(Weekly Organ of the Communist Party of India (Marxist)
June 7, 2009
Swine Flu – Giving
The Pigs A Bad Name
SWINE flu scare may have receded from the public eye, but the fear of a pandemic still remains. Along with the threat of a pandemic, the issues that have come up include the old one of the implication of patent monopoly for vital life saving drugs and whether the industrial mode of producing meat/poultry products is giving rise to threat of new diseases.
First, let us clear some misconceptions that exist on the swine flu threat. Unlike avian flu, which was largely transmission from birds to birds or birds to human, swine flu has been a case of human to human transmission. The name swine flu is therefore quite misleading. Unlike the bird flu case, there is no risk of catching the disease from pigs. Fortunately, this flu virus is not as virulent as the avian flu virus, where death rates of the infected population is much higher.
If the pigs are not the cause of this outbreak, why call this virus swine flu? This is because in this strain of the virus is largely a swine flu virus in which genetic material of bird flu as well as human flu is mixed,. However, whether the mixing of the genetic material took place within a swine population or within a human population is still an open question.
ACCORDING TO WHO
To most people, there is quite a hazy notion of what WHO calls pandemic. Why is it that there is so much concern over a flu virus, which has infected about 19,000 persons and killed about a hundred persons (as on June 2, 2009), when typhoid cases in just Delhi alone would be well beyond that?
WHO pandemic alert
has 6 levels. At level 6, WHO declares that a global pandemic has
the moment, the alert level is just short of that – it is at level 5,
means that a pandemic is imminent. At a press conference on June 2,
Fukuda, WHO's assistant director-general, characterised
The definition of pandemic in WHO dictionary does not mean what you or I would understand –– large-scale death and devastation from a disease. According to WHO Guidelines, for a pandemic to start, three conditions must be met:
· Emergence of a disease new to a population.
· Agents infect humans, causing serious illness.
· Agents spread easily and sustainably among humans.
This explains why existing diseases such as TB or typhoid –– even if they kill in far greater numbers are not counted in pandemic alerts: it does not count as emergence of a disease new to a population. A level 5 alert, the current level of WHO pandemic alert, indicates that the disease is now a community level disease in two countries in a region (world is divided into six regions by WHO). The level 6 alert – the last stage in WHO scale of 6-level alerts – is when it spreads to another WHO region.
Recent discussions have focussed on the fact that the definition of the pandemic and the alert levels do not correspond to the virulence of the disease. A highly virulent disease or a fairly benign infection would be treated the same way by WHO, irrespective of the risks. WHO is now discussing how to address this issue and incorporate severity in its different levels of alerts.
many, the swine flu outbreak may appear a minor blip in a disease
For most of the third world, a death toll of about a hundred hardly
Flu is a dreaded word in the developed world because the last really large scale pandemic it saw was Spanish flu in 1918. It infected an estimated 525 million and killed 20 to 50 million people (some estimates go up to 100 million), a death toll of the same order as that recorded in the full four years of the First World War. So every time there is the threat of an influenza epidemic, the Spanish flu rears its ugly head. Unlike other common infectious diseases such as typhoid and TB, flu is still a killer in the developed countries. Most other infectious diseases are killers only in the third world. The fear in the west of flu epidemics is that this is one disease that affects them as well.
What are the chances of the swine flu becoming a global pandemic of the 1918 kind? As it appears, the virulence of this version of flu is way below either the 1918 variety or the avian flu. The avian flu, which fortunately did not have human to human transmission, is the most virulent with death rates of above 60 per cent for those infected. The 1918 flu was way above the normal seasonal mortality rates –– it killed 2-5 per cent of the people affected. The seasonal flu mortality rates are less than 0.1 per cent. This variety seems closer to the seasonal mortality rates and not in the same league as the other great flu killer viruses. Of course, this outbreak has come at a time that the flu season is almost over in the northern hemisphere, where summer generally stops all flu infections. It may smoulder in the population till when the flu season starts again –– somewhere in September. Till then, the infection could continue in the southern hemisphere. Looking at the infection and death figures, it is unlikely to be a 1918 killer and not even on the scale of the 1968 outbreak, which killed 1 million worldwide.
