Wednesday, February 10, 2010

Contrasting Two Arguments on Global Vulnerability to “The Monster At Our Door:” Avian Flu

In my fall semester course, CH-108: Epidemics, we analyzed two different arguments for the world's growing susceptibility to the threat of H5N1, popularly known as avian flu. The first was Mike Davis' book The Monster at Our Door and the second was PBS mini-series "Rx for Survival." Personally, I was surprised how similar the arguments that each work presented were. I thought it might be an interesting exercise to compare the arguments to glean their differences. Additionally, the potential threat of avian flu is an oft-ignored topic in today's media-I was astonished to learn how pressing the threat is, and believe it should be discussed more thoroughly.

One would think that today, in a world with much more advanced scientific technology to detect and eradicate diseases than in years past, we would crush any disease that threatened the human population. However, in The Monster at Our Door Mike Davis dispels this hypothesis, arguing that various human actions have increased the likelihood of a global avian influenza pandemic. Richard Krause writes, "Microbes thrive in 'undercurrents of opportunity' that arise through social economic change, changes in human behavior, and catastrophic events. They may fan a minor outbreak into a widespread epidemic." Davis believes the major global changes that have favored the evolution of cross-species influenza and their rapid global transmission are the Livestock Revolution of the 1980-90s, the Southern Chinese industrial revolution and the superurbanization of the Third World. The final element that "closes the ominous circle of influenza ecology" is the current lack of an international health system able to deal with the new problems brought by today's large scale economic globalization. "Rx for Survival" also addresses this increased risk of an avian flu pandemic in contemporary society, focusing on quicker transmission through plane travel, drug resistance in the flu virus and the need to stockpile vaccines and to create a global surveillance and response system.

The first "catastrophic event" Davis cites as having an effect on today's increased risk of an avian flu pandemic is Third World urbanization, the shift of global poverty from rural areas to the slums of large new cities. This concentration of humans in areas with poor living conditions violates William McNeill's "Law of the Conservation of Catastrophe," which states "as virus host populations increase, there is a concomitant increase in the probability of major evolutionary changes in virus populations." Thus, as the population of the world increases, so does the probability that humans will contract a disease. Using an example from West Africa, Davis explains how due to the increased association between humans and wild animals through deforestation and hunting, the "formerly isolated microbiological reservoirs" of rainforests and mountains are being incorporated into the cities' food economies. In turn, this "undercurrent of opportunity" resulted increased leap of viruses from animals to humans (such as HIV/AIDS).

Davis goes on to describe the industrial revolution of "historical crucible of human influenzas," Southern China, specifically Guangdong. This city has become the world's leader in export-manufacturing, producing cheap toys, electronics and sneakers distributed worldwide, causing the province's GDP to grow 13.4% from 1978 to 2002. Additionally, the percentage of humans living in the urban part of the Pearl River Delta rose from 32 to 70% of the total population. Davis writes that these rapid expansions and other socioeconomic developments have reinforced Guangdong's "primacy as a viral exporter." These socioeconomic developments include high population density with a large quantity of rural immigrants, intense contact between humans and animals due to the city's numerous wet markets and resulting "extraordinary" concentration of poultry, and a high prevalence of chronic respiratory disorders. Since Guangdong is incredibly prone to "microbial traffic," Davis considers it the potential breeding grounds for an avian flu pandemic.

The third component of Davis' argument is the Livestock Revolution of the 1980-90s, which was instigated by Third World urbanization and the soaring demand for livestock in developing countries. "Disease epicenter" Guangdong is also highlighted as the center of this revolution, where export-heavy industrialization of poultry and pork production, has led increased environmental preconditions for the evolution of influenza. A large percentage of Third World urban-dweller's income depends on the animal protein business, which is expanding, creating a demand engine for swine and chicken from these countries. As a result "viral food supply," of the world, including chickens, pigs and humans, has increased exorbitantly. Remarkably, pork and poultry comprise 76% of the increased meat consumption of developing countries. The superurbanization of the Third World is paralleled by "an equally dense urbanization" of its meat supply. As a result, this increased production density leads to increased viral density. Davis writes that the Livestock Revolution of Southern China is "part of the larger world conquest of agriculture by large-scale agro-capitalism."

After thoroughly illustrating the impending doom spelled out by the 1980-90s Livestock Revolution, the Southern Chinese industrial revolution and Third World urbanization, Davis raises his last primary concern: the absence of an international public health system that can adequately deal with an avian flu epidemic, considering the scale of economic globalization. Laurie Garrett writes that an adequate system "would have to embrace not just the essential elements of disease prevention and surveillance, but also new strategies and tactics capable of addressing global challenges." Today, access to drugs and vaccines in poverty-stricken regions is limited in order to protect profit, and many Third World countries are more focused on funding new weapons instead of public health initiatives. Without an adequate amount of vaccines stockpiled, Davis writes that there will be a "mad global scramble over Tamiflu." Davis is clear: we need to work on establishing a more effective international public health system to cope with the threat of an avian influenza epidemic.

