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Wednesday, April 29, 2009

Swine Flu, Pandemics and Capitalism

The headlines have been apocalyptic – a new outbreak of swine flu is in danger of engulfing the world.

There are indeed reasons for concern. Normal seasonal type-A influenzas kill as many one million people a year globally. Even a modest increase in virulence, especially if combined with high incidence, could cause huge problems across the world.

The most lethal flu outbreak to date was in 1918-19. It killed more than 2 percent of humanity (40 to 50 million people) in a single winter.

The development of a swine flu that can be passed between humans was predictable. Influenza constantly changes and mutates to create new strains. There have already been several incidents of flu strains jumping species and unleashing a virulent pandemic.

Both the 1957 and 1968 flu pandemics are believed to have originated from the mixing of bird and human viruses inside pigs.

Concentrated poverty is one of the most important issues in what happens to a flu outbreak – how it is spread and who it hits.

Twenty million or more of the deaths in the 1918-19 flu outbreak were in poorest parts of India.

The toll of HIV/AIDS in the Global South and the two million children annually killed by malaria should be a warning that capitalism is willing to let poor people die, even of curable diseases.

The World Health Organisation, backed by Western leaders, has argued that pandemics can be contained by the rapid responses of medical bureaucracies. The idea is that the strain is identified and then dealt with by local populations getting enough anti-viral drugs.


Rather than working together to produce a vaccination for each new flu strain, which is unprofitable for the pharmaceutical companies because many new flu strains don’t reach pandemic level, governments tend to rely on generic anti-virals such as Tamiflu.

But frequently a moderate flu epidemic outstrips the vaccine prepared for it even in the richest countries. The British government says it only has enough anti-virals for half the population.

Repeated assaults on public sector health care as part of the neoliberal agenda have made it harder to deal with the problem.

A key factor behind new diseases such as the swine flu threat is the growing concentration of animal production without appropriate regulation or biological safeguards.

Food production is driven by a handful of giant global corporations. This means large numbers of livestock crammed together to maximise profits.

Two thirds of poultry production in Britain already takes place in flocks of over 100,000 birds.

In the US today 65 million pigs are concentrated in just 65,000 facilities, compared to 53 million pigs on more than one million farms in 1965.

In such huge units animals are more prone to disease, which can rapidly spread and evolve into more deadly forms.

In order to boost growth and guard against illnesses, the corporations pump animals full of antibiotics, including ones used to treat human diseases.

Cuts in the regulation and monitoring of the meat industry also create huge dangers.

Only last week Alistair Darling announced plans in the budget to save £44 million by cutting “animal disease surveillance through a more risk-based approach to monitoring and enforcement and by sharing costs with industry”.

Corporate domination of food, healthcare and pharmaceuticals all contribute to the threat of a flu pandemic – and so do the acts of governments that allow these corporations to dominate world politics.

As the US author Mike Davies puts it, “Perhaps it is not surprising that Mexico lacks both capacity and political will to monitor livestock diseases, but the situation is hardly better north of the border, where surveillance is a failed patchwork of state jurisdictions, and corporate livestock producers treat health regulations with the same contempt with which they deal with workers and animals.”

International Socialist Review Issue 43, September–October 2005

Avian flu: The monster at our door
By MIKE DAVIS Writer, historian, and activist

Mike Davis is the author of many books, including City of Quartz, The Ecology of Fear,
The Monster at Our Door: The Global Threat of Avian Flu, just published by The New Press, and Planet of Slums, forthcoming from Verso Books.

This article is an edited version of a talk Davis gave about The Monster at Our Door in New York City. Davis teaches in the Department of History at the University of California at Irvine, and lives in San Diego.

THE THREAT of avian influenza can’t really be understood apart from the impact of agro-capitalism, particularly the ongoing “livestock revolution,” upon the ecology of disease. Pandemics, like earthquakes and floods, have ceased to be purely “natural” events; viral plagues, to a surprising extent, are monsters of our own making. Like HIV/AIDS, the emergence of avian influenza demands an analysis in terms of world economic and social transformations—in short, an understanding of the capitalist relations of production and their environmental consequences on a global scale.

