The Fatal Strain Read online

  Kong Phalla spied one of her frequent Cambodian customers drive up to the curb in a new Toyota sedan and get out. She instantly abandoned her thought, grabbed the cage, and gave chase. She followed him up the long brick staircase, past the statues of lions and pink balustrades of mythical serpents and beyond the stone stupas above, beseeching him at each step to purchase some of her birds. He acceded just before vanishing into the sanctuary on the crest of the hill. Kong Phalla put down her cage on a stone bench beside those of other peddlers and waited for her next chance.

  To understand this Buddhist custom, I sought out a monk named Khy Sovanratana. I found him at his monastery in the center of Phnom Penh, a once romantic city of French colonial villas still trying to collect its thoughts three decades after Pol Pot’s reign of terror. The Khmer Rouge had abolished religion, decimating the country’s Buddhist institutions. Since then, Buddhism has revived, monks bearing alms bowls have returned in large numbers to the early morning streets, and Khy Sovanratana has emerged as a commentator on morality and social issues. Though his close-cropped hair was still black with youth when I met him, his learning had already elevated him into the ranks of senior clergy. When he received me, he was seated cross-legged on a thin cushion, his orange monk’s robe draped over his left shoulder.

  The monk started by recounting a legend of Prince Siddhartha, the Indian nobleman who would later attain enlightenment and become the Supreme Buddha. The young prince and his cousin were walking through the woods when they spotted a swan. The cousin drew his bow and shot the swan with an arrow. Siddhartha raced to the injured bird, refusing to relinquish it. His cousin grew furious. But Siddhartha caressed the swan, eventually nursing it back to health before setting it free.

  “This kind of conduct has had a big impact on Buddhist practices,” the monk said softly. “Giving life is very much extolled in Buddhism.” He explained that the simple gesture of releasing birds is rich in significance, and he slowly explicated the different layers of meaning. First, by giving life, a devotee follows in the footsteps of the Buddha. Second, the act of releasing the bird helps to cast off the “torments and tortures” of everyday life. And third, the act of liberating a living creature earns devotees religious merit toward reincarnation into a better life. For a person with financial means, the only limit on the number of birds to be released is his kindness. Sometimes, the monk said, adherents have been known to free not only birds but fish, turtles, and even cows and buffalo that are tied up awaiting slaughter.

  But setting aside the sublime, Khy Sovanratana acknowledged that believers should not be blind to the dangers of this tradition. “There’s no point if you don’t get benefits but instead catch a virus,” he counseled. “Monks should be given this kind of awareness and pass it on to devotees when preaching.”

  That’s a tall order in Cambodia, where this tradition is intertwined not only with religion but national identity. The king himself frees doves, pigeons, and other wildfowl about four times a month—in especially generous numbers to mark royal birthdays—and this has complicated efforts to regulate the practice. Its adherents rarely comment on the contradiction of trapping birds only to set them free, an irony compounded by the success of some boys in catching fowl moments after their release so they can be sold yet again. Not long before my audience with the monk, an environmental group based in the United States had tried to curtail the practice on the grounds that the sale of merit birds represented illegal trade in wildlife. The organization, WildAid, had established a rapid-response unit that included Cambodian military police and forestry officials and carried out several raids on bird peddlers. The campaign culminated in the confiscation of birds sold at Wat Phnom and elsewhere. But this provoked a religious and political backlash. The government suspended further raids.

  Even in Hong Kong, which so successfully overcame public opposition in its decisive response to the initial bird flu outbreaks, officials have been reluctant to tackle this revered ritual. Nearly ten years after the virus first jumped to humans, fears of a new outbreak in Hong Kong surged when several dead birds recovered from city streets tested positive for the lethal strain. Among these were munias, which are not native to urban Hong Kong but imported by the tens of thousands from mainland China each year for Buddhist rites. The discoveries prompted Richard Corlett, an ecology professor at the University of Hong Kong, to publicly warn that bird releases posed the principal threat of reinfection in the city. Agriculture officials urged people to refrain from freeing captive birds and asked religious organizations to make a similar appeal to their members. But while the government ultimately suspended trading at Hong Kong’s famous Bird Garden market after an infected starling was discovered there, a similar ban was not imposed on merit-bird releases. The cultural sensitivities were too great.

