excerpts, the full article can be found at: http://www.emagazine.com/view/?2826&printview
Laurie Garrett: Are We Prepared for Avian Flu?
Interviewed by Jim Motavalli
Laurie Garrett, the only reporter to win all three of journalism's big "P" awards (the Peabody, the Polk and the Pulitzer) is extraordinarily well positioned to tell the frightening and emerging story of avian flu. The author of two major public health books, Betrayal of Trust and The Coming Plague: Newly Emerging Diseases in a World out of Balance , she was a science correspondent at National Public Radio before joining the science-writing staff of Newsday in 1988. Avian influenza comes from aquatic birds, including migratory ducks, geese and herons. As Garrett explains, the loss of these birds' migratory routes in China has brought them into direct contact with humans in farms and parks. In this way, influenza is spread from migrating birds to domestic birds, then to pigs and ultimately to humans. This chain of events involves veterinary science, ecology and medicine, the triumvirate studied by the science of conservation medicine.
E Magazine: How is avian flu progressing?
Garrett: It is becoming more of a danger physically, and to add to that there's been a steady effort by the public health community to get policymakers more aware and more concerned about the situation. That is meeting with some success finally.
How does avian influenza spread?
I wish we knew the answer to that question. There's evidence of transmission via dining on the meat of animals. There's evidence [of transmission through] some very, very close contact with chickens, such as professional cock-fighting roosters. The owners of these roosters suck the blood out of the roosters' beaks with their own mouths when they start bleeding during cockfights. But it's all rather mysterious: Lots and lots of chicken handlers, chicken farmers and poultry workers are infected. And then we find infections in people who seemed to be several steps away from any chickens. So it's all quite baffling.
Americans have probably been lulled into believing we have effective vaccines for threats like avian flu.
The only diseases we have any hope of eradicating--and I'm not really sure that we're ever going to eradicate any more diseases besides smallpox--are ones that are present only in humans and are not found in animals. So smallpox was unique in that the vaccine was 100 percent effective. It was easy to spot people who were infected because they had very gross and obvious physical symptoms, and there were no animals that harbored that virus. But avian flu is not like that; we are the final end point on a long food chain of animals that this virus goes chopping its way through, and as it does so it constantly mutates. A vaccine that is effective against the flu strain one year may have very little, if any, effect against the flu strain circulating the next year. So influenza is just orders of magnitude more difficult to deal with.
Avian influenza viruses seem to originate in southern China, in the Pearl River Delta region. It's a unique ecology, with a tropical climate, extremely dense human population, a booming economy with rapid Gross Domestic Product (GDP) growth and giant mega-cities sprouting up overnight. But meanwhile, there is a large peasant population still conducting traditional poultry rearing in the way they have for centuries. The Chinese predilection for purchasing live animals that are slaughtered at home means that possible routes of exposure are infinitely greater than what would be the case in the U.S.
The virus is normally carried by aquatic migratory birds, including ducks and geese, that transverse the Asian Flyway, extending from southern Indonesia all the way up into the Arctic Circle of Siberia. The largest landmass on this migratory route is China, which has really devastated its natural ecology. So the birds are unable to find many pristine natural places to land as they make their migration every year. They're landing on farms and getting into fights with domestic animals over food and water.
The ecology of this virus is very much about what's going on right now in China. And then it's compounded by rising GDP growth, which means that more Chinese people can now afford to eat [animal] protein on a regular basis. So a family that just as recently as 10 years ago would slaughter a chicken only on a special occasion can now afford to have a chicken every week. And soon most Chinese may be able to afford to have chicken or pork every day, just as we can. And that is going to dramatically increase the number of livestock being reared in China, with very dire potential outcomes. So all of this means we're hastening the probability of the emergence of a truly lethal flu strain.
Has the appearance of avian flu led to changes in Chinese agricultural practices?
China's agricultural practices have not changed appreciably in any of the peasant areas. And, of course, the majority of China's population is still peasant, even though the society is experiencing this overall boomtown economy. Purchasing live chickens and other animals, then taking them home and killing them is still very much a cultural tradition that's deeply embedded across much of Asia, and not just China. You can see it in Vietnam and all the way up into Singapore and down towards parts of India. This is about culture, and it will not change overnight.
You were describing a process by which migratory ducks and geese have been forced out of natural areas. Doesn't that make this a good example of what is known as conservation medicine?
West Nile virus, its ecology, and how it was behaving in New York in 1999 was understood by a very complicated host of medical professionals, including veterinarians and people dealing in wildlife management. But at that time we really had no respectful mutual lines of communication between those protecting human health, those protecting animal health and those dealing with ecology. And so vital clues that might have slowed the spread of West Nile were overlooked because people in the traditional public health community weren't listening to veterinarians or people dealing with wildlife. We would have hoped that all of this would have been sewn up by now, but we still see the same sort of snobbery and the same professional niche way of thinking operating in infectious diseases all the time.
Even now there's not a real smooth operating relationship between the World Health Organization, the World Organization for Animal Health and the UN Food and Agriculture Organization. So those agencies in the UN system that deal with animals and agriculture are not as neatly plugged onto the World Health Organization, and vice versa, as one would hope. And the same is true here in the U.S. institutionally. Our U.S. Department of Agriculture and Department of Health and Human Services are not exactly good bedfellows. Agencies that traditionally deal with agriculture tend to have as their mission statement the defense of the agricultural industry. So they're very tied into the economic side of agriculture, whereas health agencies tend to view that with suspicion, and to be tied into a whole different kind of economy. So it creates a kind of natural tension between these forces, and it filters all the way down to the average doctor, the average veterinarian, the average wildlife scientist or ecologist. So the bridges haven't been built at the institutional level or at the personal level.
Garrett resigned from Newsday earlier this year after winning the paper both the Polk and Peabody awards. She cited a deteriorating climate for journalism: "All across America, she wrote, "news organizations have been devoured by massive corporations--and allegiance to stockholders, the drive for higher share prices, and push for larger dividend returns trumps everything that the grunts in the newsrooms consider their missions."
|Laurie Garrett: anticipating the next pandemic.
Specifically, as Garrett told radio host Amy Goodman, the newsroom conditions that allowed her to travel to Africa and India to report on AIDS, or take six months to report from the former Soviet Union, no longer existed. "A 32-part series on the collapse of public health in the former Soviet Union?" she said. "I don't know any institution today that would publish that."
Today, Garrett is Senior Fellow for Global Health at the Council on Foreign Relations. Her story "The Next Pandemic?" was published in the July/August issue of Foreign Affairs , the Council's bi-monthly magazine. In it, Garrett traces the history of U.S. pandemics, including the Spanish flu outbreak of 1918, which killed 675,000 Americans. Avian flu could be even worse. "If the relentlessly evolving virus becomes capable of human-to-human transmission, develops a power of contagion typical of human influenzas, and maintains its extraordinary virulence," she writes, "humanity could well face a pandemic unlike any ever witnessed. Or nothing at all could happen." According to the Centers for Disease Control and Prevention (CDC), an H5N1 avian influenza that is transmittable from human to human could sicken 80 million people and kill 16 million.
Kate Slomkowski and Shauna Dineen contributed editioral assistance.
Laurie Garrett's article in Foreign Affairs
Public Affairs Director International Bird Rescue Research Center www.ibrrc.org 831-622-7588 Helping birds around the world since 1971
United Poultry Concerns, Inc.
PO Box 150
Machipongo, VA 23405-0150