Monday, November 21, 2005

Flu: The Forgotten Killer

Influenza, more commonly known as “the flu”, does not inspire feelings of dread in the way more media-friendly diseases such as Ebola or AIDS do. It is in general viewed as a minor annoyance. Yet influenza historically was considered very serious. Historians Alfred Crosby and A.A. Hoehling among others have written extensively on such events as the influenza epidemic between September 1918 and June 19191. That epidemic in particular claimed 675,000 lives and manifested symptoms similar to pneumonia, a death toll more drastic than all the American combat casualties of World War I and II, Korea and Vietnam combined. Striking in two waves and killing combatants and non-combatants alike, the epidemic was no trivial matter. However, modern technology and understanding of epidemiology has greatly reduced the threat of the flu. It may thus seem to be deserving of its triviality status, yet this report will argue that the flu remains a relevant issue for the 21st century.

The primary danger is the pathology of the flu itself. In a December 2nd lecture to a class in UC Davis, Cinda Christensen, a pharmacist at Davis, discussed the main dangers of the flu. It can transmit itself through watery particulates at ranges of up to 3 feet, making it a danger in the winter months when people are in close quarters with each other. It infects the respiratory tract and causes massive cell damage. Because the cilia lose activity, the body is open for bacterial or viral superinfection, or opportunistic infection by microbes that normally would not find purchase in the body. In this sense, flu is worse than AIDS: not only does it strike at the body's defense mechanisms, but it also contains its own potentially deadly symptoms. Repairing the damage completely can take anywhere from two to ten weeks, and among vulnerable populations, the flu can take a course towards asphyxia and pneumonia, as it did in 1918. It is reasonably virulent and rarely kills the host, allowing it to spread rather rapidly. And, like AIDS, it is constantly mutating, making vaccination almost an exercise in futility and multiple lifetime flu infections common.

It is clear that the pathology of the flu poses a serious threat to even well-established public health systems, but what of systems in other countries? According to Christensen's statistics, the US accounts for anywhere from 3.6% to 7.2% of the world's flu casualties. A US Food Aid Service (FAS report) cites that the US has about 276 million people and that the world now has more than 6 billion humans, indicating the US has about 4-5% of the world's population.2 The vast majority of the rest of the influenza deaths are abroad. A UK Health Protection Agency FAQ mentions a 1957 'Asian Flu' and a 1968 'Hong Kong Flu', but also points out that no flu pandemic has struck in major industrialized countries for thirty years.3 The most recent epidemics and pandemics have been in Third World and industrializing countries. The “avian influenza” scare recently has obfuscated the fact that, despite the relative danger of a new strand emerging, the real dangers are not to be found here or in other European countries, as agencies like the CDC and HPA have established protocols to contain such new mutations. The real cost is borne elsewhere. A United Poultry Concerns report estimates that 50 million chickens in Asia have been exterminated to prevent an outbreak of the flu and a shift to the human population.4 This is because this flu has anywhere from a 30% to 70% mortality rate, a simply massive death toll. The report also notes that as these countries move to capital-intensive agriculture, with the now-common symptoms of incredibly confined and cramped spaces for the livestock and general inhumane treatment, diseases such as the avian flu can now spread like wildfire among the animals and mutate to a dangerous strand. A similar mass slaughter of chickens in the Netherlands, supported by the World Health Organization, cost the government $344 million. A World Health Organization study pointed out that worldwide death tolls for flu has been 50 million lives, a number higher than even the Chinese famine that Amartya Sen among others has analyzed5. It also demonstrated that 250 million vaccinations total have been administered, yet the group most in danger, seniors over the age of 65, now constitutes 380 million people. Klaus Stohr, reviewing the WHO report, argued that, “ influenza pandemic will have its greatest impact on developing countries where there is no vaccine and antiviral protection”. These concerns are key for the US, for a few reasons. First, the neoliberal regimes advanced by the US and other G-8 countries have been key forces in reducing the power of the government to effectively fight epidemics and pandemics. Edward Herman, Greg Palast and Patrick Bond, among others, have documented how neoliberal regimes drive down growth rates, push patents for drugs preventing governments from buying and distributing cheap generic drugs, privatize essential health services, and generally establish the type of poverty and health conditions essential for an outbreak.6 This means that there is a moral obligation for the US to do something, as the head mover and shaker in pushing globalization. Second, massive outbreaks of disease can help spur destabilizing pressures. Lao's Prime Minister Bounnhang Vorachit cited avian influenza as an impact of globalization and discussed it seriously as a security concern for ASEAN7. The fiscal and human impact of a pandemic can cause anger, hatred, fear, and general danger and thus spur dangerous wars. According to Rick Rowden, a Political Science teacher at Golden Gate University, the US bombing of Cambodia and subsequent famine was one of the main impetuses for the formation and popularity of the Khmer Rouge and their subsequent killing spree.8 Clearly, influenza on its own will not cause conflicts to erupt, but governments faced with serious problems including influenza outbreaks could use war as a solution for a variety of reasons. Even more likely is dissatisfaction caused by a perception that certain ethnic minorities or distant powers are responsible for the misery inflicted. In Worlds in Collision, Professor Emeritus at UC Berkeley Kenneth Waltz argued that, “Unsurprisingly... weak states and disaffected people... lash out at the United States as the agent or symbol of their suffering.”?9