But, first, why such hysteria in the press over an illness that so far has affected so few people? To date, fewer than 100 people are known to have died from avian influenza since the virus first jumped from birds to humans in Hong Kong in 1997. Tens of millions in the same period, meanwhile, have died from malaria, HIV/AIDS, or diarrheal diseases. The 1918 apocalypse The seemingly exorbitant attention that the World Health Organization (WHO) has lavished on the strain known as H5N1 derives from its murderous ancestry. The influenza pandemic of the winter of 1918–1919 was the single largest mortality event in human history: killing 1 percent of Americans, and probably 100 million people worldwide. Almost certainly, half of you reading this, whether you know it or not, have an ancestor who was carried away by the Great Pandemic.

A wartime epidemic, of course, was no surprise. Public health officials were well aware that the squalid sanitary conditions in the trenches as well as civilian food shortages were an ideal incubator for high-mortality diseases. But an influenza plague was the last fear on most experts’ minds.

Before 1918, influenza was hardly considered a major danger. It was poorly understood and almost impossible to distinguish from similar respiratory infections that occur on a seasonal basis. In its most acute form, moreover, influenza was understood simply as an accomplice of pneumonia, but pneumonia comes in so many forms and can result from so many different kinds of medical conditions, that influenza wasn’t taken very seriously.

All this changed when startlingly large numbers of healthy young conscripts started dying at army camps in Kansas, then on the East Coast, and finally on troop ships and at reception centers in France. Indeed, as influenza spread through the trenches it became a decisive factor in deciding the outcome of the First World War—German armies losing more troops to sickness than did Allies reinforced by one million Yanks.

Contemporary doctors initially resisted a diagnosis of influenza, but the verdict was inevitable. In a majority of cases, the symptoms were those of severe but familiar influenza. In a significant minority, however, people developed viral, not bacterial pneumonia—a macabre sequence in which the faces of the victims turned black and their lungs drowned in blood. Your lungs are the lightest organs in your body, and normally after an autopsy they will float in water. However, when pathologists removed the lungs of 1918 victims they looked like livers and sank in water like rocks.

Most writing about the 1918 pandemic has focused on North America and the Western Front. But the burden of mortality was in the rest of the world. The pandemic, not surprisingly, was most deadly where the ground was already prepared by hunger, war, and disease.

The epicenter was British India, where famine and influenza formed a particularly sinister alliance: at least twelve million and perhaps as many as twenty million people died as the pandemic spread inland from the port of Bombay. Like the better-known Bengal famine of 1943, the 1918 famine was a direct result of the British export of grain surpluses to England and cold indifference to life and death in poor villages. Once the influenza had reached the famine areas, the utter absence of any public health systems ensured the highest possible morality rate.

It is fashionable these days to wax nostalgic about the Raj, and colonial apologists like Niall Ferguson have become opinion-page celebrities. But Ferguson and his ilk carefully skirt one of the most gigantic facts of modern history—the unprecedented toll of famine and disease in British India between the famines of the 1890s and the influenza pandemic of 1918. Thirty to fifty million poor people died from influenza, plague, and famine-related diseases in this belle époque of British power. What is particularly striking, and to some extent unexpected, is that there were significantly fewer victims in China. Why India and not China? Did greater commercialization of grain markets, better railroads and communication (easier transmission of disease), and wartime requisitions play key roles in India’s extraordinary ordeal? These are not questions likely to be explored by purveyors of imperial nostalgia. Rogue genes and clever chaos So—holding in parenthesis, for the moment, this nexus between poverty and influenza—why is there suddenly so much expert worry that we are at the edge of another 1918? In my new book, The Monster at Our Door, I argue that major factors responsible for the reemergence of a pandemic threat have less to do with nature and more to do with the global economy—with the corporatization of livestock production, the growth of urban poverty, and the neoliberal-engineered destruction of public health response capacity. But before turning to this nexus of globalization and disease, we must take a brief look at influenza itself.