"Rx for Survival" pitches to us this statement: "In a globalized world, communicable diseases can travel anywhere in a matter of hours." But how do diseases travel so quickly? The film answers this with image after image of planes taking off and groups of people huddled in airports, as narrator Brad Pitt purrs, "No disease is more than a plane ride away, and there is no immune population." In the new era of globalization, where you can be anywhere in a matter of hours, due to the invention of planes, it is important to realize: diseases can be transmitted to anywhere in a matter of hours, too. The film hypothesized that mosquitoes brought West Nile Virus from Uganda to the U.S. via jet travel. The scariest aspect of this rapid transport is that no environment is immune-and no person, for that matter; therefore, the death rate could soar. In an instant, a disease that has never reached a country's borders can be "in your backyard." A population that has not been exposed to a disease, or, a virgin population, is generally more susceptible to it since their immune systems have not been able to develop immunities. Flu viruses can mutate rapidly and swap genes with other flu viruses, making them a difficult disease to prevent. This aspect of the influenza virus make it a formidable opponent. Ultimately, "Rx for Survival" stressed that under the conditions of jet travel, it is vitally important to prevent the avian flu virus from evolving to include person-to-person transmission.

Special complications in manufacturing an avian flu vaccine, which remains the best defense we have, led to vulnerabilities in a global fight against a potential pandemic. The fact that vaccines are often grown in chicken eggs has posed a giant obstacle: avian flu kills the embryo within the chicken egg, rendering it useless. Also, since H5N1 is constantly mutating, the current vaccine could no longer be effective. Robert Webster believes we should start stockpiling the effective vaccine in large quantities, but is concerned stockpiling will not happen since vaccines bring less profit than prescription drugs and have an attached liability concern. Webster calls our current lack of stockpiling to ensure we are prepared against an avian flu pandemic a "bloody disaster." Currently, developed countries have a limited supply of avian flu vaccine-but who would get it? Pitt tells us we cannot depend on vaccines, and instead have to develop a strong surveillance system.

According to those interviewed in "Rx for Survival," the recent SARS epidemic was a warning: although it took only 7 weeks to identify the cause of the disease and trace its source because of the world's quick and effective counter-attack. SARS "stressed and stretched the public health network we have now." Pitt describes teams monitoring hospital admissions and immediately identifying and quarantining anyone with avian flu symptoms. These teams then search for victims in the infected person's neighborhoods, administering Tamiflu to those close to the victim. However, many countries, like Vietnam, which are not prepared for disease of globalization avian flu will have to depend on the rest of the world's funding in order to receive any amount of vaccine. In the closing shots of the film, Pitt asserts to us: "what's needed is a whole new level of international cooperation." The ultimate argument is that we can avoid global suffering from a pandemic if we make a true global surveillance and response system.

The arguments from The Monster at Our Door and "Rx for Survival" have a lot of similar elements, yet each has their own focus on why we are susceptible to a global pandemic of avian flu. Davis' argument is very centralized around Guangdong and its qualities that make it a disease epicenter, whereas "Rx for Survival" takes us all over the world, but primarily focuses on the threat of avian flu in places like Thailand and Vietnam. "Rx for Survival" focuses a lot more on the importance of jet travel in the quick spread of diseases, whereas Davis writes more on the urbanization, and the resulting livestock and industrial revolutions. Additionally, the film's argument hinges more on the need for a global surveillance and response system than Davis' book does, though it is a component.

Ultimately, the tone of the two works sets them apart. Davis' work ends with disturbing image of American's infected pets. He darkly emphasizes the impending doom evident in the title of his work, and he almost encourages us to "cast nervous glances at the ducks in the pond or our neighbor's cat." On the other hand, in "Rx for Survival," after watching hundreds suffer from various diseases, we are hit with a blast of optimism. A final interviewee says, "We can do this; there isn't a single problem in global health that we don't have the means to deal with."The overarching message we receive is that as long as the world works together to form better surveillance and control measures, we will be able to fend off an avian flu pandemic. Whichever argument you believe, it is clear that we are not as safe as many may think-and that measures must be taken in order to account for the new conditions that could-or will-lead to a global pandemic of avian flu.


Davis, Mike. The Monster at Our Door. New York: New Press, 2005.

Whittlesey, Rob, dir. Rx For Survival. Narr. Brad Pitt. 2005. CD-ROM.

Brooke Evans is a contributing writer on public health for TuftScope Spring 2010.
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