by Alan Sipress
Table of Contents
Title Page
Copyright Page
Dedication
PART ONE
CHAPTER ONE - The Revenge of Begu Ganjang
CHAPTER TWO - A Visitation from Outer Space
CHAPTER THREE - The Elephant and the Lotus Leaf
CHAPTER FOUR - Into the Volcano
PART TWO
CHAPTER FIVE - Livestock Revolution
CHAPTER SIX - From a Single Spark
CHAPTER SEVEN - Cockfighting and Karma
CHAPTER EIGHT - Sitting on Fire
PART THREE
CHAPTER NINE - The Secret Call
CHAPTER TEN - Let’s Go Save the World
CHAPTER ELEVEN - The Lights Go Out at Seven
CHAPTER TWELVE - Peril on the Floodplain
Acknowledgements
Notes
Index
VIKING
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First published in 2009 by Viking Penguin, a member of Penguin Group (USA) Inc.
Copyright © Alan Sipress, 2009
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LIBRARY OF CONGRESS CATALOGING IN PUBLICATION DATA
Sipress, Alan.
The fatal strain : on the trail of avian flu and the coming pandemic / Alan Sipress.
p. cm.
Includes bibliographical references and index.
eISBN : 978-1-101-14551-7
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To Ellen
The Asian Theater
Avian Flu Timeline
Prologue
In an underground bunker carved from the soft Swiss hills above Lake Geneva, the daily intelligence briefing they call the morning prayers was beginning. The intel officers had been up since dawn, sifting through reams of electronic communications for any hint of an emerging threat, any anomaly portending disaster. Their customized computer search engine had culled and translated news reports, Web postings, and online rumors in six different languages, and now these were stitched together with official bulletins and tips from informants into a tapestry of microbial peril. Like the Men in Black who work to keep humanity blithely ignorant of the menace to this planet, these officers were engaged in a perpetual, often unpublicized contest with the most accomplished killers known to man. But this was for real.
The officers filed into the command center, a converted movie theater two floors beneath the global headquarters of the World Health Organization (WHO). They passed through doors secured with electronic locks that limit access to all but the privileged few and pulled up black chairs around the blond wood table. There was space for only six. So nearly twenty others—including special operations staff, disease specialists, and a few of the agency’s senior brass—lined the edge of the room, some seated, others forced to stand. The chief of the intel section was a stylishly dressed Australian woman, a former senior disease investigator in Canberra who had been seconded to WHO in response to the 2001 anthrax attacks in the United States. She convened the briefing, moving briskly down the list of newly uncovered outbreaks. Some were still unidentified. There were reports and rumblings from Africa, Asia, the Middle East, and the Caribbean. A pair of large plasma screens on the wall flashed maps of these evolving hot spots. A red digital display scrolled through the time in eighteen major cities from Geneva and Washington to Delhi, Hanoi, and Jakarta.
The room was small, even cozy, with recessed lighting and gray carpeting. This was the mezzanine that once housed the movie theater’s projector. But if any of the threats developed into a true epidemic, the full war room below, called the Strategic Health Operations Center, would be activated. More commonly known as the SHOC, it offers dedicated satellite communications linking it to 150 agency offices and government ministries around the world. Dispatches from field investigators and doctors in distant hospitals can be beamed directly to the high-definition video wall at the front. A private network instantly transmits data from the remotest of outposts to a series of black planar monitors, which retract with a hum into the surface of the U-shaped table in the middle of the room. The center has its own dedicated power source and computer servers, its own telephone exchange, ventilation, and air-conditioning. In case of a pandemic or a biological weapons attack, the SHOC must go on.
The briefing this morning was confidential. The premature disclosure of a suspected outbreak could sabotage WHO’s ability to mount an emergency response. It might cause panic, crippling economies and embarrassing governments.
But given a rare opportunity to sit in on morning prayers, I got a glimpse of humanity’s existential conflict with the microbes. Ebola. Monkey pox. Cholera. Plague. Yet of all these and more, it was flu that my hosts feared most. Not ordinary flu, not the kind that sends the sick to bed each winter with chills and a fever, that keeps children home from school and nursing homes on alert. They were watching warily for a novel strain of flu, a new virus against which no one on Earth has natural immunity.
In recent years, such a strain has emerged with the deceptive name of bird flu. All flu viruses in fact emanate from birds. But this particular strain was supposed to stay there. Instead it confounded scientists by repeatedly leaping the species barrier from poultry to people, often with lethal results. Now the agency’s officers were searching for any unusual outbreak signaling a sinister mutation in this fatal strain, any omen of a gathering pandemic. A few genetic tweaks and millions could perish.