ARE FACTORY FARMS
CREATING NEW DISEASE?
origin of this
outbreak has already become quite controversial. It was supposed to
originated near an American-owned major pig farm in
The reason it is called swine flu is because its genetic composition shows that it is a particular strain of swine flu that has picked up genetic material from both human and bird flu varieties. However, the mixing of the genetic material could have occurred in either a pig, bird or a human population. Given its human to human transmission, it is as likely that the mixing of the flu virus took place within a person who caught a second infection from a pig while already infected by another strain of human flu virus. Human beings are likely incubators of this variety as the much maligned pigs.
why blame the meat
industry for such outbreaks? The meat industry is notorious for unsafe
unhygienic practices. Obviously, safety is easily sacrificed to the
profits in any capitalist enterprise, the meat or food industry being
exception. Upton Sinclair's famous expose of the meat packing industry
“The Jungle” not only created a furore but led to the
the Food and Drug Administration (FDA) in the
For a number of radicals today, the solution of society's problems lie not in transforming the capitalist system but moving away from industrial mode of production. In this schema, what matters is not who owns the means of production but in the mode of producing goods itself. So painting industrial mode of food production as the villain is to forget the capitalist and suggest that going back to a foraging and farm mode of rearing life stock would solve all problems. It is not very different in its outlook from arguing against industrialisation and pleading for a largely agrarian society.
industrial mode of meat production – factory farms for pigs and
chickens – for
such new diseases, what we are
forgetting is that in any urban society, the human beings provide
same conditions of incubating new diseases. And let us not romanticise
older livestock breeding either. Those rearing pigs, goats and chickens
farms always lived closely with their animals, providing the same
disease jumping species. This was one of the problems in
Interestingly, disease and human settlements share a common history. When human beings changed from hunter gatherers to settled agriculture, disease became much more widespread. A recent study of skeleton and bone/teeth data from 11,000 individuals over the last 3000 years shows that health actually deteriorated with settled agriculture and later with urbanisation (Civilisation’s Cost: The Decline and Fall of Human Health, Science, May 8, 2009). While health declined, what increased dramatically is of course density of population: birth and reproduction rates obviously increased, while death rates fell. But those who survived in the hunter gatherer stage were healthier than their counterparts in agrarian and urban societies.
Of course industrial mode of food production has serious health hazards associated with it. Just as various industries pose serious risks if not carefully monitored for safety. The question is can we have urban societies without industrial mode of production? If we want to go back to an agrarian order, what do we do with the surplus population? And will we get back all the way and give up agriculture also in order to escape disease? The answer lies in not running away from the problem of industrialisation to a mythical and idyllic past but how to overthrow capitalism; or regulate it till we transform it.
in its article on swine flu also talks about the “strange ecology” of
mode of meat production that is giving rise to disease. For them, the
the rising consumption of meat and poultry products in
DISEASE, LIFE SAVING
If we accept that there could be a dangerous flu epidemic in the near future, what are the steps we need to take? The two issues are a) the ability to provide medicine b) the ability to provide vaccine to the population at risk.
issue of providing
medicine comes up immediately against patent monopoly. Roche has a
monopoly on the most common anti flu drug –– oseltamivir (called by its
name tamiflu), except in
if oseltamivir is
indeed a cure, then the issue is how should such patents be respected
there is a global threat of a pandemic? This brings up the issue of
Intellectual Property Rights and the current TRIPS regime. However,
enough provision in it for countries to break the patent monopoly in
of a pandemic and award compulsory licenses for oseltamivir. The
that they are too scared to buck the big pharmaceutical boys and the
governments that stand behind big pharma. Even
The other anti-flu drug is zanamivir (trade name Relenza). Unfortunately, it requires an inhaler to deliver the drug and is therefore not as easy to take as oseltamivir.
The key issue is therefore how to address the global patent monopoly of Roche. Cipla has indicated that it is willing to supply oseltamivir to other countries. However legal action by Roche could still remain a problem if countries do not issue a compulsory license and use this to buy oseltamivir from Cipla. For Cipla to ramp up production quickly to meet global demands may not be easy at short notice – so the patent scenario needs to be sorted out now.
However, oseltamivir is not a magic bullet against flu. At best it will help serious cases somewhat and not effect an immediate cure for all flu victims. So prevention through vaccination is still the best line of defence against a flu pandemic.
Vaccines for the current flu strain may take some months to make. Producing it in adequate quantities for a major outbreak demands that vaccine production be ramped up drastically from the current capacity of 400 million doses annually. This is difficult to do quickly. Though WHO is meeting vaccine manufacturers and trying to generate the basic seed stock for the vaccine, the key question is should production of seasonal flu vaccine be diverted to production of swine flu variant. Since nobody has a reliable crystal ball from predicting the spread of swine flue, a choice between the two could rebound later.
is unfortunate that the
On the whole, the swine flu threat currently does not appear to pose a major threat of a pandemic killing millions. Unless it changes from now to September and appears in a far more virulent form. However, the swine flu issue does bring out the complexity in fighting disease today. It is not science but the mode of production and its juridical representation – Intellectual Property Rights – that stand in the way of combating disease. Science is the easy part, changing society is the far more difficult one.