscription only) about the emergence of the H5N1 avian influenza, I feel both better informed and freaked out.

Garrett also identifies the economic reasons why there isn't a booming market for flu vaccines:

The total number of companies willing to produce influenza vaccines has plummeted in recent years, from more than two dozen in 1980 to just a handful in 2004. There are many reasons for the decline in vaccine producers. A spate of corporate mergers in the 1990s, for example, reduced the number of major international pharmaceutical companies. The financial risk of investing in vaccines is also a key factor. In 2003, the entire market for all vaccines -- from polio to measles to hepatitis to influenza -- amounted to just $5.4 billion. Although that sum may seem considerable, it is less than two percent of the global pharmaceutical market of $337.3 billion. Unlike chemical compounds, vaccines and most other biological products are difficult to make and can easily become contaminated. There is also a large and litigious antivaccine constituency -- some people believe that vaccines cause harmful side effects such as Alzheimer's disease and autism -- adding considerable liability costs to manufacturers' bottom lines.

The production of influenza vaccines holds particular drawbacks for companies. Flu vaccines must be made rapidly, increasing the risk of contamination or other errors. Because of the seasonal nature of the flu, a new batch of influenza vaccines must be produced each year. Should sales in a given year prove disappointing, flu vaccines cannot be stockpiled for sale in a subsequent season because by then the viruses will have evolved. In addition, the manufacturing process of flu vaccines is uniquely complex: pharmaceutical companies must grow viral samples on live chicken eggs, which must be reared under rigorous hygienic conditions. Research is under way on reverse genetics and cellular-level production techniques that might prove cheaper, faster, and less contamination-prone than using eggs, but for the foreseeable future manufacturers are stuck with the current laborious method. After cultivation, samples of the viruses must be harvested, the H and N characteristics must be shown to produce antibodies in test animals and human volunteers, and tests must prove that the vaccine is not contaminated. Only then can mass production commence.

The H5N1 strain of avian flu poses an additional problem: the virus is 100 percent lethal to chickens -- and that includes chicken eggs. It took researchers five years of hard work to devise a way to grow the 1997 version of the H5N1 virus on eggs without killing them; although there have been technological improvements since then, there is no guarantee that an emerging pandemic strain could be cultivated fast enough.

Garrett also makes a very solid case for why, even in an open global economy, the U.S. government should ensure there is a domestic industry for these vaccines:

Were the United States to falter, it would probably not be able to rely on Canadian or European generosity, as it did just last year. When the United Kingdom suspended the license for the Chiron Corporation's U.K. production facility for flu vaccine due to contamination problems, Canada and Germany bailed the United States out, supplying additional doses until the French company Sanofi Pasteur could manufacture more. Even with this assistance, however, the United States' vaccine needs were not fully met until February 2005 -- the tail end of the flu season....

In the event of a deadly influenza pandemic, it is doubtful that any of the world's wealthy nations would be able to meet the needs of their own citizenry -- much less those of other countries....

There would thus be a global scramble for vaccine. Some governments might well block foreign access to supplies produced on their soil and bar vaccine export. Since little vaccine is actually made in the United States, this could prove a problem for Americans in particular.

Click here to read a brief Q&A with Garrett on the problem.

And click here to read Michael Osteholm's assessment of the damage that a new pandemic would wreak on the global economy.

The arrival of a pandemic influenza would trigger a reaction that would change the world overnight. A vaccine would not be available for a number of months after the pandemic started, and there are very limited stockpiles of antiviral drugs. Plus, only a few privileged areas of the world have access to vaccine-production facilities. Foreign trade and travel would be reduced or even ended in an attempt to stop the virus from entering new countries -- even though such efforts would probably fail given the infectiousness of influenza and the volume of illegal crossings that occur at most borders. It is likely that transportation would also be significantly curtailed domestically, as smaller communities sought to keep the disease contained. The world relies on the speedy distribution of products such as food and replacement parts for equipment. Global, regional, and national economies would come to an abrupt halt -- something that has never happened due to HIV, malaria, or TB despite their dramatic impact on the developing world....

SARS provided a taste of the impact a killer influenza pandemic would have on the global economy. Jong-Wha Lee, of Korea University, and Warwick McKibbin, of the Australian National University, estimated the economic impact of the six-month SARS epidemic on the Asia-Pacific region at about $40 billion. In Canada, 438 people were infected and 43 died after an infected person traveled from Hong Kong to Toronto, and the Canadian Tourism Commission estimated that the epidemic cost the nation's economy $419 million. The Ontario health minister estimated that SARS cost the province's health-care system about $763 million, money that was spent, in part, on special SARS clinics and supplies to protect health-care workers. The SARS outbreak also had a substantial impact on the global airline industry. After the disease hit in 2003, flights in the Asia-Pacific area decreased by 45 percent from the year before. During the outbreak, the number of flights between Hong Kong and the United States fell 69 percent. And this impact would pale in comparison to that of a 12- to 36-month worldwide influenza pandemic.