As an Asia correspondent for the Washington Post covering the spread of bird flu, I had learned not to underestimate it. Still, I was surprised by what I saw that morning in the bunker. At the top of the agenda were two reported deaths from avian influenza on the eastern edge of Europe, a continent that had so far been spared human cases. I was required to not identify the specific country but can say that these fatal infections, if confirmed, would have opened a new frontier.
Ultimately, after investigation, the bulletin was dismissed as unsubstantiated. But I was struck by the urgency with which it was handled. The information had originated wit
h Russian medical staff working near the site of the suspected outbreak. From there, the reports had reached U.S. intelligence, which was growing increasingly anxious about the prospect of a flu pandemic. Intelligence agencies worry about its potential to disrupt the world economy, stoke political unrest, and escalate tension among countries vying for scarce medicine and other essentials that would run short. From the U.S. Office of the Director of National Intelligence, the information found its way to WHO headquarters, which in turn directed its European regional office to investigate. Within two days the report was run to ground. The episode underscored for me how gravely the pandemic threat was viewed by those in the know, even as media coverage ebbed and flowed.
By the time I sat in on the briefing, flu specialists had long since concluded we were closer to a global epidemic than we’d been in a generation. Even those who ran the command center, which integrates the best minds and technology the world can muster, conceded that they cannot prevent the inevitable. They didn’t know when, and they didn’t know whence. But the pandemic was coming.
Dr. Michael Ryan has hunted down some of the most virulent biological agents of modern times. He has parachuted into the world’s bleakest corners to confront the horrors of Ebola and lesser-known hemorrhagic diseases like Marburg fever, Crimean-Congo fever, and Rift Valley fever—viruses so infectious, so devastating that doctors don biosafety space suits when they encounter these so-called special pathogens. As a member of WHO’s special operations team, he has also helped stanch incipient epidemics of meningitis and cholera. He’s braved guerrilla insurgencies, minefields, and wars on three continents to reach these outbreaks, dodging drug runners in Afghanistan during the Taliban era and Somali bandits in Kenya. He has crossed battle lines in the Ugandan bush to secretly win the cooperation of the cruel, cultish rebels of the Lord’s Resistance Army. “I was shaking in my boots,” he recalled. He fractured his spine in multiple places when his car was forced off the road in Kurdistan by an Iraqi military convoy during the rule of Saddam Hussein and careered down an embankment. Yet each time, Ryan’s mission has succeeded. This has instilled in him an outsize sense of confidence. Until now.
Ryan is a burly, red-haired Irishman with lively hazel green eyes, full cheeks, and a gap-tooth smile. He grew up playing Gaelic football in what he describes as the “wild and savage” county of Mayo on Ireland’s west coast, and he still has the build. His colleagues have called him the bulldozer for the way he muscles aside bureaucratic and logistical obstacles. More often, they call him the Irish traffic cop. After 2001 he took charge of the urgent comings and goings of scores of WHO teams dispatched to the field each year. As the indomitable director of Alert and Response Operations, he assumed overall responsibility for intelligence activities and emergency assistance to stricken countries, as well as the divisions dealing with specific diseases, including special pathogens and influenza. He is quick-talking and can-do, at times barely able to contain his restless intensity. His impassioned monologues cascade from topic to topic. His beefy hands punctuate each exuberant thought. His full, red eyebrows bob, and his chair creaks beneath his shifting frame. Though some agency old-timers initially dismissed Ryan and his crew as a bunch of cowboys, he has brought speed and smarts to fighting disease at a time when disease spreads faster than ever.
“We can do big operations. We have done big operations,” Ryan put it to me shortly before I sat in on the agency’s morning briefing. But influenza tests his optimism. “A containment exercise would be the biggest thing we ever attempted. We need to make that intervention at a higher level of speed, at a higher level of aggression than we might ever have done in the past.”
Men like Ryan find it hard to admit the prospect of failure, much less its certainty. But pressed, he acknowledged that flu is so contagious and mercurial that a pandemic strain is destined to break free.
“That’s the reality and I absolutely accept that,” he finally said. “If you look at history, it’s bloody well inevitable.”
He moved to the edge of his chair and leaned forward.
“But what if we don’t prepare for it? You have to make an honest attempt to try, understanding that by the time we find out about it, we may have lost. What I don’t want to do is to try to find my pants in the dark when it does happen.”
So Ryan had been doggedly reworking his emergency planning and reinforcing his team. He had brought on board a Canadian contingency expert seasoned in running large emergency exercises and a British specialist in heavy-lift logistics to oversee the delivery of the vast quantities of drugs and medical supplies that would be required by a budding flu epidemic. Ryan was also lining up other UN agencies with aircraft to ferry men and materiel in a crisis.
“You don’t prepare to lose. You prepare to win,” Ryan insisted. “You get your performance to the level that you think you need, right? You can do nothing about the performance of the other team. The other team is the virus. Its performance is set. So all you can focus on is your own ability to perform. You get your performance to the maximum you can achieve.”
