The Fatal Strain Read online

  309 a running dispute with foreign scientists: The account of the NAMRU dispute is based on interviews with Andrew Jeremijenko, other NAMRU staff, and Indonesian health ministry officials.

  309 “difficult to get the damn virus”: Interview with Jeremijenko.

  310 cease all activities: “Circular Regarding the Status of NAMRU-2,” Oct. 25, 2005, signed by Secretary Titie Kabul Adimidjaja, acting head of Badan Litbangkes.

  312 “I never gave permission”: Wahya Dhyatmika and Pramono, “WHO’s Virus?” Tempo, Feb. 20, 2007.

  312 unless they met Supari’s demands: The Indonesian position is best detailed in Endang R. Sedyaningsih et al., “Toward Mutual Trust, Transparency and Equity in Virus Sharing Mechanism: The Avian Influenza Case of Indonesia,” Annals of the Academy of Medicine (Singapore) 37, no. 6 (June 2008): 482-88. Supari was one of the authors on this paper written by Indonesian health ministry officials. The position prevailing in many developing countries, in particular the United States, is well articulated in Richard Holbrooke and Laurie Garrett, “‘Sovereignty’ That Risks Global Health,” Washington Post, Aug. 10, 2008. An Indonesian response to the column by Holbrooke and Garrett is Makarim Wibisono, “The Responsible Virus and Sharing Benefits,” Jakarta Post, Aug. 27, 2008. Wibisono was the Indonesian ambassador to the United Nations in New York and in Geneva.

  313 Her attack was unprecedented: For a discussion of the global health issues raised by Indonesia’s decision to withhold virus samples, see Chan Chee Khoon and Gilles de Wildt, “Developing Countries, Donor Leverage, and Access to Bird Flu Vaccines,” DESA Working Paper no. 41, UN Department of Economic and Social Affairs, June 2007.

  313 viruses were biological resources: On two rival interpretations of international law governing virus samples, see David P. Fidler, “Influenza Virus Samples, International Law, and Global Health Diplomacy,” Emerging Infectious Diseases 14, no. 1 (Jan. 2008): 88-94.

  313 “WHO has become a target”: Personal notes of conversation.

  314 “Indonesia’s leadership alerted”: “RI ‘Will Not Share’ Flu Samples,” Jakarta Post, Feb. 7, 2007. The joint statement issued after the meetings between Supari and Heymann is “Sharing of Avian Influenza Viruses and Pandemic Vaccine Production,” Joint Statement from the Ministry of Health of Indonesia and the World Health Organization, Feb. 16, 2007.

  314 “the answer is still no, no, no”: Wahya Dhyatmika and Pramono, “WHO’s Virus?” Tempo, Feb. 20, 2007.

  314 The Indonesian leader stressed: “RI Stresses Need for Production of Affordable Bird Flu Vaccines,” Antara news agency, Apr. 4, 2007.

  314 “We will resume the sending of virus samples”: “Indonesia Confirms Readiness to Send Bird Flu Virus to WHO,” Xinhua, April 4, 2007.

  314 “I believe the developing countries are right”: Margaret Chan, Opening remarks at the Meeting on Options for Increasing the Access of Developing Countries to H5N1 and other Potential Pandemic Vaccines, Geneva, April 25, 2007.

  315 “I will fail you”: Laura MacInnis, “WHO’s Chan Pledges Fair Access to Bird Flu Vaccines,” Reuters, May 17, 2007.

  315 suggested the UN Security Council: Laurie Garrett and David P. Fidler, “Sharing H5N1 Viruses to Stop a Global Influenza Pandemic,” PLoS Medicine 4, no. 11 (Nov. 2007): e330, 1712-14.

  315 “I was exhausted”: Siti Fadilah Supari, It’s Time for the World to Change: In the Spirit of Dignity, Equity, and Transparency, Divine Hand Behind Avian Influenza (Jakarta: Sulaksana Watinsa Indonesia, 2008), 129.

  315 their private encounter: Accounts of the meeting were provided by several Indonesian and WHO officials. Supari’s comments are drawn from Supari, It’s Time for the World to Change, 129-31.