Kudos to Jim Hoge and Gideon Rose at Foreign Affairs for putting together this special section and scaring the bejeezus out of me.

posted by Dan on 06.22.05 at 09:33 AM


And don't forget the WaPo's article a few days ago (no link -- sorry) that the Chinese were treating their chickens with antivirals. Prophylactically.

One guess as to how effective that antiviral (amantadine) is now.

Don't mind me as I bang my head against the wall over here for a while.

posted by: Aaron Bergman on 06.22.05 at 09:33 AM [permalink]

Problem is, I have been reading these bird flu pandemic stories for 5 years now. In fact, I have been reading similar stories (although not focused on bird flu) since I was first old enough to pick up a _Readers Digest_, which is a loooooong time ago. As of yet, the promised pandemic/disaster has not arrived.

If these flus are so deadly, so virulent, and so unstoppable, why aren't they here now? Why aren't we all dead from bird flu, SARS, or West Nile Virus (the last having killed 90% of the birds in our metropolitan area - and all of 50 or so humans, most over 80)?


posted by: Cranky Observer on 06.22.05 at 09:33 AM [permalink]

I think Cranky is correct here, at least in regards to H5N1. Survelliance is heavy, the media is highly attuned to any reports, and government attention is keyed. Modern communications and controls will brutally quaranteen (sp?) the unfortunate victims, and the rest of us will likely cover ourselves in bleach & Purell. In other words, we know exactly what to look for, and are on constant alert for it.

Rather the next pandemic will likely come from some currently unknown virus (or highly resistant staph), perhaps mirroring the AIDS catastrophe. Recall that HIV existed in the US as early as 1959, and the epidemic had begun by the late-1970's. However, the disease itself was not identified as such until mid-1981, and the HIV virus remained undetected until 1983/84 (with blood tests waiting still another year to be produced).

posted by: jprime314 on 06.22.05 at 09:33 AM [permalink]

Far be it from the great capitalist west to consider the prospect of using government funds to create an artificial desire on the part of producers to create quantities of vacine. Spend millions on some loopy war in the ME, but heaven forfend that an emergency account be created to fund the immeadiate production of a vacine.That would be socialism. To consider anything but capitalist purity in our social dealings is relatavism. Down that road is roaring hell.

posted by: exclab on 06.22.05 at 09:33 AM [permalink]

jprime says "I think Cranky is correct here, at least in regards to H5N1. Survelliance is heavy, the media is highly attuned to any reports, and government attention is keyed. Modern communications and controls will brutally quaranteen (sp?) the unfortunate victims, and the rest of us will likely cover ourselves in bleach & Purell. In other words, we know exactly what to look for, and are on constant alert for it."

pish-posh. the key question is whether the virus mutates into a form transmissable from human to human. We have precious little control over that, and if it happens, we're in deep guano. Quarantine will be virtually impossible, bleach and Purell won't work, and no vaccine is likely to be ready for a while. So there is indeed real reason to be seriously worried.

That said, the Osterholm piece is the one to read; it seems more authoritative and is written by a top-tier scientist rather than a science journalist. His take is less alarmist than Garrett's, but quite alarming enough.


posted by: lamont cranston on 06.22.05 at 09:33 AM [permalink]

1) For Cranky and iprime. Fatal influenza is here now. The CDC estimates in excess of 30,000 deaths per year throughout the 1990s. See: for information. What would happen if a new, virulent strain appeared that merely tripled present mortality levels? Another 60,000 deaths, concentrated during the winter months. This works out to about 1 World Trade Center death toll per week during the winter. Moreover, that would be just the USA. Death tolls would be higher in many other nations.
The biology of influenza is fairly well known and the the emergence of new, virulent strains with some frequency is a well characterized phenomenon. Arguably the greatest pandemic of the 20th century was the influenza pandemic of the late 1910s, which killed millions. Take a look at Alfred Crosby's excellent book, America's Forgotten Pandemic for a good look at the impact of influenza in the USA during the pandemic. If you can't find Crosby's book, try John Barry's The Great Influenza, a more recent and inferior book, but the chapters on the pandemic in Philadelphia give an excellent idea of the impact of the pandemic.
2) Drezner's concern about present trends in vaccine manufacture are well founded. There are powerful disincentives and only modest incentives for vaccine production by big Pharma. This applies not only to manufacture of existing vaccines but development of new vaccines. Effective vaccines have been a major factor in the improvement in human health over the course of the last 50 years. Big Pharma, for example the outstanding vaccine development unit at Merck, has played a huge role in the development and manufacture of important vaccines. Good vaccine manufacturing and development programs defend not only against existing threats but also against new threats. The erosion of commercial vaccine manufacturing and development capacity is a threat to public health.

