Perhaps it will be the millions of migrating
blackpoll warblers that will bring the avian flu virus to Williamsburg
when they arrive from Alaska this autumn. Perhaps it will be some other
species. Regardless, H5N1 will come to Virginia, where it will, if all
goes as several William and Mary professors predict, take up residence
indefinitely in local wild-bird populations. At that point, one of
those professors, Dan Cristol, associate professor of biology at the
College, will be among the first human beings locally to be at risk.
The reality makes him anxious—“not panicked, but very concerned,” Cristol said. As an ornithologist, all of his research initiatives involve birds. As a neighbor, his friends bring him birds—sick birds; dead birds. In a recent column in the Virginia Gazette, Cristol placed the threat in perspective, comparing it to what others face from the mosquito-borne West Nile virus or from the rodent-borne Hanta virus, each a non-indigenous strain that has found hosts here. Once established, occasionally the avian flu strain, H5N1, will appear in humans, just as it has first in China and now in several countries of Europe and Africa. In more than 100 human cases, the virus has nearly a 50-percent mortality rate.
“Not this year, but eventually the virus will be here, and I could get it,” he said. “Worse, I could bring it home to my kids.”
At present, people who do not have prolonged contact with wild birds need not be overly alarmed, Cristol said. Evidence suggests that the current strain is not easily transferred to humans and has been transmitted only in rare instances from one infected person to another. At some point, however, an altered strain might develop that easily can spread among humans. That prospect has given rise to the specter of pandemic. Alarmists say H5N1 will make that jump sooner than later. If that does happen, Cristol said, “All bets are off. There is the real possibility for a worldwide epidemic.”
Among professors at William and Mary, the general advice offered relative to avian flu is for concern and preparation. Sue Peterson, professor of government, who studies the politics of epidemic diseases, resents the climate of fear that some media reports have fostered.
“The media does tend to produce these kinds of scares,” she said, “but that may just be the nature of the media. They’re looking for a hot story. For a time they don’t say anything about it, then when they do say something, it has the tone of ‘the sky is falling.’ That kind of panic, those public-health alarms, tend to be counterproductive.”
The prospect that H5N1, or some similar bird virus, might mutate into a form that can be spread easily from human to human has to be recognized, she said. Avian viruses do mutate. In recent months, the Spanish flu of 1918 was identified as an H1N1 strain. It killed at least 25 million people as it circumnavigated the globe.
Peterson said that U.S. strategy, at this point, needs to include more funding for institutions such as the World Health Organization to track outbreaks of the disease and more efforts to cooperate with other nations in order to respond. “We also need to consider using flu vaccines in [developing countries] that take them away from stockpiles in industrial countries,” she suggested. Such action might prevent the virus from having the time to mutate. “That is a whole political discussion we have not had,” she said.
“Our best defense against epidemic disease, most of which will originate in the developing world, is a forward defense,” she said. “Our goal should be to work with others to help nip any potential pandemic in the bud.”
Beverly Sher agreed: “A lot of public-health officials have been worried for years,” she said. “H5N1 is the first virus we’ve seen in a while that has the potential to become a pandemic. The idea is that if we are smart about this we can slow down or even stop a pandemic.”
Sher, visiting professor and health professions adviser in the College’s department of biology, has been teaching a freshman seminar on emerging diseases since 1997. During recent semeseters, avian flu has been the hot topic. Her pre-med students want to know about the basic biology of the virus. “Yes,” she tells them, “in theory it is possible for someone to make a universal vaccine against influenza.” Her international relations students want to know how countries can cooperate. “Yes,” she says, “these viruses can be cooking away in southern China, and the Chinese government might know, but the rest of the world doesn’t.” All of her students want to know what can be done.
“We need to change the way we make vaccines,” Sher said. Instead of growing them in embryonated hen’s eggs, vaccines should be made utilizing tissue-culture methods, which would produce more volume faster, she suggested. “We need to clean up questions about the patent system, because it turns out that the reverse-genetics process that is used to create the experimental H5N1 vaccine that is being tested now is patent-protected,” she added. “We need to look at better drugs for blocking the transmission of influenza.”