Dealing with this international problem would not be that difficult. Kofi Annan, in his “Astonishing Facts”, has pointed out that the amount that Europeans spend on ice cream exceeds the annual total needed to provide clean water and sewer systems to the world, that Americans and Europeans spend more on pet food than it'd cost to provide basic nutrition to the world, and that $40 billion a year (4% of the combined wealth of the 225 richest people in the world, and a drop in the bucket of most Western GDPs) would suffice to provide basic education, health care, food, water and sewage systems for the world.10 Edward Herman in his Sophistry of Imperialism outlined an alternative course for globalization and economic development that involves independence, democracy, reparations (again, relatively cheap ones relative to GDP) and autonomy11. He cites numerous examples of globalization not only lowering growth rates, but also increasing inequality. Dani Rodrik, Professor of Economics at Harvard, points out that this increase in equality also lowers growth in the long term: a 10% increase in the Gini index of inequality lowers growth rates 1.2%12. Abandoning the dogma of commitment to “free markets” would not only raise the general economic standard of Third World countries and thus help raise their immunity to the flu, it would allow governments to not privatize their health systems and provide efficient health care and establish preventative systems to avoid outbreaks. It is thus in the security and economic interests of the United States to adopt Annan's and Herman's proposals. Dealing with influenza specifically, aid and research assistance (including easing of intellectual property restrictions) would help local economies develop their own flu vaccine stores. The US could target an infinitesimal part of its budget to subsidies for vaccine development and other aid programs to attempt to contain such epidemics. Such a simple investment could avoid the massive economic impact of slaughtering infected livestock and losing worker productivity to disease. Not only does the US, thanks to its colonial and neocolonial history and ongoing practice, have an obligation to help Third World economies recover, develop and defend their people from disease and famine, it has a practical interest in doing so. After all, disease is borderless: in the age of jet planes and cruise ships, a disease in Africa can spread to America and Europe.

A third problem concerning flu is the domestic analog to the international issue. Luckily, here the US is not so remiss. A USDA news release of May 12, 2004 outlines a USDA program to help defend against avian influenza.13 These kind of preventative programs can help prevent what happened in February of this year, where the outbreak necessitated massive poultry euthanasia and trade restrictions on infected countries. However, the danger remains real. The same USDA press release predicts that one gram of contaminated manure could infect up to a million birds. It is important for government officials to avoid fearmongering, however. While the flu is dangerous, it is not close to pandemic proportions, and US health care systems are capable of dealing with the stress. Vaccine rationing this year is highly prudent, as Dr. Christensen demonstrated convincingly (cited above). CBS News ran a story on October 18, citing the CDC Director as saying, “It's important for people to understand we've got 20 million doses of flu vaccine coming on the way. It's coming out of the factory in an orderly manner and we're doing everything to get it to the people who need it most in an orderly manner.”14 However, this has required using an experimental vaccine, something not too likely to have dangerous ramifications, but a frightening thought nonetheless. The difficulty with effective policy-making is caused by the fact that the flu mutates constantly, making stockpiling vaccines useless. Instead, the government should double the most pessimistic predictions and order that many flu shots. The excess can be shipped to other countries at a discount. The essential point is to shore up as much demand as possible and encourage companies to avoid abandoning flu vaccine production. This is essential because, as the same CBS story reported, “Some economists expect losses in productivity, not just in terms of sick employees but lost workdays to tend to sick family members, reports The Wall Street Journal. One expert tells the paper twice as many people could get the flu this year because of the lack of vaccine. In a normal year, the flu is the leading cause of Americans calling in sick to work. David Cutler, a professor of economics at Harvard University, estimates that the flu's effects on the economy could approach $20 billion this year. ”

The fourth problem regarding the flu is the media reporting and framing of the issue. In general, the media seem to adopt a crisis-response agenda, shortcircuiting discussion of long-term and perennial issues. Noam Chomsky (in Manufacturing Consent) among others has pointed out that the American media is especially prone to “brevity” and sound-bite style reporting due to the high degree of advertising saturation15. Thus, the media focus on SARS instead of the perennial death toll of the flu. Only when there is a crisis such as a flu vaccine shortage does the issue enter the public mind. This causes chronic public underconcern and thus ineffective policy-making and a public prone to panic. The government should fund awareness programs in schools and communities to bridge the gap and provide reasonable and available information. Simply put, if people spent more time worrying about the flu than SARS, it would be easier to deal with the flu.