Viruses are protein-clad, rogue genes that are parasites on living cells. Their origin is unclear: they may have “leaked” into the environment from cellular genomes, or, perhaps, preceded the evolution of the rest of the biosphere. In any event, they occupy the ontological boundary between what is obviously non-living and what is incontestably alive. Prior to entering a living cell, viruses are inert, in fact they can be crystallized and stored indefinitely. Once in contact with a cell, however, they become dynamically active and hijack the cell’s genetic machinery to make copies of themselves.

Influenza belongs to a family of unusual, exceedingly primitive, but also remarkably streamlined viruses that use RNA rather than DNA as their software. All cellular life and the great majority of viruses reproduce themselves on the basis of DNA. As we now understand it, DNA is a fabulous technology for preserving and transmitting information because it has its own error-correction capability. DNA replication works, if you will, like medieval monks pouring over a manuscript day by day, month after month, searching for errors. As a result, the number of errors passed through DNA—errors that arise, for example, from random mutation caused by background radiation—are astonishingly few. This provides life with a stable genetic platform and assures that information stored in DNA degrades or mutates very, very slowly.

Influenza, however, is built upon a chaotic software platform called RNA. RNA’s function in living cells is as an intermediary in the transcription and carrying of information contained in DNA in order to make more DNA or to manufacture proteins according to instructions coded by DNA. But RNA as a stand-alone genome lacks DNA’s passion for accuracy. Indeed, an RNA genome is like a modern publishing house under the whip of an illiterate Rupert Murdoch that no longer edits authors’ work or really gives a damn about what appears between the covers. Manuscripts are submitted, sent to the printer with barely a second glance, and then stocked on the shelf replete with errors.

Indeed, the genome of influenza is so error-prone that it totters on the verge of what is known as “error catastrophe”—a few more mistakes and it would self-destruct as non-viable gibberish. Its genetic platform is probably as unstable and chaotic as continued replication will permit. But if the rest of life is organized around the reliability of stored information, what evolutionary advantage is there to being the equivalent of the New York Post?

The particular talent of an RNA genome is simply this: Every time influenza enters a cell, hijacks its replication machinery, and manufactures clones of itself, many copies are flawed, by an amino acid or more. Most of these mutants are doomed, their errors confer no advantage. But when the incredibly powerful immune systems of humans and other mammals (like pigs) attack influenza, some mutants will usually escape detection. Their different amino-acid configurations make their proteins invisible to the immune system onslaught.

This high volume of variance—genetic noise, if you prefer—assures that some portion of influenza’s “mutant swarm” will live to fight again. Influenza, in other words, is constantly reinventing itself. That’s why it is necessary to get an annual shot for influenza rather than a lifetime vaccination, as with smallpox. (Smallpox, of course, is far more deadly, especially to populations that have no experience with it, but its genome is highly stable and one vaccination provides protection for years.) Influenza’s annual evolution, a few small amino steps at time, is known as genetic drift.

But influenza has another, even more spectacular trick up its sleeve, which explains why it can periodically metamorphose from a common respiratory ailment—dangerous to old people but no more than an annoyance to most of us—into a mass murderer. Influenza RNA is packaged in eight separate segments that disperse inside a host cell before replication and reassembly. In the infrequent but inevitable event that a host cell is infected simultaneously by two different strains of influenza, it is possible for segments of different origins to be “reassorted” into a radically new strain. The production of hybrid influenzas by this shuffling of segments is called genetic shift and it is believed to be responsible for the sudden emergence of deadly pandemic strains.

A few other things you must know about influenza: In its default state, influenza is a benign infection of water birds, especially ducks. Every year, tens of millions of ducks gather in lakes from Minnesota to the Yukon, and likewise in Siberia and Kamchatka, to begin their annual migrations to warmer climes (like California and Guangdong). If you were to analyze a typical sample of this lake water, you would find a soup of duck fecal matter containing incredible quantities of different strains of influenza. There are about 130 possible flu subtypes among ducks, but duck influenza is quite stable and doesn’t kill or disable birds.

The current crisis began when influenza from wild ducks and geese jumped to Chinese chickens and domestic ducks in 1997. This has happened in the past with sometimes 100 percent mortality among infected poultry, but it was generally believed that avian influenzas could only be transmitted to humans through reassortment in pigs’ guts. Pigs can easily contract both bird and human strains of influenza and are believed to be the ideal “viral blenders” for creating pandemic strains.