  By the banks of Phnom Penh’s Tonle Sap River stands an ornate, carnival-colored shrine called Preah Ang Dang Ker. Under its steeply pitched roof rests a likeness of the Buddha gazing across the broad gray waters. Around the outside linger peddlers surrounded by cooing and chirping. “I have no concern about getting sick with bird flu, and the buyers have no concern,” offered Srey Leap, a stocky woman in a sweat-stained shirt keeping vigil from the shade of an umbrella. “They never worry about this. It is our Cambodian tradition.” When a family approached, Srey Leap and the other hawkers converged. The five visitors paused to haggle, then purchased an entire cage frenetic with the flapping of about a hundred pairs of wings. They carried it to a low stone wall above the water’s edge. They pulled the birds two by two from behind the mesh and, with the occasional whisper of a prayer, set them loose, casting a line of silhouettes down the ancient river until the entire contents of the cage and whatever contagions it concealed had disappeared along the banks.

  CHAPTER EIGHT

  Sitting on Fire

  To thwart a gathering pandemic, the perimeter must hold. Once it is breached, there’s no turning back. This precarious frontier, the first and last line of defense separating the pathogen’s animal hosts from the human race, runs through thousands of remote Asian villages. These outposts are vulnerable and often unsuspecting, like the Javanese hamlets that scale the lush, terraced slopes of the Mount Lawi volcano. There, an Indonesian animal-health officer who goes only by the name Suparno had been drafted into keeping the virus in check before it crossed to people. But the day I met Suparno, he preferred to go to lunch.

  It was late one morning in May 2005 when this lanky, good- humored veterinarian arrived at an elderly woman’s farmhouse partway up the slopes. Clad in the tan uniform of a civil servant, Suparno announced he’d come to inoculate her chickens against bird flu. While a human vaccine had so far proven elusive, workable poultry vaccines were already in production, and several Asian countries, including Indonesia, had made them the centerpiece of their efforts to contain the virus. Suparno knew the woman kept some chickens. Nearly every family in her village did.

  “How many do you have?” he asked her.

  “Twenty-five,” she answered. The woman motioned initially toward a low, concrete barn out back where she kept some of them. Then she swept her right arm in front of her, indicating the rest were wherever he might find them.

  Suparno led his team around the side of the house into the cramped backyard. Crouching on the dirt, he set down the small, pink pail that held his gear. He took out a plastic bottle of vaccine, then slowly drew the fluid through a tube into an automatic needle. His colleagues produced five black hens from the barn, one by one, and clasped their wings and legs tightly while Suparno injected half a milliliter of vaccine into their breast muscle.

  After only a few moments, he rose to his feet and got ready to leave.

  “What about the rest of the birds?” I asked him.

  “Too hard to catch,” he responded. They might be hiding in the trees or in the crawl space beneath the house.

  Then, changing the subject, Suparno and his fellow officers agreed it was time to eat. He invited me to j
oin them. With no irony intended, they suggested a local joint specializing in chicken.

  I had come to the province of Central Java to spend several days observing Indonesia’s much-publicized effort at fighting the infection that had been coursing through the country’s flocks for more than a year. Central Java, as its name implies, is at the center of Java island, which, in turn, is home to the majority of Indonesians and has always dominated the country’s politics. My base would be the old royal city of Solo, host to one of Java’s two main sultanates. Solo remains the premier seat of Javanese culture and tradition. So I’d figured, given the political, cultural, and geographic centrality of the city, that the surrounding countryside would be at the forefront of the national campaign to root out the disease.

