The Fatal Strain Read online

  As Supari escorted them from her office, they were unexpectedly confronted by a pack of reporters. She hadn’t bothered to tell her guests she’d invited the media. It felt like an ambush, and two things immediately became clear: They would miss their flight. And there was now little hope of keeping the dispute from boiling over into a heavily publicized political row that could sabotage global cooperation between rich and poor.

  Heymann struck a diplomatic note for reporters, telling them, “Indonesia’s leadership alerted the international community to the needs of developing countries to benefit from sharing virus samples, including access to quality pandemic vaccines at affordable prices.” He said he hoped Indonesia would soon resume sending its specimens to WHO.

  Supari turned and glared at him. “Without the new regulations,” she said, “until our last drop of blood, the answer is still no, no, no!”

  It was time for Margaret Chan as director general to weigh in. She could speak with unquestioned authority for WHO and, by virtue of her position, demonstrate to Supari that she was being accorded all due respect. Chan, moreover, could connect with Supari as an Asian woman. But if Supari wanted to rumble, Chan was an adroit inside fighter well seasoned by Hong Kong’s contentious politics.

  At the end of February 2007, the women spoke by telephone. The conversation seemed to end in agreement, with Supari pledging to begin sharing samples. But within hours, they were disputing what they’d agreed to. Supari told the press that Chan had acceded to demands that specimens be used only to monitor the evolution of the virus and not for making commercial vaccines. WHO officials adamantly denied the account. No samples were sent.

  A month later, Chan made an unscheduled detour from Singapore to pursue the issue with President Yudhoyono himself at the Istana Negara palace in Jakarta. The Indonesian leader stressed that international drug companies had to make affordable, high-quality vaccines available to developing countries. Chan agreed, vowing to do what she could. Afterward, Supari, who had attended the talks, came out and announced the disagreement was essentially resolved. “We will resume the sending of virus samples for the sake of global interests,” she told reporters. “The delivery will take place this year, within two months from now at the latest.” Again, it didn’t happen.

  And so it continued over the months, with each side accusing the other of bad faith. One grueling negotiating session followed the next, often grinding far into the night and deep into the fine print of international law. In public Chan would at times express sympathy for Indonesia. “I believe the developing countries are right to ask us to address the issue of equitable access now,” she told a meeting of drug industry executives and laboratory directors. “To date, developing countries have suffered the most from this virus.” But in private, she was increasingly exasperated. Sometimes she let it show. “If you do not share the virus with us, I want to be absolutely honest with you, I will fail you,” Chan warned ominously during a speech at the annual meeting of WHO member states in May 2007. She didn’t name Indonesia, but she didn’t have to. “I will fail you because you are tying my hands. You are muffling my ears. You are blinding my eyes.”

  The prospect of a flu pandemic had deepened the fissure between rich and poor, which in turn was subverting international efforts to head off the coming plague. Poverty had always hamstrung the fight against disease, leaving humanity vulnerable to epidemics that arise in the developing world. The emergence of AIDS from Africa was but one tragic example. But now the world was also at risk because Indonesia had realized that viruses were a resource potentially more prized than oil and could be used to press its claims against the wealthy. The challenge represented such a threat to global health that some veteran observers suggested the UN Security Council might ultimately be asked to break the impasse.

  When the two women met next, in November 2007, the Indonesian minister was coming off her impassioned speech in Geneva’s Palais des Nations. The jet lag and drama were taking their toll. “I was exhausted,” she recounted. But at the moment, it was Chan she pitied. “I knew I made her feel uneasy,” Supari later said. “My move had made her tremendously busy.”

  Supari steeled herself for their private encounter, telling herself to be strong. The two women hugged tightly. Then they started in, speaking in little more than whispers.

  Chan urged the minister to trust her.

  She did, Supari answered. “But I don’t trust the WHO system.”

  Chan appealed for understanding, explaining that she and Heymann were trying to transform the antiquated system they’d inherited. She needed Supari’s help to do it.

  Supari was struck by Chan’s apparent good will. But the minister refused to bow. “I tell you once again, Madame Chan, my trust in the WHO will resume only if they materialize a new mechanism which is equitable and transparent. We, the Third World, have long been suffering from the inequity, Madame Chan. It is time to change.” Supari felt compassion for Chan, an Asian sister who she believed had been forced to do the bidding of rich, powerful countries like the United States. “She was a brave warrior, like me, actually,” Supari thought. “But she had to give up her principles, her conscience, to keep her position in the WHO.”

  The minister apologized, repeating that Indonesia would not compromise on its demands.

  “I need a total and fundamental transformation, Madame Chan. And I will continue to speak about this all over the world,” she continued. “I am your friend and I do not deliberately put you into this difficult position. However, the bigger concern of humanity made me do this. I am very sorry, Madame Chan.”

  The dispute metastasized much as senior WHO officials had feared. The distrust engendered by the clash over virus sample sharing and associated benefits infected other facets of the effort to contain bird flu. Moreover, during 2008 and on into 2009, Indonesia’s grievance grew into a crippling distraction. Jakarta continued to press its campaign on behalf of the world’s underprivileged while largely ignoring a virus that was assiduously putting down ever deeper roots across the Indonesian archipelago. Other governments were entangled in the diplomatic quarrel with Indonesia while frittering away years crucial for their own pandemic preparations.