This time, however, an avian subtype jumped directly to a small number of humans. This shocked and terrified researchers, since a thoroughly “wild” avian strain is initially invisible to our immune systems. The genetic license-plate number given to the 1997 virus—H5N1—was also incredibly virulent. Like the 1918 strain, it kills victims through grisly viral pneumonia, but it is even more deadly than its ancestor. In 1918, about 5 percent of the infected population died; H5N1 has killed almost half of its known victims.

By the summer of 2005, the WHO warned that avian influenza was at the “tipping point.” “The world is now in the gravest possible danger of a pandemic,” the WHO director for the Western Pacific told reporters. With several proven or probable cases of human-to-human transmission, experts believe that H5N1 is on the verge of acquiring the slight genetic modification (via either drift or shift) to spread explosively through human populations.

As the grim 1918–1919 experience testifies, however, influenza outbreaks are almost impossible to quarantine once they have acquired pandemic velocity. Unlike the case of SARS, where victims are spreaders only when they express symptoms, someone infected with avian flu would copiously shed the virus twenty-four hours or more before they developed a fever. Influenza, moreover, is characterized by asymptomatic cases—people who never become sick but nonetheless spread the virus. The livestock revolution The coming pandemic, then, may combine the virulence of AIDS/HIV or Ebola fever with the transmissibility of a common cold. In the evolution of such a formidable viral monster, dramatic ecological changes must attend changes in molecular biology and antigen behavior. The emergence of H5N1 and its possible demon offspring have required, in particular, unprecedented concentrations of wild birds, poultry, and humans in ecological intimacy with each other.

In my book, I focus especially on the role of the so-called livestock revolution in accelerating the evolution of virulent influenza strains. The industrialization of livestock production on a global scale is an ongoing development of the last ten or fifteen years, and is part of a much larger upheaval as vertically integrated agribusiness displaces or subordinates remaining zones of peasant and small-plot production. The origins of large-scale agrocapitalism, of course, date back to the end of the nineteenth century and became the subject of important studies by Rosa Luxemburg, Karl Kautsky, Vladimir Lenin, and other classical Marxists.

On the demand side, the Livestock revolution is being driven by dramatic increases in the consumption of animal protein in rapidly urbanizing countries like China and Indonesia. In the West, we equate meat with beef, but in most of Asia, the major traditional source of animal protein has been pork. Pork consumption indeed has increased dramatically, but even more spectacular has been the increase in per capita consumption of chicken. Globally, chicken has replaced beef to become the second most important source of animal protein, and soon will replace pork in countries where previously people have eaten very little chicken. The hundreds of KFC franchises across China are only the tip of an iceberg.

The state-of-the-art template for the livestock revolution—pork production as well as poultry—is Tyson Industries. Tyson, as previous articles in ISR have shown, is one of the worst exploiters of labor in the Untied States. Arkansas-based companies like Wal-Mart, Tyson has flourished in the same Southern, union-free environment of right-to-work laws and Darwinian entrepreneurialism.

Tyson is Henry Ford applied to poultry, or in official terminology, the world’s biggest “integrator.” Hard scrabble family farmers contract with Tyson as little more than poultry warehousemen. Everything is supplied by the corporation: baby chickens, feed, veterinary products, technology. The contractors, however, bear all the risk if the chickens get sick or die. Across the South, Tyson has huge central processing plants surrounded by belts of contract growers. Chickens are slaughtered in almost incomprehensible numbers: one billion each year in northwestern Arkansas, another billion in Georgia. The vertically integrated, continuous-flow process bears more resemblance to the petrochemical industry than to traditional agriculture, and the ultimate output is also consumed assembly-line fashion at the nearest KFC or McDonald’s.

The Tyson model has been adopted with enormous ruthlessness in Southeast Asia, particularly by Bangkok-based Charoen Pokphand (CP) that has expanded throughout China. As a result, poultry populations have been essentially “urbanized.” The Tyson/CP model has created huge, unprecedented concentrations of poultry—hundreds of millions of birds—in small geographical areas. Such super-populations, of course, have never existed before in nature, and the new densities of birds radically change key variables in the relationships between poultry and the diseases they carry. In the case of influenza in particular, industrial poultry production has put viral evolution on fast-forward.

