Getting in a flap over bird flu

Why is everyone from the World Health Organisation (WHO) to the news media so intent on stirring up a panic about a pandemic of bird flu among humans? No such pandemic exists; it is by no means certain that such a pandemic will ever occur; and in the event that such a pandemic does occur, panicking about it now will hinder rather than help whatever efforts are necessary to contain it.

The emergence of cases of bird flu in birds in Turkey and Romania has caused significant concern, following the latest human casualties in Indonesia – although the confirmed number of human bird flu deaths in the latter country has actually been reduced from initial reports, and now stands at three. Worldwide, there have only been 117 confirmed cases of the disease in humans to date, and 60 people have died from it.

Compare this with SARS, another recent infectious disease that prompted fears that were out of all proportion to the threat. Most notably, the fears surrounding SARS did nothing to assist the rapid and thankfully successful measures taken to tackle the disease. Worldwide, SARS is known to have infected around 8,400 people to date, of whom 800 have died – a tragedy no doubt, but nothing like the apocalyptic scenarios that circulated when the disease first emerged.

The prevailing fear with bird flu, however, is that the H5N1 bird flu virus subtype – which since 1997 has been known to be transmitted from bird to human, and is also known to mutate rapidly – will mutate into a form that can be easily transmitted from human to human, thus triggering a global pandemic (1).

Given the terms in which the bird flu pandemic is discussed, one could be forgiven for thinking that it was already a reality rather than a mere possibility. WHO representatives have said a pandemic is ‘inevitable’, while UK chief medical officer Liam Donaldson says it is a ‘biological inevitability’ that a flu pandemic will hit Britain badly. The UK Department of Health is fond of quoting the statement, in its 2002 report Getting Ahead of the Curve: A Strategy for Combating Infectious Diseases, that ‘most influenza experts believe that it is a matter of when, not whether, another influenza pandemic strikes’ (2).

Encouraged by WHO and other health organisations, governments are rushing to issue detailed plans for dealing with a new flu pandemic. These governments are desperate to be seen to be doing something, but in truth it is far from clear what might be achieved by making such detailed contingency arrangements a matter of public discussion. British citizens now know the precise criteria for allocating vaccines, if a pandemic should occur and if demand for vaccines should subsequently exceed supply. No doubt this makes for reassuring reading, for anyone not fortunate enough to be a key worker, over 65 or diabetic (3).

There have also been concerns raised over the insufficient number of NHS critical care beds, should we experience a major outbreak of flu. More NHS beds would doubtless be a nice thing to have for our present purposes, much less a major new disease outbreak. But it’s worth keeping in mind that there will never be sufficient beds to cope with every conceivable eventuality, unless a bed is allocated to every member of the population (4).

Elsewhere, President George W Bush has seen to it that everyone knows what he read on his summer holidays, namely John M Barry’s book The Great Influenza: The Epic Story of the Deadliest Plague In History. Most mentions of this fact in the news bizarrely flag up the book’s 500-plus page count, as though this in itself were an indicator of how seriously the president is taking the threat of flu. But after his incompetent handling of the Hurricane Katrina relief efforts, and the public drubbing that this earned him, it seems that Bush is taking no chances of being caught unawares this time around (5).

As for the measures now being adopted in relation to the European countries where bird flu has been detected, restrictions on the export of live birds and feathers seem sensible enough. Only the experts, however, can reliably say whether culling 45,000 domestic birds in Romania, following the detection of bird flu in a mere three farmyard ducks, is an overreaction or a sensible precaution. It is certainly disconcerting that nobody other than angered Romanian villagers seems to be asking this question, with most commentators preferring instead to demand that more be done (6).

The extent of public obsession with bird flu can be glimpsed in the growing number of morbid blogs and wikis dedicated to the disease, giving exhaustive daily updates on the latest cases to emerge and on the migratory habits of potentially affected birds. One can even purchase an extensive range of bird flu clothing – ‘H5N1 wear’ in the jargon – and other merchandise, emblazoned with slogans such as ‘Bird flu tour 2005-2006’ (accompanied by a list of the world’s major cities) and ‘Ask me about bird flu’ (7).

