Dense Slums A Tinderbox For Flu Firestorm

by Mike Davis

Mass death soon may be coming to a neighborhood near you, and the Department of Homeland Security will be helpless to prevent it. The terrorist in this case will be a mutant offspring of influenza A subtype H5N1: the explosively spreading avian virus that the World Health Organization (WHO) worries will be the progenitor of a deadly global plague.

The most lethal massacre in human history was the 1918-19 influenza pandemic that culled more than 2 percent of humanity (40-50 million people) in a single winter. Although never proven, many researchers believe that the pandemic was caused by a bird virus that exchanged genes with a human strain and thus acquired the ability to spread easily from person to person. Humans have little immune protection against such species' jumps.

The biological reservoir of influenza is the mixed agriculture of southern China where wild and domestic fowl, pigs (another influenza vector) and humans are brought into intense ecological contact in farms and markets.

Breakneck urbanization, a soaring demand for poultry and pork, and what Science magazine recently characterized as "denser concentrations of larger poultry farms without appropriate biological safeguards" create optimum conditions for the rapid evolution of viruses and their promiscuous passage from one species to another.

Influenza, indeed, is like a viral fashion industry: every winter changing styles (glycoprotein coats) to create new strains, but then, perhaps every 30 years, undergoing a revolution (species jump) that unleashes a virulent pandemic.

The last pandemic killed half a million people in 1968, but scientists interviewed by Nature and Science expressed fears that H5N1 might be on the verge of evolving into something more like the 1918-19 monster. Although so far we have confirmation only that it has been transmitted by direct contact with birds and especially their droppings, the current strain is far more lethal than last year's SARs epidemic that caused so much international havoc. As a result, a top researcher told Nature, "Everyone's preparing for the worst-case scenario." At this moment, WHO investigators are checking on the terrifying possibility that the first human-to-human transmission has already occurred in Vietnam.

Moreover H5N1 is spreading at a much higher velocity than previous avian flus. There have been outbreaks annually since 1997 -- a phenomenon that puzzled WHO researchers until they discovered that migratory birds are dying in large numbers across Asia. (It is chastening to recall that West Nile virus, also a bird disease, was able to "fly" across the Atlantic.)

H5N1's progress has also been abetted by poor monitoring and government secrecy in half a dozen countries, but especially in Thailand, Indonesia, and China. The Chinese staunchly deny covering up an avian epidemic as they did SARs, but the eminent virologist Kenneth Shortridge, interviewed by Science, said all evidence points to "natural reservoirs in southern China" where the disease might have emerged as early as last October.

This winter's moderate flu epidemic, which overwhelmed emergency rooms and quickly used up supplies of vaccine, vividly demonstrated how ill-prepared even the richest countries are to deal with an imminent pandemic. Current vaccine production lines, which depend upon a limited supply of fertile hen eggs, couldn't meet even a fraction of potential demand.

But a true pandemic would probably overwhelm the world long before a vaccine could be developed and produced in large quantities. The potential accelerators of a new plague are the huge slums of Asia and Africa. Concentrated poverty, indeed, is one of the most important variables in any model of how a pandemic might grow.

The bustees of Kolkata, the chawls of Mumbai, the kampungs of Jakarta, or the katchi abadis of Karachi are, from an epidemiological standpoint, landscapes saturated in gasoline, only awaiting an errant spark like H5N1. (Twenty million or more of the deaths in 1918-19 were in poor, congested and recently famished parts of British India.)

Last fall the United Nations Human Settlements Program published a historic report, The Challenge of Slums, warning that slums across the world were growing in their own hothouse, viral fashion. One billion people, mainly uprooted rural migrants, are currently warehoused in shantytowns and squatters' camps, and the number will double in the next generation.

The authors of the report broke with traditional UN circumspection to squarely blame the International Monetary Fund (IMF) and its neocolonial 'conditionalities' for spawning slums by decimating public-sector spending and local manufacturing throughout the developing world.

During the debt crisis of the 1980s, the IMF, backed by the Reagan and Bush administrations, forced most of the third world to downsize public employment, devalue currencies and open their domestic markets to imports. The results everywhere were an explosion of urban poverty and sharp fall-offs in public services.

A principal target of IMF austerity programs has been urban public health. In Zaire and Ghana, for instance, "structural adjustment" meant the laying off of tens of thousands of public health workers and doctors. Similarly in Kenya and Zimbabwe, implementation of IMF demands led to huge fall-offs in healthcare coverage and spending.

In South Asia, likewise, investment in public health has lagged far behind the growth of slums. The five largest cities of the region alone have a total slum population of more than 20 million, and standards of sanitation are symbolized by ratios of one toilet seat per 2000 residents in the poorest parts of Bombay and Dhaka.

Thanks to global neo-liberalism, then, disease surveillance and epidemic response are weakest precisely where they are most important: in the mega-slums of Asia and Africa. That's where the brushfire of H5N1 could turn into a deadly biological firestorm.

In that event, it would consume more than just the poor. Once a new pandemic had acquired the momentum of mass mortality in Asia it would inexorably spread to North America and Europe. It would easily climb the walls of gated communities and other fortresses of privilege.

Here, of course, is the rub. In the past, the rich countries, with few exceptions, have shown callous indifference to the monstrous human toll of AIDs in Africa or of the two million poor children annually claimed by malaria. H5N1 may be our unexpected reward.