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Flu and the Family of Man

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So why am I blogging about avian flu?

Because, like many environmental threats, it's an overwhelming problem if you look for a perfect solution, but it's kid's stuff if you want to reduce the risk dramatically but not completely. And the barriers to making us safer from avian flu are the same as the barriers to making us safer from most environmental hazards.

I don't know whether avian flu will or will not mutate into a human pandemic. Scientists agree, though, that if it does, it will almost certainly make the leap in some poor country -- not the U.S. The front line against the pandemic will be in China or Vietnam or Indonesia -- a developing country with lots of direct contact between humans and poultry, and an under-funded public-health system.

The Bush administration has repeatedly argued that the way to make us safe from terrorism is to fight it where it originates. (Iraq was not such a place, but that's another sad story.) But neither the Administration nor the world at large seems able to apply this lesson to avian flu. Lots of money is being spent to cope with the flu after a pandemic is well-established and reaches the U.S. or Europe. But almost no money is being spent on the front lines, which is an almost certain way to ensure that any pandemic will be broadly established before we can get on top of it. In fact, the WHO says it has only $20 million of the $100 million needed to fund poultry vaccination and surveillance in countries such as Indonesia and Cambodia.

So prevention and preparedness are playing second fiddle to treatment. This is a familiar story. It's why we didn't spend enough money to build levees in New Orleans to protect against a Class 4 hurricane. It's why electronics companies in Silicon Valley failed to take simple and cheap measures to ensure proper management of their hazardous solvents and ended up with expensive Superfund sites to clean up. It's why we invest billions in treating the health consequences of air pollution from outmoded factories and power plants but won't spend much smaller sums to clean them up. (Even the Bush administration admits that every dollar we spent cleaning up air pollution in the 1990s saved us ten dollars later on.)

Now, you could argue that the failure to embrace prevention in the environmental-health arena is because those who would have to pay to prevent pollution would rather pass the bill on to the rest of us. But you can't make that argument about avian flu. Health systems and authorities in the U.S. and Europe are certain to be stuck with the treatment bill. And they could invest right now in prevention and preparedness in the front line regions to avoid that. But they don't. How come?

Well, let's look at another aspect of this avian flu crisis -- the drugs. Absent a vaccine, the best defense against avian flu is a drug called Tamiflu. Tamiflu is patented by the Swiss pharmaceutical company Roche. It charges $60 per treatment. Roche was asked to license its drug to other manufacturers so that enough could be produced to deal with a pandemic at a reasonable cost. It refused. It said it "fully intends to remain the sole manufacturer of Tamiflu." It claimed that since it won't show other companies how to make the drug, it will take them "two or three years, starting from scratch" to produce. It said these things with apparent pride.

In a sane world, Roche's position is obviously indefensible, and yesterday the company backed down after it was widely pointed out that millions of people's lives are put at risk by this kind of pride. What's more, an Indian pharmaceutical company, Cipla, said it could produce Tamiflu in a generic form much faster than Roche claimed -- and for "humanitarian prices." (For my money Cipla and its owners, the Hamied brothers, are some of the great humanitarian heroes of the 21st century -- 400,000 people use its inexpensive HIV drugs in poor countries.)

What Cipla is doing might, technically, be a violation of Indian law, because the Tamiflu patent is, by a few months, just recent enough to be covered by India's reluctant agreement to respect U.S. drug patent laws. This agreement was rammed down the throat of India and other third-world countries by the U.S. and Europe to protect the patent monopolies of their big drug companies, even if it means death or impoverishment for millions in the third world who can't afford U.S. or European prices.

Tom Friedman devotes a whole chapter in his recent book, The World Is Flat, to defending the theory of comparative advantage, the economic doctrine that says that free trade is ultimately good for everyone because it allows each country to do best what it is good at, and prevents monopolies in other countries from artificially raising prices.

But Friedman, and other "free trade" advocates, don't admit that drug patents -- whether you think they are wise for the U.S. and Europe or not -- are a form of monopoly, and that India and Brazil enjoyed an enormous comparative advantage in producing drugs because they did not allow such monopolies to constrain free competition. Now, in the name of "free trade," we have forced these countries to give up their comparative advantage by compelling them to globalize our domestic U.S. monopoly-protection patent laws.

While the trade agreements that made the world safe for drug monopolies have some escape hatches in extreme circumstances, the avian flu crisis reveals how inadequate those safeguards are to protect human lives in a situation like this one, where we don't know where, or when, or even if the pandemic will explode. The drug monopoly makes prevention and preparedness too expensive for most countries to afford.

The avian flu virus, of course, does not respect drug monopolies, just as global warming won't impact only the countries that are big wasters of fossil fuels. These are global threats. While we can't eliminate them, the steps to reduce risk are obvious: In the case of avian flu, make enough drugs, stockpile them in the countries where the pandemic is likely to break first, fund testing and surveillance systems in those countries, and be ready to fight the pandemic wherever in the world it first occurs. So far, all we've done is start making the drugs and stockpiling them where we're sure the pandemic won't start.

With global warming, the steps are also straightforward: Start reducing our subsidies to and dependence on fossil fuels, invest in efficiency and renewable energy in the U.S. and Europe, and use the savings to finance similar non-carbon energy futures for India, China, Brazil, and Africa.

That global prevention and preparedness would save enormous sums and millions of lives is self-evident. Why don't we do it, even for avian flu?

When I was young, one of my favorite books was The Family of Man, a photographic essay on the human community. It made the point that we are all one family, an idea that in the early years after World War II had a grip on popular culture. It's the lack of that kind of solidarity, the unwillingness to see the world as a global community that leads the U.S. and other countries to the folly of stockpiling $60-a-dose Tamiflu that no one even knows for sure will be effective in a pandemic. Meanwhile public health workers in Southeast Asia lack for lab facilities to test their patients for the moment when the flu first takes pandemic form.

Whatever you think of the "right" length of patent protection for drugs, the U.S. would never tolerate patent laws that routinely made life-saving drugs unaffordable by 80 percent of our population -- yet on the global level that's exactly what our trade agreements are trying to do. We act like untreated illness is OK -- as long as it is somewhere else, somewhere poor. It's the same lack of community and global solidarity that causes countries, like the U.S. and Australia, that are destabilizing the global climate to act as if they owned the sky, and that all the world can do about the weather is wait for it to kill people and then cope with the resulting disasters.

We can't really embrace prevention until we embrace each other.