  As the negotiations dragged on, the United States became Indonesia’s main interlocutor. In their respective capitals, the thinking was that if two governments that were so far apart on the issue could find a resolution, everyone else would agree. But other countries, such as Brazil, India, and Thailand, were now starting to agitate for sovereign control over their viruses, suggesting that a deal with Indonesia alone would no longer settle the matter. At the same time, the disagreement between Washington and Jakarta was becoming ever more shrill. Then Supari released her book.

  In early 2008 she published It’s Time for the World to Change: In the Spirit of Dignity, Equity, and Transparency, Divine Hand Behind Avian Influenza. Drawn from her diary, the book was a blistering critique of the industrialized world and WHO’s global system for virus sharing. The most sensational attack was saved for the United States: her claim in the first chapter that the U.S. government could use bird flu samples to fashion weapons of mass destruction. Her evidence was that genetic data from some virus samples was stored in a database at Los Alamos National Laboratory, a U.S. government lab that conducts advanced research on such diverse subjects as national security, climate change, traffic management, and disease dynamics.

  “It was the same laboratory that designed the atomic bomb to destroy Hiroshima in 1945,” Supari wrote. “It is likely that they utilize the same facility to research and develop chemical weapons. What a terrifying fact! The DNA sequence data had been the privilege for the scientists in Los Alamos. Whether they used it to make vaccine or develop chemical weapon would depend on the need and the interest of the U.S. government.”

  The notion that the United States would weaponize bird flu is ludicrous to most Americans. “I think it’s the nuttiest idea I ever heard,” quipped U.S. Defense Secretary Robert Ga
tes. But in developing countries, some were inclined to believe the worst, and in some quarters of Jakarta, Supari’s book got a rapturous reception.

  The dispute over virus sharing also spilled over into negotiations over the status of the NAMRU lab. The U.S. and Indonesian governments, which were quietly discussing a new agreement to authorize its activities, had been hung up over the finite question of how many U.S. personnel at the lab would be accorded diplomatic immunity. Full of fury, Supari abruptly announced in 2008 that it was time to expel the lab altogether. “NAMRU-2’s presence is of no use to us,” she averred in June of that year. “In fact, its operations are an encroachment on our country’s sovereignty.” She urged the Indonesian parliament to close it down. One lawmaker called for a probe into reports circulating among Indonesians that the navy lab was a front for spying. The fate of the most advanced disease lab in Indonesia grew even more uncertain.

  Next Supari disclosed that the government would no longer announce human cases of bird flu on a routine basis as before. Days after she made that declaration in June 2008, she assured me Indonesia would still report the cases to WHO. But no more would the government release details to the public with each new infection. “The families of victims of avian flu have very, very fresh wounds,” she explained, and the practice of announcing cases had been “very insensitive to them.”

  Maybe so. But yet another source of vital intelligence had been choked off. Indonesia had severed the supply of virus samples to the world’s labs. It had shut down the one lab inside the country capable of fully analyzing specimens. And now the government had deprived flu hunters, and Indonesians themselves, of information needed to confront a budding epidemic. Supari promised that all details would be released in time. But time is the most precious commodity when it comes to flu.

  The fracture between haves and have-nots now yawned wide. Even as the novel strain increasingly marked its territory in Indonesia, the world became ever less able to chart its progress.

  CHAPTER TWELVE

  Peril on the Floodplain

  The figures first appeared on the ridgeline. They emerged one after another from behind a bluff in the middle distance, more than a dozen of them. Then, like ants, they started down a dirt track hewn from the lush, sculpted mountains separating Vietnam from China. The descent was steep, the footing treacherous. The slopes above were densely forested. But the trail itself was broad and exposed, the deep brown earth well trampled. As the smugglers drew closer, their stooped forms became visible in the afternoon light. Their backs heaved under the weight of their freight. Soon the cargo came into view. They were hauling bamboo cages crammed with live, bootleg chickens.

  On the paved road below, two young men waited, mounted on a pair of red dirt bikes. They were lookouts. My Vietnamese driver had pulled our car to the side so I could check out the foot traffic coming over the border. Now, as I stood beside the guardrail, staring past a cornfield up into the craggy cliffs, I was the one being checked out. The two sentinels revved their engines and brazenly approached, slowing briefly as they buzzed by. Several dozen yards away, they stopped their bikes. One man produced a two-way radio and barked into it. Though his words were inaudible to my translator and me, within moments the figures on the slopes above began to shift to the edge of the track and melt into the surrounding brush. Yet almost instantly, more traffickers appeared over the ridge from China. Even more were bounding down a second path about a hundred yards to the left. This trail was narrower, largely concealed by banana palms and other trees. These smugglers apparently figured I couldn’t see them and continued their progress undeterred by the alarm.

