Looming pandemic

U.S. needs to affirm global nature of avian flu

Almost 90 years after the spectacularly deadly influenza pandemic of 1918 claimed its last victim, the world is now anxiously watching the evolution of avian flu.

An electron micrograph of the avian flu virus © DR. GOPAL MURTI/PHOTOTAKE

“In the 1918 flu epidemic, it is estimated that anywhere from 20 million to 100 million people died worldwide,” said Rosemary C.R. Taylor, associate professor of sociology and community health. Mortality estimates in a similar avian flu pandemic range from 2 million to 180 million, she said. Thirty percent of the world’s population would become ill, and the economic losses would be in the billions.

“The estimates vary, and the numbers are overwhelming,” Taylor said. Focusing on the statistics or worst-case scenarios, she added, will not help people make sense of the threat.

Restoration of public health infrastructure
What’s needed worldwide in the face of a possible avian flu pandemic, Taylor said, is preparedness at individual, community and national levels. And if any lesson has been learned from the AIDS epidemic, it is that public information alone does not necessarily generate action. People’s response is contingent on social networks and the resources available in their communities, which can be affected—sometimes inadvertently—by government policies. In the United States, there needs to be a commitment to restoring the country’s public health infrastructure, she said.

In addition, Taylor said, Americans need to acknowledge the global nature of the disease. Like the wild birds whose winged migration has carried the strain of flu virus known as H5N1, this threat knows no national borders.

If a human avian flu pandemic erupts—and experts tend to say “when” rather than “if”—“the front-line people are going to be in places like Vietnam, Cambodia, Thailand,” Taylor said. If protection becomes a matter of allocating scarce supplies of vaccine—assuming a vaccine is even available—how will national leaders balance political concerns with global health demands?

This semester Taylor is teaching her popular course on “Epidemics: Plagues, Peoples and Politics.” The class covers epidemics throughout history, looking back at ancient and enduring plagues and forward to how societies cope with potential threats such as bioterrorism—and now, avian flu.

Origins of H5N1
The strain of avian flu now under scrutiny was first identified in humans in 1997 in Hong Kong. Researchers believe it originated in wild birds, spread to domesticated fowl and then was transmitted to people. Transmission of the H5N1 virus from infected patients has been rare, according to the World Health Organization (WHO). However, flu viruses are constantly mutating, and the fear is that H5N1 could change enough to spread easily among people.

In the face of a possible avian flu pandemic, sociologist Rosemary C.R. Taylor said the U.S. public health infrastructure needs to be restored. © BRIAN LOEB

According to WHO, there have been 149 human cases of H5N1 recorded between December 2003 and January 19, 2006, with more than 50 percent of those cases resulting in death. The mortality rate of those who got sick from the 1918 flu is estimated at between 2.5 percent and 5 percent, so the virulence of the current virus has caused alarm, Taylor said.

In many respects, it’s hard to draw lessons from 1918 that would be relevant in the United States today, Taylor said. The social and economic structure of the country was vastly different then. More significantly, there was little medical understanding of viruses. (The influenza virus itself was not identified until 1933.)

“One lesson concerns truth-telling,” Taylor said. “In 1918, politicians realized what a threat [influenza] was, but they wouldn’t speak of it for fear of hurting the war effort.” World War I was under way, and more soldiers died of influenza than in combat. “It became known as the ‘Spanish flu,’ because Spain was neutral, so news about it was publicized there,” Taylor said.

Since then, a lack of accurate public information has played a disastrous role in other epidemics, Taylor said, including China’s cover-up of SARS when it emerged in 2003, or the reluctance of the British government to admit there could be a problem with British beef during the early days of the “mad cow” crisis.

“It is important for governments to reveal potential risks within their territories,” she said, “but we must recognize that in doing so, they confront the danger of damage to other vital interests such as trade, tourism and reputation. The political economy of providing information is a complicated affair.”

Helene Ragovin is a senior writer in Tufts’ Office of Publications. She can be reached at helene.ragovin@tufts.edu.