posted by: Roger Albin on 06.22.05 at 09:33 AM [permalink]

Should this situation not be part of the GWOT? Given the current prime terrorists(Jihadists) and their use of sucide bombers what is to stop them from becoming the new rats of the plague. Exclab point is one of things that always makes me want to fall back on the position that the war was manufactured for political reasons. We all should be thankful their pronouncements(which do not receive sufficient attention) keep reminding us that they want to kill everybody whom is not one of them.

posted by: Robert M on 06.22.05 at 09:33 AM [permalink]

On the Newshour a month or so ago, one of the pundits invited to discuss the bird flu mentioned that this past year marked the first time the virus jumped from birds to pigs. That is very bad news.

posted by: Aaron on 06.22.05 at 09:33 AM [permalink]

In regard to Canada's SARS issues, a good part of that was due to Canadian hospitals' rather poor disease protocols at that time. I seem to recall a few travelers with SARS ending up in the U.S. where they were quickly isolated in local hospitals, and note, we had very little problems with SARS. Let's hope that at least Canada has gotten it's act together - the horrific Chinese health care and hospital system will have little chance of dealing with a true epidemic.

posted by: Don Mynack on 06.22.05 at 09:33 AM [permalink]

foreign affairs is full of hot air and writes these stories because it tries to be "cutting edge". the real danger to the world and humanity is that the bush administration is getting more radical, dangerous, militaristic and racist.
Nuclear Warrior Replaces Bolton as Arms Control Chief
Tom Barry
International Relations Center
June 18, 2005

The top United States government official in charge of arms control advocates the offensive use of nuclear weapons and has deep roots in the militarist political camp.

Moving into the old job of John Bolton, the administration’s hard-core unilateralist nominee to be the next ambassador to the United Nations, Robert G. Joseph is the right-wing’s advance man for counter-proliferation as the conceptual core of a new military policy.

Within the administration, he leads a band of counter-proliferationists who — working closely with such militarist policy institutes as the National Institute for Public Policy (N.I.P.P.) and the Center for Security Policy (C.S.P.) — have placed preemptive attacks and weapons of mass destruction at the center of national security strategy.

Joseph replaced John Bolton at the State Department as the new undersecretary of state for arms control and international security affairs.

United States security strategy, according to the new arms control chief, should “not include signing up for arms control for the sake of arms control. At best that would be a needless diversion of effort when the real threat requires all of our attention. At worst, as we discovered in the draft B.W.C. (Biological Weapons Convention) Protocol that we inherited, an arms control approach would actually harm our ability to deal with the W.M.D. threat.”

Before the Sept. 11, 2001 attacks, proponents of national missile defense and a more “flexible” nuclear defense strategy focused almost exclusively on the W.M.D. threat from “competitor” states such as Russia and especially China, and from “rogue” states such as Iran, Iraq, Libya, Syria, and North Korea.

Joseph and other hard-line strategists advocated large increases in military spending to counter these threats while paying little or no attention to the warnings that the most likely attack on the United States and its armed forces abroad would come from non-state terrorist networks.

Instead of advocating improved intelligence on such terrorist networks like Al Qaeda, which had an established record of attacking the United States, militarist policy institutes such as N.I.P.P. and C.S.P. focused almost exclusively on proposals for high-tech, high-priced items such as space weapons, missile defense, and nuclear weapons development.

After 9/11 Joseph and other administration militarists quickly placed the threat from terrorism at the centre of their threat assessments without changing their recommendations for security strategy.

Joseph points to Iran and North Korea, as well as China, as the leading post-Cold War missile threats to the homeland. Typical of strategists who identify with the neoconservative political camp, Joseph continually raises the alarm about China, alleging that China is the “country that has been most prone to ballistic missile attacks on the United States.”

Joseph participated as a team member in crafting the influential 2001 report by the National Institute for Public Policy titled “Rationale and Requirements for U.S. Nuclear Forces and Arms Control.”

The report recommended that the government develop a new generation of “usable” lower-yield nuclear arms. The N.I.P.P. study served as the blueprint for President Bush’s controversial Nuclear Posture Review.

Joseph was instrumental in inserting the concept of counter-proliferation into the centre of the Bush administration’s national security strategy. Counter-proliferation is the first of the three pillars of the administration’s W.M.D. defense strategy, as outlined in the National Strategy to Combat Weapons of Mass Destruction — a document that Joseph helped draft — and in the White House’s National Security Strategy.

In 1999, Joseph told the Senate Armed Services Committee that the country was unprepared to defend the homeland against new W.M.D. threats. He recommended that the “United States acquire the capabilities to deny an enemy the benefits of these weapons. These capabilities — including passive and active defenses as well as improved counterforce means such as the ability to destroy mobile missiles — offer the best chance to strengthen deterrence, and provide the best hedge against deterrence failure.”