The fifth problem concerning flu outbreaks is a simple sanitation and health issue. Flu spreads during the winter months because people are confined, yet simple practices such as getting enough sleep, eating healthy food, washing one's hands, regularly cleaning the home with disinfectant, covering one's mouth when coughing, being willing to keep kids at school and sick adults at home, and other common sense habits can help slow the spread even during winter months.16 For this, public awareness programs can help substantially, as well as improving programs to allow workers more sick days and less fear of repercussion if they don't go to work. Both are relatively easy proposals to institute.

While people in Western countries often consider the flu simply an annoyance, it is serious business. It is a perennial and historic disease, yet modern technology and techniques can legitimately make it into simply an annoyance. Yet the majority of the world's population does not have that luxury. This Congress can and should place health issues as a number one priority. If the US is going to be a world leader, it might as well be a world leader in preventing pandemics and not simply raw military and economic might.


1. See Crosby, Alfred W., Jr. Epidemic and Peace, 1918, Westport, CT: Greenwood Press, 1976; and Hoehling, A.A. The Great Epidemic, Boston: Little, Brown and Company, 1961.
2. Food Aid Service. October 12, 2004. “Who's Coming to Dinner: How Global Population is Growing.” Accessed December 12, 2004.
3. Health Protection Agency. “Frequently asked questions on flu.” Accessed December 12, 2004.

4. United Poultry Concerns. February 13, 2004. “Avian Influenza – Death Toll: 50 Million and Rising.”

5.The Lancet Infectious Diseases Vol. 2 September 2002. “Reflection and Reaction: Influenza - WHO Cares.” Reprinted at the World Health Organization website and citing their work. For Sen's work, see Dreze and Sen's Hunger and Public Action.

6. The Vientiane Times. December 1, 2004. “Bounnhang advocates peace and stability.”

7. Rick Rowden. San Francisco Chronicle August 1997, reprinted at the Light Party website. “Khmer Rouge first gained popularity as fighters of Lon Nol regime.”

8. In general, Z Magazine's coverage of this topic has been excellent and cogent. See in particular: Herman, Edward. April 30, 2001, “The Media at the Barricades in Support of 'Free Trade'”. Bond, Patrick, accessed December 12, 2004, “Cultivating African Anti-Capitalism”.

9. Walth, Kenneth. Worlds in Collision, edited by Boothe and Dunne.

10. Annan, Kofi. “Kofi Annan's astonishing facts”, reprinted in New York Times News Service, September 27, 1998.

11. Herman, Edward. “Sophistry of Imperialism”, Z Magazine March 2 2002.

12. Rodrik, Dani. “Where Did All the Growth Go? External Shocks, Social Conflicts and Growth Collapses.” John F. Kennedy School of Government, Cambridge MA; last revised August 1998.

13.United States Department of Agriculture. “USDA Funding Approved for Avian Influenza Prevention Program.” Washington, May 12, 2004.

14.CBS News. “Feds: No Need for Flu Shot Panic”, citing an AP release. October 18, 2004.

15.From a list of quotes from Noam Chomsky: ..." suppose I'm talking about international terrorism, and I say that we ought to stop it in Washington, which is a major center of it. People back off, "What do you mean, Washington's a major center of it?" Then you have to explain. You have to give some background. That's exactly what Jeff Greenfield is talking about. You don't want people who have to give background, because that would allow critical thought. What you want is completely conformist ideas. You want just repetition of the propaganda line, the party line. For that you need "concision". I could do it too. I could say what I think in three sentences, too. But it would just sound as if it was off the wall, because there's no basis laid for it. If you come from the American Enterprise Institute and you say it in three sentences, yes, people hear it every day, so what's the big deal? Yeah, sure, Qaddafi's the biggest monster in the world, and the Russians are conquering the world, and this and that, Noriega's the worst gangster since so-and-so. For that kind of thing you don't need any background. You just rehash the thoughts that everybody's always expressed and that you hear from Dan Rather and everyone else. That's a structural technique that's very valuable. In fact, if people like Ted Koppel were smarter, they would allow more dissidents on, because they would just make fools of themselves. Either you would sell out and repeat what everybody else is saying because it's the only way to sound sane, or else you would say what you think, in which case you'd sound like a madman, even if what you think is absolutely true and easily supportable. The reason is that the whole system so completely excludes it. It'll sound crazy, rightly, from their point of view. And since you have to have concision, as Jeff Greenfield says, you don't have time to explain it. That's a marvelous structural technique of propaganda...."

16.Dr. Vincent Iannelli. “Don't Get Sick with the Flu!” Reproduced in part from a CDC Influenza Vaccine Q&A in 2003-2004.


Post a Comment

<< Home