At best, that would mean slowing death’s inexorable progress.
“If that’s too little to stop the virus, fine,” he conceded. “I will die in peace.”
As I write these words in the spring of 2009, a novel strain has broken on our shores. Rarely in public health has an event been so anticipated, and yet it came as a surprise. The virus known as swine flu was a strain that global health specialists had not been expecting, that virologists had not been tracking. Most eyes had been turned to the East, the traditional wellspring of influenza viruses. Instead, this flu apparently emerged from Mexico and within a few weeks had spread to dozens of countries on at least five continents. At WHO, the full strategic operations center had been activated.
This book, conceived long before swine flue erupted, is an account of why influenza pandemics are inevitable. The scientific and social forces that produced this latest global outbreak are partly obscured because of its sudden, stealth birth. But they are on display elsewhere, notably in Asia, where humanity has been locked for more than a decade in a contest with flu, its most implacable viral adversary.
For forty years, the world eluded the inevitable. Scholars had urged that a pandemic was overdue. When swine flu broke out, it gave the world an initial fright but soon proved relatively mild. Whether the virus would stay that way or take a virulent turn was unknowable in those first weeks. Yet no matter how swine flu plays out its hand, it offers a warning: even after it’s done with us, we’re not done. The prospect of another pandemic remains real. And it could be far worse. Nothing about swine flue has altered the cruel dynamic of its avian cousin, which kills more than half of those it infects, or allayed the fears of the disease hunters who stalk it. There’s no way to forecast how many lives this fatal strain will take and families it will destroy, how many hospitals and governments could tumble under its siege. The attributes of a novel virus that make global epidemics unavoidable also make its appetite impossible to predict. Yet today we remain closer than we’ve ever been to a repeat of the Great Influenza of 1918, which cost at least 50 million lives worldwide and killed more Americans than all the wars of the last hundred years combined.
In the first of the book’s three parts, we meet the antagonists in this struggle, man and microbe, as they’ve confronted each other since the waning years of the twentieth century in what America’s premier flu hunter, Dr. Keiji Fukuda, called an “accelerated number of near-misses.” On one side—or on one team, as Ryan’s sporting metaphor would have it—is the World Health Organization. In its own ranks and through external allies like the U.S. Centers for Disease Control and Prevention (CDC), WHO can marshal the world’s most brilliant doctors and researchers, intrepid investigators, and sophisticated labs. The agency embodies our faith in rational science and our noblest aspirations for humanity. It may also be all that now separates us from cataclysm.
On the other side is flu. Ubiquitous in natu
re. Ever changing. Savage. No other virus can match its grim genetics. Given enough chances to remake itself, flu is guaranteed to breed a pandemic strain.
But microbiology alone does not account for the inevitability of pandemic. The virus must be afforded those chances to follow its logic. Today, they are greatest where flu’s minute genetic idiosyncrasies meet the vast realities of Asia. The opportunities there are unprecedented and growing.
The second part of the book explores these ground truths. If the struggle to preempt the next great epidemic were waged just outside the doors of WHO’s headquarters in Geneva, the flu hunters would face better odds. Switzerland, after all, is a citadel of efficiency, social order, and good government. It is famed for its precision watchmaking and global civil servants. But in the theater of conflict that is Asia, the battlefield is defined by poverty, superstition, unregulated development, and corrupt, parochial politics. Tradition often trumps science. Survival today trumps survival tomorrow. On this unfriendly terrain, the initiative lies not with the flu hunters. It belongs to the backyard chicken farmers, cockfighters, witch doctors, political bosses, and poultry smugglers.
The final part examines the limits inherent in the world’s effort to prevent a pandemic strain from emerging and, failing that, snuff one out when it does. Over the centuries, flu has repeatedly preyed on a defenseless world. The first documented global outbreak came in 1580, starting in Asia and spreading west across Africa and Europe to the Americas. Lesser epidemics have occurred since the twelfth century. Though scholars have yet to glean definitive proof of earlier outbreaks from the historical record, the virus no doubt accounted for a share of the myriad unidentified plagues that have been chronicled as far back as ancient Greece. Modern medicine, dating only to the nineteenth century, has a long way to catch up. The study of molecular genetics, born within the lifetime of many who are still alive, is in its infancy. As astounding as these scientific advances have been, they all too often fall short. Flu researchers working behind the double airtight doors of their biosafety labs, as well as clinicians on the wards, constantly confront the limits of their science, just as flu investigators run into the limits of epidemiological inquiry nearly every time they enter a village. The fight is also bedeviled by a second set of limitations that, while man-made, might as well be equally immutable. These are the constraints of money and mandate.