Joseph, the founder and director of the Counterproliferation Center at the National Defense University, told the Senate committee: “We are making progress in improving our ability to strike deep underground targets, as well as in protecting the release of agents [meaning radioactive fallout]. We are revising joint doctrine for the conduct of military operations in an N.B.C. environment [meaning one in which nuclear, biological, and chemical weapons are the weapons of choice], based on the assumption that chemical and biological use will be a likely condition of future warfare.”

“In the new world we have entered, the only path to peace and security is the path of action,” concludes Joseph — and that action includes the preemptive use of W.M.D.s.

Not a high-profile hardliner like John Bolton or former undersecretary of defense for policy Douglas Feith, Joseph successfully avoided the public limelight — that is until the scandal of the 16 words in Bush’s 2003 State of the Union Address about Iraq’s alleged nuclear weapons development program. Press reports and congressional testimony by Central Intelligence Agency officials later revealed that the C.I.A. had vigorously protested the inclusion of any assertion that Iraq was developing nuclear weapons since their intelligence would not support such a conclusion. Alan Foley, the C.I.A.’s top expert on weapons of mass destruction, told Congress that Joseph repeatedly pressed the C.I.A. to back the inclusion in Bush’s speech of a statement about Iraq’s attempts to buy uranium from Niger.

The new undersecretary of state for arms control has said that his “starting point and first conclusion” in formulating national security strategy is the fact that “nuclear, biological, and chemical weapons are a permanent feature of the international environment.”

As his second conclusion, Joseph asserted that nuclear, biological, and chemical weapons “have substantial utility,” adding as a corollary that a versatile W.M.D. capability is essential “to deny an enemy of these weapons” since “the threat of retaliation or punishment that formed the basis for our deterrent policy in the Cold War is not likely to be sufficient.”

Arms control chief Joseph is a new breed of militarist who believes that in a world where weapons of mass destruction may be proliferating, it behooves the United States to bolster its own W.M.D. arsenal and then use it against other proliferators.

For more about Robert Joseph, see the I.R.C.’s complete profile and extended analysis at

Tom Barry is policy director of the International Relations Center, online at, and a regular contributor to Inter Press Service, which first published this news analysis June 10.

posted by: if you need to worry on 06.22.05 at 09:33 AM [permalink]

Well the Crosby book must be one hell of a tome because I'm reading the Barry book (The Great Influenza), and it's terrific.

posted by: Doug on 06.22.05 at 09:33 AM [permalink]

Comparing deaths from flu to 9/11 is absurd. 9/11 was targeted to do the maximum economic damage, $1 trillion worth. The victims were people at the prime of their lives, a high proportion of them movers and shakers and future movers and shakers. People who die of the flu, although they are missed, are usually retired or otherwise not contributing to society. Years of life lost from flu epidemics do not compare to years of life lost from large scale disasters such as 9/11 or a weapons of mass destruction attack.

The problem is fanatic muslims and their religious teachers. These muslims are more than willing to disseminate a killer plague among all the non-fanatics in the world. Naturally derived flu virus will not be difficult to deal with. It is artificially derived viruses and bacteria that will stimy medical science.

posted by: If you really need to worry on 06.22.05 at 09:33 AM [permalink]

Its unwise to assume that existing mortality patterns will persist in a major influenza pandemic. The great pandemic of the early 20th century had very high mortality rates among relatively young individuals.
There is actually no comparison between human caused events and epidemic disease. The death toll from the worst human caused disaster in the 20th century, WWII, is about 50 million deaths. Reasonable estimates of small pox mortality over the century prior to its eradication exceed 300 million.

posted by: Roger Albin on 06.22.05 at 09:33 AM [permalink]

You forget that this isn't 1918 anymore. Projecting 1918 death rates to the 21st century is futile. Some people are advocating stocking up on Tamiflu. Anti-influenza drugs are getting better. Biotechnology advances bring new approaches to vaccine development. Stop extrapolating the past to the future.

If the muslim fanatics succeed in creating a working biowarfare lab, perhaps with help from the North Koreans or Chinese, all bets are off. If the disease agent is intentionally created to be resistant to known drugs, and intentionally spread to a target population, most of the present barriers to large scale epidemics can be breached.

posted by: If you really need to worry on 06.22.05 at 09:33 AM [permalink]

In some ways, the 21 century is a scarier period from a public health point of view. Many, many more large and poor conurbations. Many, many more people in close proximity with poor sanitation, nutrition, and access to medical care. Virulent influenza in someplace like Mexico City or Cairo could be horrible. Much, much faster and a much, much higher volume of international travel. Much harder to control tranmission.

posted by: Roger Albin on 06.22.05 at 09:33 AM [permalink]

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