  317 weapons of mass destruction: Supari, It’s Time for the World to Change, 19.

  317 “the nuttiest idea I ever heard”: “Remarks by Defense Secretary Robert Gates to the Indonesian Council on World Affairs, Jakarta, Indonesia,” Federal News Service, Feb. 25, 2008.

  317 a rapturous reception: See, for example, “Alarm as Indonesia Thumbs Nose at West over Bird Flu,” Agence France Presse, Sept. 7, 2008.

  317 “of no use to us”: “RI Seeking Equality in Cooperation with NAMRU-2: Minister,” Antara news agency, June 26, 2008.

  317 One lawmaker called for a probe: “News Focus: Call for Closure of NAMRU- 2 in Indonesia Increasing,” Antara news agency, June 27, 2008.

  Chapter Twelve: Peril on the Floodplain

  321 a quarter of all the illegally trafficked chickens: “Illegal Chickens in Northern Area Test Positive for Bird Flu,” Viet Nam News, Mar. 22, 2008.

  321 uncovered lab evidence: H. Chen et al., “Establishment of Multiple Sublineages of H5N1 Influenza Virus in Asia: Implications for Pandemic Control,” PNAS 103, no. 8 (Feb. 21, 2006): 2845-50.

  321 on “multiple occasions”: Tien Dung Nguyen et al., “Multiple Sublineages of Influenza A Virus (H5N1), Vietnam, 2005-2007,” Emerging Infectious Diseases 14, no. 4 (Apr. 2008): 632-36.

  322 The strain made its debut: For more discussion, see Carl Suetens et al., “Eagles Testing Positive for H5N1 Imported Illegally into Europe from Thailand,” Eurosurveillance 8, no. 44 (Oct. 28, 2004); and Debora MacKenzie, “Europe Has Close Call with Deadly Bird Flu,” New Scientist, Oct. 26, 2004.

  322 “very, very lucky”: MacKenzie, “Europe Has Close Call.”

  322 exploded out of East Asia: See overviews in “Epidemiology of WHO-Confirmed Human Cases of Avian Influenza A(H5N1) Infection,” Weekly Epidemiological Record 81, No. 26 (June 30, 2006): 249-57; and “Update: WHO-Confirmed Human Cases of Avian Influenza A(H5N1) Infection,” Weekly Epidemiological Record 82, No. 6 (Feb. 9, 2007): 41-47.

  322 each time researchers checked: See, for example, B. Pattnaik et al., “Phylogenetic Analysis Revealed Genetic Similarity of the H5N1 Avian Influenza Viruses Isolated from HPAI Outbreaks in Chickens in Maharashtra, India, with Those Isolated from Swan in Italy and Iran in 2006,” Current Science 91, no. 1 (July 10, 2006): 77-81; M. F. Ducatez et al., “Multiple Introductions of H5N1 in Nigeria,” Nature 442 (July 6, 2006): 37; and Siegfried Weber et al., “Molecular Analysis of Highly Pathogenic Avian Influenza Virus of Subtype H5N1 Isolated from Wild Birds and Mammals in Northern Germany,” Journal of General Virology 88 (2007): 554-58.

  323 fallen sick in Turkey: For details, see Ahmet Faik Oner et al., “Avian Influenza A (H5N1) Infection in Eastern Turkey in 2006,” NEJM 355, no. 21 (Nov. 23, 2006): 2179-85.

  323 the famed bird market: Elaine Sciolino, “In the Land of Coq au Vin, Soul Searching over Bird Flu,” New York Times, Feb. 24, 2006.

  323 the ravens at the Tower of London: Mary Jordan, “Bird Flu Fears Coop Up London’s Famous Ravens,” Washington Post, Feb. 22, 2006.

  323 dumped in the Nile River: Daniel Williams, “Spooked by Bird Flu, Egyptians Horde [sic] Water,” Washington Post, Feb. 26, 2006.

  323 “While it was originally suspected”: “Nigeria; Bird Flu: FG Links Source to Illegal Importation of Chicks,” Africa News, Mar. 3, 2006.