“What we basically need to be doing is putting political pressure on the people who have the money to spend and to insist that they spend it wisely so that we are prepared,” Sher said. She called recent efforts by the Bush administration to earmark funds and to initiate dialogue with potential global partners a first step. “We have a long way to go,” she said.
As the avian flu virus continues its global spread, pandemic scenarios are sure to proliferate. Many will invoke doomsday rhetoric. Some will pin assertions in terms of national-security concerns, a tie-in that Peterson will find troubling. AIDS has established the current benchmark as to when a disease threatens national security, she believes. A recently completed study with colleague Stephen Shellman showed that AIDS indirectly affected national security in many nations by lowering gross domestic product, by devastating educational institutions and by eroding support for political institutions.
“My take on this is that, whether you are talking about AIDS or the avian flu, we have to be careful when we throw around words like national security threat,” Peterson said. “National security traditionally has been about the use of force, about the preservation of our territorial integrity, of our national sovereignty and of our political institutions.” Disease can rise to that level, she admitted, but it would have to unleash a massive pandemic. By comparison, AIDS, which has killed or infected 70 million people worldwide, does not constitute a threat to U.S. security, she said. “AIDS is a humanitarian crisis of epic proportion, and we need to respond to it as such. In fact, American security is not directly challenged by AIDS.”
She suggested that, likewise, were avian flu to kill a few thousand people in the United States, certainly it would be “a tragedy for the individuals” and a “health problem for the nation,” but it would remain far below the level of threatening the political or territorial sanctity of the nation.
If the virus does adapt a form that enables it to be passed from human to human in the next 12 months or so, Peterson is aware that severe hardships would be created. “What’s scary is that the numbers will actually swamp our emergency rooms, our ability to respond,” she said. “That’s assuming everything goes well. Will public-health workers even show up? That is assuming a lot.”
Said Sher, “We would be cooked. If it hit now, we wouldn’t have enough drugs; we wouldn’t have a vaccine for six months to a year. Hospitals would be overwhelmed. A lot of people would be on ventilators; we don’t have enough ventilators in our country.”
Sher is encouraged by discussion among officials with the Centers for Disease Control and Prevention (CDC) that reference employing a floating corps of professionals to follow outbreaks though communities and to call for “snow days,” essentially shutting down communities when the virus flares. “Eliminating unnecessary gatherings and reducing human-to-human contact in society would have an enormous economic impact,” she said. Sher also believes that by cooperating with other countries and planning wisely, there is a chance that pandemic can be averted, perhaps for the first time in the history of the world.
In the meantime, she maintains no personal preventive strategy.
“I’m not taking any precautions,” Sher said. “People ask me if I got Tamiflu for my family. I haven’t. If I knew avian flu was spreading person-to-person in San Francisco, I would avoid crowds and keep my hands clean. I might teach my seminar by computer for awhile.”
Cristol, however, is taking precautions. He and his students are wearing gloves each time they handle wild birds; if they do so within an enclosed space, they are wearing gloves and masks. When the flu arrives, he said, respirators will be added to the required gear.
“Until it can move person-to-person with ease, you have to come into contact with birds as a farmer or researcher—direct contact and probably prolonged contact,” he said. “That may change any time, as we all know. Meanwhile, people should be concerned about whether the government is doing anything to prepare us for an epidemic and to reduce the chance of an epidemic.”
Despite the rhetoric, Cristol said, he has seen little tangible evidence of that thus far.
Perhaps it will be the millions of migrating blackpoll warblers that will bring the avian flu virus to Williamsburg when they arrive from Alaska this autumn. Perhaps it will be some other species. Regardless, H5N1 will come to Virginia, where it will, if all goes as several William and Mary professors predict, take up residence indefinitely in local wild-bird populations. At that point, one of those professors, Dan Cristol, associate professor of biology at the College, will be among the first human beings locally to be at risk.