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From the January 2006 Anthropology News Post-Katrina, Pre-Pandemic America
Monica Schoch-Spana
U Pittsburgh Medical Center
Center for Biosecurity
“All analogies have their faults,” cautioned Anthony Fauci, director of the Institute for Allergy and Infectious Diseases at the National Institutes of Health (NIH), when Bill Moyers interviewed him for “H5N1—Killer Flu,” a September 20, 2005, PBS broadcast. Fauci made the warning when he and Moyers drew a parallel between the Gulf Coast hit by Katrina, a hurricane like it had “never experienced before,” and a human body infected with a pandemic strain of influenza virus, not the familiar seasonal variety. Both men—one, a polished spokesperson on public health; the other, a veteran journalist and ordained minister—reached for just the right image to relate a technically obscure but publicly grave matter: emergence of a novel virus lethal to large numbers of people.
The pair continued their figurative leaps. US authorities had intelligence about possible attacks, Moyers commented, but the September 11th terrorist campaign still took place. Projections about New Orleans’ fate in the context of a Category-5 hurricane failed to motivate controlled development, levee improvement and realistic evacuation planning. Was the country, the journalist inquired, similarly poised for inaction and denial, last minute intervention, and loss of life in the case of pandemic flu? “We have our eye on this terrorist, and nature can be the worst terrorist,” responded Fauci. “[W]e can promise you and the American public … we’re following it very carefully.”
Political Artifacts
Carefully orchestrated proof of a proactive stance came seven weeks later. On November 1, President Bush announced the release of the “National Strategy for Pandemic Influenza,” 12-pages of broad-level doctrine, in a speech at the NIH. Cabinet members, bipartisan Senate leaders, chiefs of all federal health agencies, the World Health Organization Director General, and the UN influenza coordinator attended the highly publicized event. The president also petitioned Congress for $7.1 billion in emergency appropriations to implement the strategy, and announced the activation of pandemicflu.gov to give Americans information they need “to protect themselves and others.” On November 2, the Secretary of Health and Human Services (HHS) issued his agency’s “Pandemic Influenza Plan” (the “Plan”), a 200-plus page operational guidebook.
| The September 11 attacks, Hurricane Katrina and now a possible flu pandemic are strung together in the minds of US politicians, health and safety professionals, journalists, and many citizens by dint of chronological proximity, the need to make sense of human tragedy, and the onus upon everyone to fathom how homeland security initiatives have made the country any safer. |
More than just how-to manuals for a flu pandemic, the documents are powerful political artifacts. Their carefully timed delivery boosts the image of a White House under mounting pressure to explain how dramatic economic, social and military investments in “security” have actually made Americans safer. The publicized release came just days after a series of grave political blows to the administration: the 2,000th soldier killed in connection with the Iraq War; Harriet Miers’ withdrawal as Supreme Court nominee; and the grand jury indictment of the vice-president’s chief-of-staff. The serially released documents help make tangible the administration’s claim to be on top of things.
Pandemic publications, however, also serve as important rallying points for medical and public health stakeholders to advocate more forcefully on a number of concerns. The plan’s silence on how exactly the US will produce adequate supplies of pandemic vaccine in the short and long term presents an important opportunity to spotlight a chronically weak vaccine manufacturing sector. The plan’s laundry list of hospital “to do’s” in readying for a pandemic unaccompanied by a budget easily prompts the pointed query about how officials intend to mobilize a fragmented, mostly for-profit health care system to meet the crushing demand for medical services.
Failed Analogies
A US game plan for pandemic flu is a welcome development given mounting concern among world health authorities about more frequent and widespread outbreaks of H5N1 avian flu, and the general prospect of a human influenza pandemic someday evolving. The White House embrace, whatever its complex motivations, provides lurching-forward motion to a public health issue that has been in stasis for some time. From one source, a generic pandemic flu “plan” has been under construction for ten years; from another, since the 1970s when memories of swine flu were fresh. Even now, only two employees work full-time on the plan, and one is leaving federal service in December. Proactive policy for a future health crisis is typically a hard political sell.
Recent impetus for US pandemic flu policy, however, is integrally related to the repackaging of public health, primarily in terms of national security. Readying for an influenza pandemic easily strikes a chord in a populace primed for public health emergencies like bioterrorism. However, treating a flu pandemic as a defense matter—as in Fauci’s nature-as-terrorist metaphor—rather than the global ecological event it actually is makes for poor health policy. The “National Strategy,” HHS plan, pandemicflu.gov and the president’s speech reveal erroneous ideas about containing a pandemic flu virus. Showing a fortress mentality, the documents falsely reassure that the US can escape pandemic flu unscathed through containing the first cluster of human infections overseas, monitoring points of “entry to and egress from affected areas” and imposing geographic quarantines at home. In his speech, the president invokes a forest fire image: “If caught early it might be extinguished with limited damage; if allowed to smolder undetected, it can grow to an inferno that spreads quickly beyond our ability to control.”
The virology, epidemiology and sociology of a human influenza pandemic suggest profound faults with these analogies. Past influenza pandemics have not developed in a slowly mounting linear fashion, but in quick multi-focal bursts. Targeting antiviral drugs and quarantine at the pandemic’s point of origin (that is, promptly dousing the spark in the forest) is simply not feasible. Mathematical models of quarantine for flu show that there must be a nearly perfect degree of limitation of travel to be effective—another practically unachievable goal. Lastly, implying a foreign point of origin for the pandemic against which the country can and must be secured creates a “geography of blame” likely to stigmatize Asia and Asian-American peoples, neighborhoods and commodities.
The September 11 attacks, Hurricane Katrina and now a possible flu pandemic are strung together in the minds of US politicians, health and safety professionals, journalists, and many citizens by dint of chronological proximity, the need to make sense of human tragedy, and the onus upon everyone to fathom how homeland security initiatives have made the country any safer. In the meantime, failures of imagination continue to plague US policy regarding complex modern disasters.
Monica Schoch-Spana is an assistant professor of medicine and infectious diseases at the University of Pittsburgh. She has worked on public health and biological weapons policy for the last seven years.
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