  323 introduced to the country three separate times: M. F. Ducatez et al., “Multiple Introductions of H5N1 in Nigeria,” Nature 442 (July 6, 2006): 37.

  323 most likely along internal trade routes: “FAO Urges Nigeria to Increase Bird Flu Control Measures,” FAO news release, Feb. 20, 2007. In most of the affected Nigerian states, the flu strains continued to evolve into new forms. See Isabella Monne et al., “Reassortant Avian Influenza Virus (H5N1) in Poultry, Nigeria, 2007,” Emerging Infectious Diseases 14, No. 4 (Apr. 2008): 637-40.

  324 Are wild birds the culprit: The evidence implicating wild birds has been mounting. The following is a sampling: H. Chen et al., “H5N1 Virus Outbreak in Migratory Waterfowl,” Nature 436 (July 14, 2005): 191-92; Dennis Normile, “Are Wild Birds to Blame?” Science 310, no. 5747 (Oct. 21, 2005): 426-28; Robert G. Webster et al., “H5N1 Outbreaks and Enzootic Influenza,” Emerging Infectious Diseases 12, no. 1 (Jan. 2006): 3-8; H. Chen et al., “Establishment of Multiple Sublineages of H5N
1 Influenza Virus in Asia: Implications for Pandemic Control,” PNAS 103, no. 8 (Feb. 21, 2006): 2845-50; Dennis Normile, “Evidence Points to Migratory Birds in H5N1 Spread,” Science 311, no. 5765 (Mar. 3, 2006): 1225; Bjorn Olsen et al., “Global Patterns of Influenza A Virus in Wild Birds,” Science 312, no. 5772 (Apr. 21, 2006): 384-88; Marius Gilbert et al., “Anatidae Migration in the Western Palearctic and the Spread of Highly Pathogenic Avian Influenza Virus H5N1 Virus,” Emerging Infectious Diseases 12, no. 11 (Nov. 2006): 1650-56; Raja Sengupta et al., “Ecoregional Dominance in Spatial Distribution of Avian Influenza (H5N1) Outbreaks,” Emerging Infectious Diseases 13, no. 8 (Aug. 2007): 1269-70; Juthatip Kwawcharoen et al., “Wild Ducks as Long-Distance Vectors of Highly Pathogenic Avian Influenza Virus (H5N1),” Emerging Infectious Diseases 14, no. 4 (Apr. 2008): 600-606; Donata Kalthoff et al., “Pathogenicity of Highly Pathogenic Avian Influenza Virus (H5N1) in Adult Mute Swans,” Emerging Infectious Diseases 14, no. 8 (Aug. 2008): 1267-70; and A. Townsend Peterson et al., “Influenza A Virus Infections in Land Birds, People’s Republic of China,” Emerging Infectious Diseases 14, no. 10 (Oct. 2008): 1644-46.

  324 Or is it trade in poultry: There is also a body of evidence indicating that the role of wild birds in spreading the virus is less significant than that of commerce. See, for example, D. S. Melville and Kennedy F. Shortridge, “Influenza: Time to Come to Grips with the Avian Dimension,” Lancet Infectious Diseases 4, no. 5 (May 2004): 261-62; Chris J. Feare, “The Role of Wild Birds in the Spread of HPAI H5N1,” Avian Diseases 51, no. S1 (2007): 440-47; M. Gauthier-Clerc, C. Lebarbenchon, and F. Thomas, “Recent Expansion of Highly Pathogenic Avian Influenza H5N1: A Critical Review,” Ibis 149 (2007): 202-14; Thomas P. Weber and Nikolaos I. Stilianakis, “Ecological Immunology of Avian Influenza (H5N1) in Migratory Birds,” Emerging Infectious Diseases 13, no. 8 (Aug. 2007): 1139-43; and “Don’t Blame Wild Birds for H5N1 Spread—Expert,” Reuters, Jan. 23, 2008.