As H5N1 has decimated flocks and killed farm children in Vietnam and Thailand over the past two years, CP, Tyson, and other livestock revolution giants have attempted to use the avian influenza scare to restructure poultry production in their favor, by blaming the epidemic exclusively on the practices of small farmers. But the virulence of H5N1 seems to have evolved out of the coexistence of both systems of production, small and large. If Asia’s ubiquitous backyard flocks bring domesticated and wild birds in constant contact, the corporations’ huge warehoused poultry populations provide ideal conditions for the natural selection of the most virulent strains. In Thailand, China, and Indonesia, moreover, governments have colluded with CP and other politically powerful corporations to cover up infections and allow the export of meat from diseased birds. Density, debt, and death The livestock revolution, of course, is spurred by the urban revolution throughout Asia and the Third World. China’s cities alone added more population in the single decade of the 1980s than did all of Europe, including Russia, during the entire nineteenth century. And everywhere, city growth is the urbanization of formerly rural poverty. The explosion of informal urban settlement over the last generation—the UN now officially estimates a world slum population of more than one billion—has created unprecedented concentrations of biologically vulnerable humans living in congested and unsanitary conditions. The largest slum in Bombay, for instance, has a population density much higher than the Lower East Side of New York in 1910. All through Asia and Africa, indeed, are dense concentrations of poverty as inviting to disease growth as the environment of any First World War troop ship or frontline trench.

So, in addition to the livestock and urban population revolutions, you also have unprecedented numbers of people in poor health (often with chronic respiratory ailments) living in dense, unsanitary conditions. In the last instance, humans are simply a viral food supply. Added to this is the shrinkage of time and distance due to globalization—with shorter travel-times for the transmission of viruses and bacteria to any corner of the world—and you have the optimum conditions in human history for new plagues and pandemics.

What has been the systemic response to these new potentials for disease emergence? Globalization’s transformation of livestock ecology and disease evolution, of course, has taken place without any countervailing investment in the public health systems needed to surveil and respond to novel infections or the reemergence of old plagues. Indeed, one of the principal impacts of a generation of debt has been the deliberate shrinkage of public health expenditure in poor countries. The results, especially in Africa, have been devastating: hospital and clinic closures, the emigration of doctors and medical staff, and inability to buy life-saving but expensive pharmaceuticals. The genocidal progress of HIV/AIDS in the tropics owes as much to neoliberal structural adjustment as it does to biological factors.

Thus, if the livestock revolution has created conditions for the accelerated evolution of influenza strains, global urban poverty and disinvestment in public health assure the vulnerability of huge populations. The same kind of catastrophic synergy between influenza, hunger, and poor health that devastated India in 1918 could kill tens of millions in India or Africa tomorrow.

But viruses will also track down the affluent in their gated suburbs. We live in an age of blind and ignorant belief that spatial apartheid will protect gilded lifestyles from the turbulent world outside. By driving a huge SUV (a gated community on wheels) and living in a “protected by armed response” outer suburb, the haves reproduce an illusion of invulnerability to the consequences of global inequality. A pandemic may be a great equalizer.

Certainly the Bush administration has squandered every opportunity to organize an effective defense. Unlike HIV/AIDS, an avian influenza pandemic would be no surprise attack. The world’s leading influenza researchers, together with the WHO and the UN’s Food and Agricultural Organization (which monitors animal diseases), have been sounding the tocsin since 1997. This desperate campaign by contagious disease experts to make avian flu a global priority, moreover, has coincided with the sudden availability of massive federal funding to meet the so-called threat of bioterrorism.

After 9/11, when Secretary of Health Tommy Thompson and President Bush were scaring the pants off Americans with dire warnings about anthrax and other terrorist-engineered plagues (the better to justify the invasion of Iraq), many public health advocacy groups endorsed the specter of bioterrorism because they calculated that some of the expenditure would trickle down to worthy causes like tuberculosis research and vaccine development for avian influenza.