Naturally, a helpline for those concerned about bird flu has been set up in the UK, which is par for the course for every aspect of health and wellbeing nowadays, even if the disease in question hasn’t affected a single individual in the country. Furthermore, the public has been encouraged to report evidence of disease in birds migrating from affected areas. A representative of the Wildfowl and Wetlands Trust, to her credit, showed some awareness that trying to make non-experts feel useful in this way is a waste of everyone’s time, when she requested that members of the public not report ‘any old sick pigeon’ (8).

Another source of solace, for the British citizen worried about bird flu, is the Department of Health leaflet Pandemic Flu: Important Information for You and Your Family. This helpfully informs us that ‘scientists predict that another pandemic will happen, although they cannot say exactly when that will be’, and that ‘once a flu pandemic affects other countries it will almost certainly reach the UK’. How will we know when the pandemic has hit us? ‘The government will issue warnings.’ Thanks for that. The five ‘key facts’ with which the leaflet concludes can be broadly paraphrased as ‘we don’t really know what will happen or how we’ll deal with it if a pandemic hits us, but it’s likely to be bad’ (9). Why, exactly, is this useless information supposed to be ‘important’ to ‘you and your family’?

Let’s be clear. It is entirely correct and necessary that experts in the fields of medicine and policy should research and prepare for potential future disease pandemics, not least so that the rest of us don’t have to spend our time fretting about such matters. Apart from anything else, most of us are quite powerless to influence the likelihood of a disease outbreak of such magnitude. Therefore, premature concern about such an eventuality is a sad waste of energies that could be more productively invested elsewhere.

Asking everyone to be vigilant and cautious about an as yet non-existent disease outbreak is worse than useless. It induces feelings of fear and helplessness in the general public, while distracting experts from whatever discreet, specialist work they might usefully be engaged in at this anticipatory stage.

Read on:

Welcome to Chicken Little Britain, by Mick Hume

spiked-debate: Plagues of the future?

(1) See Indonesia lowers bird flu toll, BBC News, 6 October 2005; Avian flu, BBC News, 13 October 2005; Avian influenza (‘bird flu’) and the significance of its transmission to humans, World Health Organisation, 15 January 2004

(2) World slow to face bird flu threat, Adam Blenford, BBC News, 25 August 2005; Flu pandemic ‘will hit UK hard’, BBC News, 30 September 2005; Getting Ahead of the Curve: A Strategy for Combating Infectious Diseases (Including Other Aspects of Health Protection), 10 January 2002. See Bird flu and pandemic influenza: what are the risks?, Department of Health, 13 October 2005

(3) See Reason to be fearful? , Tom Geoghegan, BBC News, 11 October 2005; Influenza pandemic contingency plan (.pdf 336 KB), Department of Health, 1 March 2005

(4) Flu outbreak may ‘overwhelm’ NHS, BBC News, 23 September 2005

(5) See Officials race to head off a bird flu pandemic, Steve Sternberg, USA Today, 10 October 2005; US racing to head off flu epidemic, Voices, 11 October 2005

(6) Romania culls birds in flu scare , BBC News, 11 October 2005; Bird flu found in Romanian ducks, BBC News, 13 October 2005

(7) See Bird flu blogs, Jane Perrone, Guardian, 12 October 2005; H5N1 wear, on the Cafépress website

(8) Bird watchers placed on flu-watch, BBC News, 11 October 2005; Scottish site in bird flu study, BBC News, 11 October 2005; Reason to be fearful? , Tom Geoghegan, BBC News, 11 October 2005

(9) Pandemic Flu: Important Information for You and Your Family (.pdf 332 KB), Department of Health, 4 April 2005, p6, 8-9