6-08-09, 9:34 am
Original source: People's Democracy (India)
The 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.
PANDEMIC 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?
The WHO pandemic alert has 6 levels. At level 6, WHO declares that a global pandemic has started. At the moment, the alert level is just short of that – it is at level 5, which means that a pandemic is imminent. At a press conference on June 2, 2009, Keiji Fukuda, WHO's assistant director-general, characterized Australia, Japan, the United Kingdom, and Spain as countries “in transition” from limited to sustained community spread of the virus. “Globally, we believe that we are at phase 5, but are getting closer to phase 6,” said Fukuda.
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.
For many, the swine flu outbreak may appear a minor blip in a disease ridden world. For most of the third world, a death toll of about a hundred hardly merits concern. In India, about half a million die from TB every year. The global death toll from influenza is roughly between 300,000 to 500,000. So why the hullabaloo over swine flu?
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 smolder 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?
The origin of this outbreak has already become quite controversial. It was supposed to have originated near an American-owned major pig farm in Mexico and originally, the pig industry was blamed for the current outbreak. It is clear now that this was not the origin of the outbreak. The only recorded case of pigs getting infected is in Canada and not Mexico, and the likelihood is that it was a human to pig transmission and not the other way around. While the origin of the virus may not be clear, it is now widely accepted that this has been a case of primarily human to human transmission: this outbreak has originated in the human population.
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.
So why blame the meat industry for such outbreaks? The meat industry is notorious for unsafe and unhygienic practices. Obviously, safety is easily sacrificed to the altar of profits in any capitalist enterprise, the meat or food industry being no exception. Upton Sinclair's famous expose of the meat packing industry in 1906 “The Jungle” not only created a furore but led to the establishment of the Food and Drug Administration (FDA) in the US. The Bush administration has many sins to its credit, not the least of gutting the FDA. But damning the meat industry for poor safety and asking for abolition of the industrial mode of food production are two different things.
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 industrialization and pleading for a largely agrarian society.
In blaming the 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 exactly the same conditions of incubating new diseases. And let us not romanticize the older livestock breeding either. Those rearing pigs, goats and chickens in such farms always lived closely with their animals, providing the same condition of disease jumping species. This was one of the problems in South East Asia during the avian flu outbreak. For the record, the H1N1 strain jumped species to enter the pig population from the human population during the 1918 pandemic. This was before large scale factory farms for meat production were set up.
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 urbanization (Civilization'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 industrialization to a mythical and idyllic past but how to overthrow capitalism; or regulate it till we transform it.
Interestingly, Newsweek in its article on swine flu also talks about the “strange ecology” of factory mode of meat production that is giving rise to disease. For them, the cause is the rising consumption of meat and poultry products in China and India, which is giving rise to this dangerous ecology. As long as the whole world raised meat without consuming it for the developed West, Newsweek had no problems. Every time there is a global crisis – whether climate change to a new disease – the guilty parties are now India and China for daring to consume more than subsistence levels.
DISEASE, LIFE SAVING DRUGS AND PATENT MONOPOLY
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.
The issue of providing medicine comes up immediately against patent monopoly. Roche has a world wide monopoly on the most common anti flu drug – oseltamivir (called by its trade name tamiflu), except in India. Roche did not discover oseltamivir, it merely bought worldwide rights from Gilead Science. Incidentally, Cipla in India started manufacture of oseltamivir and opposed Gilead/Roche's patent. The Indian patent office has upheld Cipla's pre-grant opposition and ruled that Gilead's application lacked inventive step, freeing Cipla from any long term threat from Roche. Unless if the courts reverse the decision of the patent office.
So if oseltamivir is indeed a cure, then the issue is how should such patents be respected when there is a global threat of a pandemic? This brings up the issue of Intellectual Property Rights and the current TRIPS regime. However, TRIPS has enough provision in it for countries to break the patent monopoly in the case of a pandemic and award compulsory licenses for oseltamivir. The problem is that they are too scared to buck the big pharmaceutical boys and the US/EU governments that stand behind big pharma. Even India, at the time of avian flu scare, the government played safe and stocked up most of its oseltamivir from Hetero, who had got a license from Roche.
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 defense 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.
It is unfortunate that the government of India has recently shut down three public sector vaccine manufacturing firms. To see vaccine manufacture through the prism of market economies is not to understand either public health or economics. The cost of treating a sick population is much higher than preventing disease. Or is it that there is a vested interest in disease and the big bucks that pharma companies make? Therefore the shutting down of vaccine manufacturing companies?
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.