Their opportunism has been cruelly rewarded. Recently 700 medical researchers led by Nobel Laureates published a petition protesting the draining of federal research funds from vital areas of disease research in order to support exotic biowarfare projects. Billions have been wasted on stockpiling vaccines for hypothetical smallpox or anthrax attacks, while influenza vaccine development has received less annual funding than “abstinence education.” Despite repeated assurances that it takes the avian flu threat seriously, the Bush administration has seemingly been more worried about promiscuity than pandemics.

At the same time, little has been done to redress the damage that fiscal retrenchment and the HMO revolution (with its bottom-line emphasis on reducing the number of hospitals and hospital beds) has done to the U.S. public health infrastructure. The Government Accountability Office (GAO) recently pointed out that not a single American state could deal with a large-scale epidemic outbreak. A few years ago, indeed, hospital capacity in Los Angeles—where a quarter of beds have been lost in the wake of budget cuts and HMO mergers—was overwhelmed by patient demand due to a more vicious than usual strain of “regular” flu.

What about vaccinations and wonder drugs? The GAO has repeatedly criticized first the Clinton administration and then the Bush regime for failure to get vaccine production under way in anticipation of an avian flu pandemic. Some trials are now taking place, but Washington is proposing to manufacture only a couple of million doses. Moreover, H5N1 is still evolving and there is no certainty that the vaccine under development will actually work.

Antivirals also exist, but their efficiency depends on careful safeguards against rampant misuse that encourages the evolution of viral resistance. Thus, the cheapest and most widely available antiviral, amantadine, no longer works against H5N1 because of secret and promiscuous employment in China to protect poultry after the original 1997 outbreak.

The sole remaining defense against avian flu is a far more expensive species of antivirals known as neuraminidase inhibitors. The principal pharmaceutical, called Tamiflu, is manufactured by Roche in a single plant in Switzerland. Canada, Australia, and Japan, following scientific recommendations, have stockpiled enough Tamiflu to protect one-quarter of their populations. Likewise, Britain and France have ordered large quantities.

The Bush administration, despite pleas from influenza experts, has stockpiled only two million courses, with another three million recently ordered but not yet delivered. Out of a population of almost 300 million people, of whom at least 100 million are expected to contract influenza during a pandemic, to whom will the Tamiflu go? At a recent conference, public health experts were unable to agree whether they should prioritize emergency personnel, health workers, or chronically ill elderly people. Soon after, however, the Pentagon clarified the situation with a memorandum assigning priority use of antivirals to military forces on active duty around the world. Socialism and human solidarity If the sole superpower has failed to minimally protect its citizens, what is the fate of the far more vulnerable populations in poor countries?

The answer is brutally simple: no vaccines, no antivirals. When a Thai representative at a recent summit conference on avian influenza proposed that Tamiflu be generically manufactured to increase the supply and reduce the cost (currently about $60 per course), the United States and France circled wagons around Roche’s monopoly. Likewise, the Bush administration has rebuffed Vietnam’s desperate pleas for help in establishing a comprehensive system of viral surveillance and testing.

In the event of a pandemic outbreak, the greatest loss of life, as the WHO has repeatedly warned, will be in sub-Saharan Africa. Only white and wealthy South Africans have access to antivirals and potentially to a vaccine. In the rest of the continent, with its huge population of immune-suppressed and sick people, there is not a single firebreak against an H5N1 conflagration.

The threat of avian influenza, in conclusion, maps with uncanny accuracy to the global topography of inequality, debt, and poverty. Like HIV/AIDS, avian flu is a plague that grows directly out of the new ecology of globalization, the world public health crisis, and the obscene misallocation of resources by global capitalism. The pharmaceutical industry, as the recent flu vaccine shortage illustrated, has largely abandoned the research and development of “non-profitable” vaccines and antibiotics.

If neither the empire nor the market is willing to defend the planet against viral invasions, then what should be done? I think the socialist position is simple: lifeline medicines, like clean water and public health clinics, are an elementary human right. And capitalism is a fatal disease.

1 comment:

Josh On said...

Mike Davis also wrote an article on the current crisis: