September 19, 2005
United States Orders French Bird Flu Vaccine While Indonesian Cases Suspected

George W. Bush has decided to order an experimental French avian flu vaccine.

At the United Nations on Wednesday, President Bush proposed an "international partnership" to combat the disease, and the United States announced last week that it had placed orders for $100 million worth of a promising but technically unlicensed vaccine that is under development by the French drug maker Sanofi-Aventis.

If it was up to me I'd take money away from Bush's massive Gulf Coast mini-Great Society boondoggle (why subsidize rebuilding in a flood plain where hurricanes will hit again and again?) and use it instead to develop better influenza vaccine production technologies and other measures to protect against the inevitable next influenza pandemic. Why subsidize the movement of people back into harm's way when we could instead fund research that would remove people from harm's way? But my knee jerk use of rational analysis keeps placing me outside of the emotional mainstream.

We are overdue for the next big influenza pandemic and it is just a matter of time till the pandemic happens.

"We know we're overdue for an influenza pandemic strain, and we know it will occur, but we don't know when or even exactly what virus will cause it," said Dick Thompson, a WHO spokesman. "It is possible that the virus won't be H5N1 at all or that this virus will change in a way so that the vaccine under development doesn't work against it."

Thompson added that government orders for unproven vaccines still are worthwhile because they provide incentives for companies to do vaccine development work against H5N1. That makes sense. The companies will be further up the learning curve on H5N1 and will also have more vaccine production facilities in place available to switch over to a different vaccine variant once the exact pandemic strain emerges.

The backdrop to these statements is the avian flu news from Indonesia. Indonesia has 4 dead from the H5N1 avian flu strain and birds all over the Indonesian islands have the flu.

The developments highlighted Indonesia's continuing struggle against bird flu, which is endemic in chicken flocks across the sprawling island nation and has killed four humans since July, the most recent being a 37-year-old woman who died nine days ago.

3 Indonesian children have suspected cases of H5N1 avian influenza.

Three Indonesian children are suspected of having been infected with bird flu, a health official said, while the Jakarta zoo remains closed over an outbreak of the disease.

'There are now three suspected cases of bird flu infection, all children,' said Sumardi, the health ministry's acting spokesman.

Unlike other (and rather poor) countries in the region Indonesia says it doesn't have the money to do massive culls of commercial poultry populations which have bird flu.

Apriyantono later told reporters his ministry had requested more funds to handle the outbreak, but said the government had little money to conduct a mass slaughter of poultry or birds.

"Depopulation will need a huge amount of funds. This year, we need more funds for avian influenza to do research, surveillance and selective depopulation."

The WHO would support recommendations by the World Organisation for Animal Health and by the U.N. Food and Agriculture Organisation (FAO) for a mass cull in Indonesia, Petersen said.

I'd love to know what the cost of a huge domestic bird depopulation would cost in Indonesia. Suppose the US withdrew from Iraq and used some of the money against domestic avian flu in poor countries. How many weeks of fighting in Iraq would yield enough money to pay for a cull of infected birds in Indonesia, Cambodia, and Laos?

WHO regional director Shigeru Omi says poor Asian farmers are a weak link for stopping an avian flu pandemic.

The WHO regional director for Western Pacific, Shigeru Omni, said at the opening of a WHO conference in New Caledonia that poor Asian farmers are a weak link in the fight to contain the disease. He said these farmers are reluctant to report bird flu outbreaks because of a lack of financial incentives to do so.

WHO says countries should hold a mass culling when an outbreak occurs, but some nations refuse. Indonesia has launched a vaccination drive for poultry, but has carried out only limited culling because it lacks the money to compensate farmers.

When the pandemic comes it will cost industrialized countries trillions of dollars. Why not spend a small fraction of that up front to reduce the odds of the pandemic in the first place? As one of the B-52s women singers once sang "I'm just asking!".

World Health Organization (WHO) Indonesia country representative Georg Petersen says that farmers living in close proximity to their chickens makes the spread of avian flu to humans hard to control. At the same time an Indonesian government official says Indonesians should just accustom themselves to getting sick from H5N1 avian influenza.

``The problem with this country, as in many Asian countries is that a large portion of the chickens are raised by farmers in their backyard and even within the cities, people are raising chickens and this is very difficult to control,'' Petersen said.

Indonesians ``will have to be prepared to live together with bird flu, as it has with dengue,'' agriculture minister Anton Apriantono told reporters while visiting Pasar Cempaka Putih, a traditional market that sells live poultry in central Jakarta today. Dengue, which causes, fevers, rashes, headaches, muscle pain and sometimes death, is an annual occurrence in Indonesia.

Bottom line? Your own considerable future risk of getting killed by an H5N1 avian influenza pandemic comes from an attitude prevalent in Third World countries that lots of disease sicken and kill people so why get worked up about just one more infectious disease?

Share |      Randall Parker, 2005 September 19 02:06 PM  Dangers Natural Bio

Steve said at September 19, 2005 5:45 PM:

I'm surprised no one has commented on this article yet.

Randall Parker said at September 19, 2005 6:49 PM:


I'm familiar with Marc Siegel's argument. But is he right? Is H5N1 really at low risk of crossing over into humans? Some scientists think the risk is higher. Are they naive? Maybe the ones who see the risk as high are all epidemiologists, medical doctors, and public health officials who lack the requisite knowledge in influenza virology and they are exaggerating the risk out of ignorance. But is Siegel more knowledgeable? He's an internist and does not represent himself as a virology expert does he? Does his book quote some top notch virologists?

I'm going to dig for more on the mutations needed to make H5N1 into a pandemic strain. Keep in mind that recombination with a human influenza during co-infection is considered to be a way to jump thru many mutational hurdles very quickly.

Here's one article on the mutation risk for H5N1 to become easily transmissible in humans:

Ranged against H5N1, say virologists, are four genetic and environmental obstacles that discourage it from becoming established in a human population:
  • Its viral replication in human cells may be inefficient. There may be too few viral offspring emerging from infected cells to create a big "viral load" that can be spread through coughing or sneezing, as the human flu virus does so well.
  • The avian virus is unable to lock on effectively to human cells, or more accurately certain types of human cells. The spike that enables it to lock on to the cell receptor is the wrong shape.
  • Avian viruses' natural home is the gut of birds, where the temperature is a balmy 37 degrees Celsius. The human respiratory tract, though, is 33 degrees to 34 degrees Celsius. That coolness could have an impact on how well the virus reproduces.
  • Bird viruses are well adapted to evading the immune system of birds by skirting the molecular tripwires that unleash antibodies and white blood cells that destroy invaders. But they do not yet have this in humans.

For H5N1 to spread efficiently among humans, "you are probably going to need changes in more than one gene", said Zambon.

Given that the virus only has 10 genes, that might seem to be a major obstacle.

But Zambon is cautious, noting that very little is known about exactly which genetic changes can switch on a virus' virulence.

Here's an indication that the H5N1 bird flu strains is becoming more of a threat to animals less genetically distant than birds are to humans:

Robert G. Webster of St. Jude Children's Research Hospital has studied avian flu strain H5N1 since 1998, and in a study in last week's Proceedings of the National Academy of Sciences reported that the most recent samples are more infectious and more deadly to mice. Webster suggested that the continuing advance of H5N1 mutations could soon allow it to infect humans more easily. Currently, the virus cannot be transmitted from person to person.

Note that report was from July 2004. Here's a report on what Webster told a biosafety conference in Lyon France in March 2005:

Whether the current H5N1 strain reassorts with a human adapted influenza strain or simply evolves efficient human to human transmission through mutation, the risk of a pandemic from this virus is very real, Webster said. He traced the evolution of H5N1 over the last 8 years, highlighting the chain of multiple episodes of reassortment resulting in the current dominant Z genotype. This virus readily infects pigs but, at least at the moment, cannot be transmitted by them. He pointed out the expanding host range of this strain, including tigers and domestic cats, and the rapid evolution of the virus in ducks.

The fact that the virus is expanding its range of species that it can infect strikes me as a strong argument that it represents a real threat to humans. Here is a CDC report on probable tiger-to-tiger transmission of H5N1 and the lethal consequences for tigers.

Steve said at September 20, 2005 4:40 AM:


Thanks for the response. I had been reading this blog and others about the dangers posed by avian flu, and along came this article that says "don't worry, be happy." I was just curious to hear someone elses take on it.

Andrew Berman said at September 20, 2005 7:34 AM:

I strongly recommend that people reading this go and purchase a few doses of tamiflu. At $65 for treatment (10 pills), it's not cheap for many of you, but neither is death. Even if you have 10 people in your family, a single treatment might be enough to keep whomever gets sick first alive long enough to get more of it.

And what's the chance that it will be a wasted $65? Even if it's 99 percent chance you don't need it, that means you're valuing your life at less than $6500 if you don't buy it.


autumn said at October 24, 2005 7:06 AM:

helo, my name is autumn and i am doing a report on bird flu at school. i would like to comment on steve, i think that the bird flu epidemic is very agnostic. also, it shold be very cautionable that bird flu could out break at any moment is if they dont protect them selves very good.thank you ,autumn

Karen said at October 27, 2005 4:05 PM:

Newsweek article dated Oct 31,2005:
"Already the [H5N1] virus contains five of the ten mutations that made the notorious 1918 flu bug contagious [human to human]."
Unlike the press and most of the viewing populace of reality tv, I am not a moron and am looking for answers to these questions: What exactly is meant by "mutation?" What is the chronology of the five mutatios that scientists obviously have been tracking? Can this virus "mix" with an existing flu strain creating a new bug that is transmissible between humans?
Google searches from today [October 27] are stating that the H5N1 strain is showing resistance to Tamiflu. How did that happen, how did scientists determine this?

Karen said at October 27, 2005 4:06 PM:

Newsweek article dated Oct 31,2005:
"Already the [H5N1] virus contains five of the ten mutations that made the notorious 1918 flu bug contagious [human to human]."
Unlike the press and most of the viewing populace of reality tv, I am not a moron and am looking for answers to these questions: What exactly is meant by "mutation?" What is the chronology of the five mutatios that scientists obviously have been tracking? Can this virus "mix" with an existing flu strain creating a new bug that is transmissible between humans?
Google searches from today [October 27] are stating that the H5N1 strain is showing resistance to Tamiflu. How did that happen, how did scientists determine this?

monica said at November 18, 2005 7:53 AM:

Okay i do agree the bird flu is very deadly and a great threat to this country,but unless you live in the Gulf Coast you can't understand why we need to rebuild. Without us the country would be boring and full of seriousness without any fun. I am from New Orleans,my city was the most unique and diverse in the nation and now part of it is gone. We can't not rebuild such a great city and you have no idea what you're talking about as far as that goes. However i do vbelive when they rebuild the city,they should raise,as they did Galveston after the hurricane of 1902(i believe). But just as easy as we(the Gulf Coast) get hit,the East Coast could also be hit,so do myou think we shouldn't rebuild the east coast,if to say it got hit?If so please explain to me why them and not us. Thank you and i hope you reply me letter and I respect your opnion.

Randall Parker said at November 18, 2005 6:01 PM:


People who choose to live in low lying coastal areas in hurricane zones should either pay for their own rebuilding or move to places where their houses can't get wrecked by hurricanes.

I do not see why people who live in safer areas should be forced via taxes to subsidize those who choose to live in harm's way. I understand why some people want to live near the coast. They like the weather. They like the scenery, the fishing, and other water sports. But why should everyone else subsidize their living standards?

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