  At first I was encouraged. The chief livestock officer in one nearby district, Sragen, told me how she’d set up a twenty-four-hour bird flu command center. Sri Hardiati, a gregarious yet autocratic woman with a stylish haircut and piercing dark eyes, described how her office monitored poultry outbreaks and even had a small diagnostic lab for dissecting stricken birds. But as I toured the countryside with my assistant, we discovered that containment efforts were just public relations. We had asked to see the vaccination campaign at work. Yet in district after district, livestock officials declined. They said they had none to show us. Finally, after some pestering on our part, Hardiati asked us to accompany her chief vet, Suparno. He made only one stop, pausing long enough to vaccinate the woman’s five black hens. When he bypassed all the other homes in the village, I realized the outing had been simply for my benefit, little more than a photo op.

  Over the coming days, we would learn the extent of the ruse. Indonesia’s central government was claiming it provided millions of free vaccine doses for small and midsize Javanese farms and that 98 percent of these had already been used. But local officials and peasants told us this was fiction. “Maybe the farmers get the vaccine. The percentage who use it is small,” said the chief livestock officer in neighboring Karanganyar district. In Boyalali district, the chief livestock officer told me he had a hundred thousand doses in a refrigerator, but no one had asked for any in months. He was content to let them sit there.

  As we continued to drive the narrow byways of the Javanese countryside, we were also starting to learn from villagers and local veterinary officers that die-offs among chickens had been occurring much longer than we’d believed. Indonesia had officially confirmed its first poultry outbreak in January 2004, not long after Vietnam and Thailand initially reported theirs. But the local accounts we were hearing contradicted the version we’d been provided back in the Indonesian capital, Jakarta. We were fast realizing that Indonesia’s central government had covered up the mounting epidemic for almost half a year, since mid-2003, until it was too late to reverse the tide.

  Now, as we explored Central Java in May 2005, Indonesia had still to confirm its first human cases. But that too would change within months when death struck a suburb of Jakarta and Indonesia joined the growing list of countries with casualties. It wouldn’t be long before the death toll in Indonesia outstripped that of anywhere else on Earth.

  Yet Indonesia wasn’t alone in concealing the disease. I would come to learn that every Asian country with major outbreaks in livestock had hidden them from view, for months or even longer. The fatal strain’s progress across East Asia had been a journey veiled in secrecy and blessed with neglect. This microbial killer, born in the deep south of China, had repeatedly slipped across international borders over the previous decade, evolving and increasing its virulence until the toll on both people and poultry could no longer be denied.

  But even then, when it became untenable for governments to keep up the lie, they often chose to discount the danger rather than mount a serious campaign to defeat it. Instead of attacking the virus, they too often went after the scientists, journalists, and other whistle-blowers who tried to reveal the threat.

  The virus exploited this opportunity to put down roots. It became entrenched in Asia’s poultry, thus posing a long-term menace to humanity. While some Asian governments eventually intensified their efforts to contain the disease, total eradication was now a distant prospect at best. Not a single one of these frontline countries—China, Indonesia, Thailand, and Vietnam—had adopted the most powerful disease-fighting weapons: truth and transparency.

  Later, when I arrived on my first trip to Geneva, a senior WHO official gave me a piece of advice. He counseled me that influenza is all about politics. And those antiquated politics have proven every bit as intractable as the virus itself.

  This tale of death and deception begins in the coastal Chinese province of Guangdong, close to where the first human cases were confirmed in Hong Kong back in 1997. The H5N1 flu strain, which went on to ravage farms on at least three continents, infect hundreds of people, and pose the most serious threat of pandemic in a generation, was first isolated in a sample taken from a sick goose during a Guangdong outbreak in the summer and early fall of 1996. That was more than seven years before China first acknowledged any infection in its flocks. By the time Chinese officials went public in early 2004 and stepped up efforts to contain it, the virus had already seeded outbreaks in the country’s neighbors.