  I had come to the village of Dong Dang escorted by two provincial officials. Now, with some urgency, they were inviting me to get back in the car. The smugglers were a violent lot, known to set upon outsiders with stones, even guns. In recent weeks, the traffickers had bat tled soldiers dispatched to intercept them. In one case, five troops had been injured and their car destroyed. I quickly understood who had the upper hand. “You can put helicopters up there, really mobilize the army and put all kinds of resources in, and it would still go on,” Jeffrey Gilbert of the UN Food and Agriculture Organization told me after I returned to Hanoi. “It’s like the Ho Chi Minh trail.”

  Every day, despite an import ban, the smugglers were hauling more than a thousand contraband chickens into Lang Son, one of six Vietnamese provinces along the untamed Chinese frontier. In Lang Son alone, the jagged border runs for 150 miles through angular, misty mountains that seem drawn from a stylized Oriental painting. The highest peak, Mau Son, rises nearly 4,500 feet. It also lends its name to the local rice wine, widely sold in unmarked, five-hundred-milliliter plastic bottles for about sixty cents each. My government escorts had knocked back enough shots over lunch that it had taken some of the edge off their anxiety.

  For centuries, extended tribal families straddling the border have navigated highland footpaths to run goods from one side to the other. In recent years these had come to include electronics, DVDs, exotic wildlife, and all sorts of clothes and shoes. The illicit poultry business had turned lucrative in 2004 after Vietnam began slaughtering about 50 million chickens to contain its bird flu epidemic. The resulting shortage of chicken meat, a favorite protein source for the Vietnamese, sent prices soaring on their side of the border. But with the increase in the illegal poultry trade, the traffickers had also unknowingly—and repeatedly—smuggled the virus from its source in southern China into Vietnam, at times introducing altered strains that bedeviled efforts to contain the outbreaks.

  Two months before my visit to Lang Son in July 2006, Vietnamese veterinary officials had disclosed they’d identified the virus in a sample taken there from smuggled chickens during a bust on the border. Two years later, provincial health authorities reported they were discovering H5N1 in nearly a quarter of all the illegally trafficked chickens they were confiscating. Researchers had already uncovered lab evidence implicating cross-border commerce in spreading the disease. In mid-2005 they had isolated a strain of the H5N1 virus in Vietnam that was entirely new to the country—different from the subtype that had burned through farms starting in 2003 and killed dozens of people—but similar to one found months earlier in China’s Guangxi region, just over the mountains from Lang Son. Another study published in 2008 found genetic evidence that the virus may have been introduced from Guangxi to northern Vietnam on “multiple occasions,” most likely by poultry trade.

  An average of 1,500 birds came over the mountains into Long San each day, provincial officials reported. Along the entire Vietnam-China border, the total could run well into the thousands. The syndicates running the smuggling rings were paying local villagers about thirty cents a bird to haul the contraband along mountain trails that could snake for more than ten miles. Some smugglers, especially women and children, could carry only a few birds. But hardy highland men lugged as many as twenty at a time. Their earnings could far outstrip the salaries of animal-health officers, inspectors, and others charged with stemming the commerce.

  Once the smugglers came down from the slopes, they often transferred their haul to motorbikes, which ferried it to local farms serving as transit depots. From there, the chickens were loaded onto trucks for transport, in many cases to the markets of Hanoi, five hours away, and points even farther south. The smugglers were repeatedly seeding new outbreaks, and each outbreak was affording the virus a new chance to ensnare human victims and, even more ominously, mutate. This was how the novel strain continued to press its offensive.

  Do Van Duoc was the director of animal health in Lang Son, a friendly man with full cheeks and silver hair that sat atop his head like a mushroom cap. He explained it would be nearly impossible to stem the smuggling as long as prices on either side of the border were so different. On average, chicken that sold for thirty cents a pound in China was fetching a dollar or more in his country. But that wasn’t the whole explanation. He accused Chinese farmers of unloading chickens from areas
struck by bird flu at bargain-basement prices.

  China’s agriculture ministry confirmed for me that poultry was being illegally transported into Vietnam. An investigation by Guangxi animal-health investigators had discovered three clandestine routes originating in different areas adjacent to Lang Son. But Chinese officials, true to form, denied that any birds coming from their side of the border were infected. Duoc wasn’t buying that. “We have evidence,” he told me. “We’ve tested and we can prove there’s H5N1.”

  The farther influenza goes, the closer it comes to hitting the microbial jackpot. Extent means opportunity, more chances to mutate or swap genes. By 2009 the virus had stricken birds in at least sixty countries and spread to people in fifteen of them.

  The strain made its debut in Europe in October 2004 when customs officers at Brussels airport discovered two infected eagles in a passenger’s hand luggage. A Thai traveler had smuggled them from Bangkok, wrapping the creatures in cotton cloth and shoving them headfirst into a pair of two-foot-long woven bamboo tubes. Then he had tucked these into an athletic bag, left unzipped slightly so the birds could breathe. His delivery had been destined for a Belgian falconer who had paid nearly $1,900 for the pair. They would have arrived unnoticed but for the passenger’s bad luck. He was stopped and searched as part of a random drug check. “We were very, very lucky,” Rene Snacken, the flu chief at Belgium’s Scientific Institute of Public Health, said at the time. “It could have been a bomb for Europe.”