  324 both these opportunities: See, for example, Joseph Domenech et al., “Trends and Dynamics of HPAI—Epidemiological and Animal Health Risks,” Background Paper at the Technical Meeting on Highly Pathogenic Avian Influenza and Human H5N1 Infection, Rome, June 27-29, 2007; and A. Marm Kilpatrick et al., “Predicting the Global Spread of H5N1 Avian Influenza,” PNAS 103, no. 51 (Dec. 19, 2006): 19368-73. For a wide-ranging examination of the role wild birds play in the spread of the virus, see the presentations at the FAO-OIE International Scientific Conference on Avian Influenza and Wild Birds, Rome, May 30-31, 2006.

  324 “far from over”: “New Avian Influenza Flare-ups,” FAO news release, Jan. 24, 2008.

  324 “finally cause a human influenza pandemic”: “Bird Flu Situation in Indonesia Critical,” FAO news release, Mar. 18, 2008.

  325 actively undergoing genetic changes: On the endemicity and continuing evolution of the virus in Indonesia, see Tommy Tsan-Yuk Lam et al., “Evolutionary and Transmission Dynamics of Reassortant H5N1 Influenza Virus in Indonesia,” PLoS Pathogens 4, no. 8 (Aug. 2008): e1000130.

  325 only a few localities were completely capable: Minister of Agriculture and Rural Development Cao Duc Phat, quoted in “Vietnam Preventive Measures Are Not Enough,” Thai Press Reports, Mar. 24, 2008.

  325 poultry vaccination program was flagging: Deputy Minister of Agriculture and Rural Development Bui Ba Bong, quoted in “Half-Done Vaccination Poses High Bird-Flu Risk,” Saigon Times Daily, Mar. 13, 2008.

  325 would be unable to keep paying: See, for example, Jan Slingenbergh, senior officer of the FAO’s Animal Production and Health Service in “H5N1 HPAI Pathogenicity Rising, but Situation in Check,” FAOAIDE news, Situation Update 55, July 25, 2008.

  325 were both becoming more lethal: Mary Pantin-Jackwood of the U.S. Department of Agriculture and colleagues from the Viet Nam National Centre for Veterinary Diagnosis in “H5N1 HPAI Pathogenicity Rising.” FAOAIDE news, Situation Update 55, July 25, 2008.

  325 “We still have a very serious situation”: “China Needs Better Bird Flu Surveillance Experts,” Reuters, Feb. 18, 2009.

  326 the Thai government launched: Supamit Chunsuttiwat, “Response to Avian Influenza and Preparedness for Pandemic Influenza: Thailand’s Experience,” Respirology 13, suppl. 1 (2008): S36-S40; and Kumnuan Ungchusak, “What Happened When the H5N1 Virus Visited Thailand,” lecture at the Asia Medical Forum, Lancet 2006, in Singapore, May 4, 2006.

  326 continued to detect the virus: Alongkorn Amonsin et al., “Influenza Virus (H5N1) in Live Bird Markets and Food Markets, Thailand,” Emerging Infectious Diseases 14, no. 11 (Nov. 2008): 1739-42.

  326 “Some commercial producers”: E-mail from Juan Lubroth, Aug. 11, 2006, citing information from the U.S. Agency for International Development.

  326 a baffling transplant: “New Bird Flu Strain Detected in Nigeria,” FAO news release, Aug. 11, 2008. For more discussion see Alice Fusaro et al., “Introduction into Nigeria of a Distinct Genotype,” Emerging Infectious Diseases, 15, no. 3 (March 2009): 445-47.

  326 “Somewhat surprising”: “Bird Flu Returns to Germany,” Deutsche Welle, Oct. 9, 2008.

  326 “particularly worrying”: “New Avian Influenza Flare-ups,” FAO news release, Jan. 24, 2008.

  326 “a new chapter in the evolution”: “Bird Flu Virus in Europe—a Hidden Danger,” FAO news release, Oct. 25, 2007.

  327 “We must never forget”: “Concern Over Flu Pandemic Justified,” Address to the Sixty-second World Health Assembly, Geneva, Switzerland, May 18, 2009.

  327 “Do not drop the ball”: “World Is Better Prepared for Influenza Pandemic,” Address to the ASEAN+3 Health Ministers’ Special Meeting on Influenza A (H1N1), Bangkok, Thailand, via teleconference, May 8, 2009.

