Global growth of megaslums will increase likely toll from flu pandemic


WorldView: 2005 was, among other things, the year in which it was feared an avian flu pandemic would strike, killing hundreds of millions of people, writes Paul Gillespie

First detected in Hong Kong poultry in 1997, the pathogenic H5N1 virus has become endemic among birds. It is thought to have killed at least 133 humans around the world in 2004 (mainly in Asia) the latest case being reported from Fujian province in China yesterday.

So far no person-to-person infection has been recorded. But the potential of a pandemic caused by viral mutation to humans is there and has now become global after wild birds brought the disease to Russia, Ukraine and Romania this autumn, as well as to Australia and the United States.

The scare did not figure prominently in many of the year-end surveys I saw, which were more concerned with natural disasters. Is this because the threat has receded or been contained and may anyway have been mainly a media scare story? Not so, say trusted experts, including the British government's chief medical officer, Sir Liam Donaldson, who says: "This [ pandemic] will come, it will be real, and only if we plan can we reduce its impact."

Media attention often depends on how near we are to the threat. A CNN/Time survey of Asian opinion published yesterday found fear of avian flu the top concern, followed by an economic downturn and terrorism. And with surprising regularity leading US officials cite avian flu as one of their most pressing worries.

When he announced his resignation in December 2004, the secretary of health and human resources there, Tommy Thompson, told a press conference what worried him most was the threat of a human flu pandemic. "This is a really huge bomb that could adversely impact on the health of the world," killing 30-70 million people, he said.

This quotation is taken from a brilliant short polemical study by Mike Davis, The Monster at Our Door, the Global Threat of Avian Flu, published earlier this year. A polymath Californian historian, sociologist and radical, Davis became intrigued by the subject as he studied the phenomenal growth of Third World cities.

The resulting population density, industrialisation of food production and impoverishment are creating the perfect ecology for such a pandemic.

In a riveting interview with the website this month he brings the argument up to date, drawing together the themes of epidemiology, globalisation and chronic poverty. Since the 1980s, 200 million people have left the land in China searching for city employment - more than in all of Europe throughout the 19th century. Similar processes are happening in India, Bangladesh and west Africa.

They create a new demand for animal protein to feed them, especially chicken. Pork and poultry are in the foreground of an industrial revolution in factory farming that has seen total meat production grow in China from 16 to 53 million metric tonnes in the period 1983-97, with growth to 2020 projected at 107 million tonnes.

There are unprecedented concentrations of animals and people: in China 880 million people now live close to 14 billion chickens and ducks.

Davis points out that while the techniques of industrialised poultry and livestock production - vertically co-ordinated production, exploitation of contract growers, visceral anti-unionism, rampant industrial injury, downstream environmental production and political corruption - were first developed by Tyson Foods in Arkansas, they have spread to Thailand and China (and to the Netherlands and Brazil) in the last 20 years.

He asks: might not one of these be a pandemic crucible, and could production density become a synonym for viral density? There is convincing evidence that they have, he argues, in the US and Europe as well as south Asia over recent years. Successive outbreaks have led to millions of cullings, often without any publicity, and have been confined to animals.

But the potential for viral transmission to humans is there, as recurrent outbreaks of conjunctivitis and flu-like symptoms among production and disease prevention workers show. And there is a structural similarity with the conditions that led to the emergence of the H5N1 virus in Thailand, Vietnam and China, which was transmitted around the world in 2005.

How can the danger be monitored, controlled and prevented? Answering these questions brings several major issues and forces of contemporary world politics into play. Among them the role of big pharmaceutical companies, political corruption and govern-

mental ill-preparedness for public health protection loom large.

It is reckoned by a Harvard researcher that the 10 big drug companies included in the Fortune 500 in 2002 earned more in profit than all the other 490 corporations combined. But worldwide sales for all vaccines produce less revenue than one major company's single anticholesterol medication.

Products that cure or prevent disease, like vaccines or antibiotics, are less profitable than those that manage diseases such as diabetes, high blood pressure and asthma. So there is far less research and development of such drugs.

In the case of avian flu there was a flurry of reportage this year on the fact that one of the only genuinely effective drugs against it, Tamiflu, is produced almost exclusively by one company and one plant in Switzerland - Roche.

It had not expanded production sufficiently to anything like the demand required for one quarter, let alone the entire populations of developed states - not to mention the vast Third Word cities where a pandemic would strike most lethally. Hence the long delays in getting the drug and the likelihood that enough will simply not be available, making it necessary to decide who should have access to it.

Rather than setting up public companies to manufacture generic drugs, governments prefer to offer incentives, probably because campaign funding ensures these companies a privileged hearing. International bodies are equally hesitant. This year researchers reactivated the virus responsible for the 1918 influenza pandemic that killed between 40 and 100 million people (all round the world but mostly in India and Asia).

Given that population densities in today's mega-slums are far greater and more numerous than in Victorian times, the global impact of what medical researchers regard to be an inevitable flu pandemic would probably be much worse.