The Monster at Our Door

Laid low with illness -- while work piles up, undone and unrelenting -- you think, “I really couldn’t have picked a worse time to get sick.”

It’s a common enough expression to pass without anyone ever having then to draw out the implied question: Just when would you schedule your symptoms? Probably not during a vacation....

It’s not like there is ever a good occasion. But arguably the past few days have been the worst time ever to get a flu. Catching up with a friend by phone on Saturday, I learned that he had just spent several days in gastrointestinal hell. The question came up -- half in jest, half in dread -- of whether he’d contracted swine variety.

Asking this was tempting fate. Within 24 hours, I started coughing and aching and in general feeling, as someone put it on "Deadwood," “pounded flatter than hammered shit.” This is not a good state of mind in which to pay attention to the news. It is not reassuring to know that the swine flu symptoms are far more severe than the garden-variety bug. You try to imagine your condition getting exponentially worse, and affecting everyone around you -- and everyone around them.....

So no, you really couldn’t pick a worse time to get sick than right now. On the other hand, this is a pretty fitting moment for healthy readers to track down The Monster at Our Door: The Global Threat of Avian Flu, by Mike Davis, a professor of history at the University of California at Irvine. It was published four years ago by The New Press, in the wake of Severe Acute Respiratory Syndrome (SARS), which spread to dozens of countries from China in late ‘02 and early ‘03.

The disease now threatening to become a pandemic is different. For one thing, it is less virulent -- so far, anyway. And its proximate source was pigs rather than birds.

But Davis’s account of “antigenic drift” -- the mechanism by which flu viruses constantly reshuffle their composition -- applies just as well to the latest developments. A leap across the species barrier results from an incessant and aleatory process of absorbing genetic material from host organisms and reconfiguring it to avoid the host’s defense systems. The current outbreak involves a stew of avian, porcine, and human strands. “Contemporary influenza,” writes Davis, “like a postmodern novel, has no single narrative, but rather disparate storylines racing one another to dictate a bloody conclusion."

Until about a dozen years ago, the flu virus circulating among pigs “exhibited extraordinary genetic stability,” writes Davis. But in 1997, some hogs on a “megafarm” in North Carolina came down with a form of human flu. It began rejiggering itself with genetic material from avian forms of the flu, then spread very rapidly across the whole continent.

Vaccines were created for breeding sows, but that has not kept new strains of the virus from emerging. “What seems to be happening instead,” wrote Davis a few years ago, “is that influenza vaccinations -- like the notorious antibiotics given to steers -- are probably selecting for resistant new viral types. In the absence of any official surveillance system for swine flu, a dangerous reassortant could emerge with little warning.” An expert on infectious diseases quoted by CNN recently noted that avian influenza never quite made the leap to being readily transmitted between human beings: "Swine flu is already a man-to-man disease, which makes it much more difficult to manage, and swine flu appears much more infectious than SARS."

There is more to that plot, however, than perverse viral creativity. Davis shows how extreme poverty and the need for protein in the Third World combine to form an ideal incubator for a global pandemic. In underdeveloped countries, there is a growing market for chicken and pork. The size of flocks and herds grows to meet the demand -- while malnutrition and slum conditions leave people more susceptible to infection.

Writing halfway through the Bush administration, Davis stressed that the public-health infrastructure had been collapsing even as money poured into preparations to deal with the bioterrorism capabilities of Iraq’s nonexistent weapons of mass destruction. The ability to cope with a pandemic was compromised: “Except for those lucky few -- mainly doctors and soldiers -- who might receive prophylactic treatment with Tamiflu, the Bush administration had left most Americans as vulnerable to the onslaught of a new flu pandemic as their grandparents or great-grandparents had been in 1918.”

The World Health Organization began stockpiling Tamiflu in 2006, with half of its reserve of five million doses now stored in the United States, according to a recent New York Times article. The report stressed that swine flu is driving up the value of the manufacturer’s stocks -- in case you wondered where the next bubble would be.

But don't expect to see comparable growth in the development of vaccines. As Davis wrote four years ago, “Worldwide sales for all vaccines produced less revenue than Pfizer’s income from a single anticholesterol medication. ... The giants prefer to invest in marketing rather than research, in rebranded old products rather than new ones, and in treatment rather than prevention; in fact, they currently spend 27 percent of their revenue on marketing and only 11 percent on research.”

The spread of SARS was contained six years ago -- a good thing, of course, but also a boon to the spirit of public complacency, which seems as tireless as the flu virus in finding ways to reassert itself.

And to be candid, I am not immune. A friend urged me to read The Monster at Our Door not long after it appeared. It sat on the shelf until a few days ago.

Now the book seems less topical than prophetic -- particularly when Davis draws out the social consequences of his argument about the threat of worldwide pandemics. If the market can’t be trusted to develop vaccines and affordable medications, he writes, “then governments and non-profits should take responsibility for their manufacture and distribution. The survival of the poor must at all times be accounted a higher priority than the profits of Big Pharma. Likewise, the creation of a truly global public-health infrastructure has become a project of literally life-or-death urgency for the rich countries as well as the poor.”

There is an alternative to this scenario, of course. The word "disaster" barely covers it.

MORE: Mike Davis discusses the swine flu outbreak in an article for The Guardian. He also appeared recently on the radio program Beneath the Surface, hosted by Suzi Weissman, professor of politics at St. Mary's College of California, available as a podcast here.