  327 For each one of those fatalities: Juan Lubroth, a senior FAO official, estimated in June 2008 that 240 million birds had died or been slaughtered. Julia Zappei, “Health Experts: Global Fight Against Bird Flu Remains Weak, Can Worsen Global Food Crisis,” Associated Press, June 20, 2008.

  327 reducing the circulation of these viruses in animals: The likelihood of altogether eliminating the H5N1 virus is at best slim. Animal-health expert Les Sims, who first confronted this strain in Hong Kong in 1997 and has followed it since, writes, “The prospects of global eradication of H5N1 HPAI viruses circulating in Asia, Africa and Europe within the next 10 to 20 years is poor. Unless the viruses change or there are major shifts in the way poultry are reared, arising from accelerated rural development, they may never be eradicated.” Les D. Sims, “Lessons Learned from Asian H5N1 Outbreak Control,” Avian Diseases 51, no. S1 (2007): 174-81.

  328 relations were strained: See, for example, the discussion over sample sharing between the agencies in Declan Butler, “‘Refusal to Share’ Leaves Agency Struggling to Monitor Bird Flu,” Nature 435 (May 12, 2005): 131.

  328 cash-strapped veterinary counterparts: Senior officials at the World Organization for Animal Health, known by its French initials OIE, offered a similar critique: “Although financial resources have been targeted to the human health rather than the animal health field under the pressure of a possible human pandemic, the main message . . . remains that the viral load in the environment and therewith the risk of a pandemic should be diminished by eradication of the virus at its animal source.” Christianne Bruschke, Alex Thiermann, and Bernard Vallat, “Implementing Appropriate OIE/FAO Prevention Measures in Different Country Contexts,” Background Paper at the Technical Meeting on Highly Pathogenic Avian Influenza and Human H5N1 Infection, Rome, June 27-29, 2007.

  330 “The present situation is unique”: “Sharing of Influenza Viruses and Access to Vaccines and Other Benefits,” Opening Remarks at the Intergovernmental Meeting on Pandemic Influenza Preparedness, Geneva, Nov. 20, 2007.

  330 Researchers initially concluded: Christophe Fraser et al., “Pandemic Potential of a Strain of Influenza A (H1N1): Early Findings,” Science, published online before print May 11, 2009, doi: 10.1126/science.1176062.

  330 no greater than that for ordinary flu bugs: Dr. Da
niel Jernigan, deputy director of the CDC Influenza Division, at a CDC telebriefing on the investigation of human cases of H1N1 flu, May 20, 2009.

  330 planning for hospitals and public health systems remains wanting: See, for example, Christopher Lee, “U.S. flu Outbreak Plan Criticized,” Washington Post, Feb. 2, 2008.

  Index

  acute respiratory distress syndrome (ARDS)

  Adam Malik General Hospital (Indonesia)

  adenovirus

  adjuvants

  Africa, bird flu transmission to

  age, influenza mortality curve

  Alert and Response Operations, Dr. Ryan, role of

  amantadine, illegal use, China

  Anderson, Dr. Roy

  animals

  and mutation of flu virus

  SARS, origin of

  zoonotic diseases

  antibody tests

  antigenic drift

  antigenic shift

  Apichai Ratanawaraha

  Ap Lei Chau cases

  Apuchase, Louise

  Asia, as influenza epicenter

  Asian flu (1957)

  autopsy, research needs

  Azerbaijan outbreak

  Bach Mai Hospital (Vietnam)

  backyard birds, infection to

  Bang-on Benphat

  Bangun, Heni Boru

  Bangun, Suherman

  bataks

  Baxter International

  Begu Ganjang (spirit)

  bird flu

  Asian outbreaks. See Cambodia; China; H5N1; Hong Kong; Indonesia; Thailand; Vietnam

  fatalities, prediction of

  H5N1

  H7s

  origin and spread of. See bird flu transmission

  pandemic risk. See influenza pandemics

  preventing epidemic. See epidemiologists; prevention

  compared to SARS

  signs of. See diagnosis; symptoms

  compared to Spanish flu

  timeline

  victims, age of