  Molecular biologists were later able to identify the Guangdong pathogen as the common ancestor of all subsequent H5N1 viruses by analyzing the eight segments of RNA that all flu viruses contain. Each of the segments in a single virus has its own signature, a specific sequence of basic building blocks called nucleotides that make up the RNA. As viruses evolve, these segments mutate. They can even be completely replaced as the promiscuous flu strains swap genetic material. In the lab, genetic genealogists determine the pedigree of viruses by looking for similarities in their RNA. Isolates that share the same pattern are often related and descended from the same specific virus.

  A combined team of researchers from the U.S. CDC and China’s official National Influenza Center reported in 1999 that the virus that had killed people in Hong Kong two years earlier was related to the Guangdong goose isolate. The specific H5N1 subtype was identified at the Chinese influenza center. At least three other academic papers written in Chinese by Chinese researchers also reported in 1998 and 1999 that H5N1 had been isolated in Guangdong in 1996, disclosing in one instance that up to 40 percent of the geese on a farm stricken by the outbreak had died. These findings had been reported by Chinese government researchers in government publications. Yet for years, senior Chinese officials continued to deny publicly that Guangdong had been struck by bird flu in 1996 or that it had spawned the wider epidemic.

  Over the coming years, Chinese and foreign scientists continued to report periodic outbreaks in southern China, including a large poultry die-off in Guangdong just months before the Hong Kong cases in 1997. A series of research articles published between 2000 and 2002 further documented that H5N1 viruses were continuing to circulate in southern China, for instance in geese and ducks exported from Guangdong to Hong Kong. The virus was also isolated in a specimen taken from frozen duck meat exported from Shanghai to South Korea in 2001. A team composed primarily of mainland Chinese researchers later reported that tests on ducks from southern China between 1999 and 2002 had repeatedly come back positive.

  The most damning evidence came in a study published in 2006 by scientists from China, Indonesia, Malaysia, Vietnam, and the United States, which identified China as the wellspring of the international epidemic. “We have shown that H5N1 virus has persisted in its birthplace, southern China, for almost 10 years and has been repeatedly introduced into neighboring (e.g., Vietnam) and distant (e.g., Indonesia) regions, establishing ‘colonies’ of H5N1 virus throughout Asia that directly exacerbate the pandemic threat,” the researchers wrote. They concluded that addressing the “pandemic threat requires that the source of the virus in southern China be contained.”

  Chinese initiatives to tackle the disease may have only fueled its spread and honed its lethality. Just da
ys after the government first disclosed in January 2004 that it had detected the disease, New Scientist reported that Chinese poultry producers had been vaccinating their flocks against it for years. But the vaccination campaign may have been mishandled, obscuring the usual symptoms without eradicating the virus itself. “The intensive vaccination schemes in south China may have allowed the virus to spread widely without being spotted,” the magazine alleged.

  Animal-health experts later told me about an even riskier strategy that China had adopted to suppress the spreading virus years before officials publicly disclosed its presence. Acting with the approval and encouragement of the government, Chinese farmers had tried to douse major outbreaks among chickens with amantadine, an antiviral drug meant for humans. As a result, international researchers concluded that this drug might no longer protect people in case of a flu pandemic. The H5N1 subtype circulating in Vietnam and Thailand had become resistant to the drug, which is one of two types of medication for treating human influenza, though another viral subtype found elsewhere was still sensitive to it.

  China’s use of amantadine violated international livestock regulations. It had long been barred in the United States and many other countries. But veterinarians and executives at Chinese pharmaceutical companies said farmers had been using the drug to contain the virus since the late 1990s. “Amantadine is widely used in the entire country,” confirmed Zhang Libin, head of the veterinary medicine division of Northeast General Pharmaceutical Factory in Shenyang. He added, “Many pharmaceutical factories around China produce amantadine, and farmers can buy it easily in veterinary medicine stores.” Zhang and other animal health experts said the drug was used by small private farms and larger commercial ones. China’s agriculture ministry had approved the production and sale of the drug, and local government veterinary stations instructed Chinese farmers on how to use it by adding it to the chickens’ drinking water—and at times even supplied it.