Jakarta Pandemic, The (64 page)

Background Material Cut from first draft of The Jakarta Pandemic

A Brief History of the Avian Flu Pandemic of 2008

During the spring of 2008, World Health Organization officials received alarming information, acquired from an undisclosed source deep within the Chinese Health Ministry. This highly classified intelligence underscored a troubling resurgence of widespread pneumonic illness in the Qinghai province, one of the provinces at the core of a major international controversy during 2005.

In 2005, thousands of suspected avian flu cases were reported in the Qinghai and Sichuan provinces by Xining News and Boxun, both underground internet-based Chinese news sources. Based on these reports, WHO officials asked the Chinese government to open the preliminary examination of these cases to the international community and formally invite the world’s combined scientific resources to guard against the pandemic potential of the H5N1 virus.

WHO scientists were predominantly concerned with H5N1’s potential adaptation to human-to-human transmission, since strains of H5N1 had already demonstrated a rapid acceleration in animal-to-human transmission. Predictably, the Chinese government gave little tangible cooperation, prevented effective WHO investigation, and eventually misinformed the world regarding the outbreak of avian flu in 2005.

Official Chinese press releases denied a widespread avian flu problem, though health ministry officials announced that a highly contagious and potentially deadly illness had spread throughout the region, resulting in hundreds of deaths. Surprisingly, Chinese government officials blamed swine streptococcus, a rare human pathogen, for the outbreak, quickly announcing that the epidemic had been contained. The WHO remained puzzled by the unusually high incidence and mortality rates, and soon grew extremely skeptical of the Chinese story.

At the very onset of the crisis, WHO scientists, working unofficially with sympathetic Chinese virologists in Hong Kong’s Centre of Public Health, had examined hundreds of virus samples sent to the Centre’s labs from the concerned provinces. They determined with certainty that the H5N1 virus had caused the epidemic. The results of their investigation were buried in China, most probably along with the collaborating Chinese scientists. WHO scientists and representatives were immediately expelled from the country, and when confronted by the WHO regarding these scientific findings, Chinese health officials denied that the tests were ever conducted, maintaining that their expulsion was due to misconduct. It became immediately clear to the international community that the Chinese government intended to keep the real facts of the 2005 epidemic inside China.

Most worldwide government health organizations quietly acknowledged the 2005 Chinese cover-up as a dangerous threat to world safety. However, with China on the rise as a major economic power, fully entangled with the world’s economy, the international community never overtly pushed China to further involve WHO investigators. Instead, the international community quietly concurred that the Chinese could not be trusted to take the responsible and effective actions necessary to prevent the spread of H5N1, should the virus shift to effective human-to-human transmission. Subtle plans were activated, which would at least provide the world with advanced warning of a coming pandemic. In April 2008, one of the plans yielded startling information. This information immediately activated the international community.

Intelligence deemed highly credible by U.S. and European intelligence agencies was received by British agents in early April 2008 and immediately disseminated to the WHO and U.S. intelligence agencies. The information contained a warning that the Chinese government had mobilized the largest Health Ministry response in history to the Qinghai province. The official reason given by Chinese health officials was once again swine streptococcus, but the source strongly disputed the Chinese explanation. The source stated that the massive Health Ministry response was due to the confirmed presence of a quickly developing H5N1 flu epidemic in the Qinghai province, already larger than the outbreak in 2005.

Most alarmingly, the majority of the cases appeared to be individuals that were never in contact or near birds discovered to carry H5N1, and the infection spread easily among human contacts within close-knit rural villages. The source stressed the high likelihood that a major antigenic shift occurred within the known H5N1 virus, evolving into a strain easily passable between humans. Also notable, neither Xining News nor Boxun ever reported the 2008 outbreak of the Qinghai province epidemic. Apparently, these underground reporting services had been quickly and efficiently silenced, adding to the complexity and sensitivity of the diplomatic situation. The world needed to address the issue with the Chinese without admitting that they had been spying.

Several nations’ diplomatic services immediately contacted Chinese diplomatic officials, softly pressing for information, citing that rumors have persistently circulated about a new epidemic. The Chinese denied the presence of a problem in Qinghai, blaming anti-government factions for leaking false information in an attempt to sabotage the 2008 Summer Olympics in Beijing.

Hoping to quickly disintegrate the Chinese cover-up, the WHO, backed by several major governments, took several immediate controversial steps within a few weeks of receiving the information. First, the WHO revoked several million doses of an effective H5N1 vaccine that had been promised to the Chinese Health Ministry for the control of an avian flu epidemic. These doses were pre-staged in several east-Asian nations, ready for immediate deployment to China, but now would be allocated to the surrounding region in an initial effort to contain the virus. The international community had plausible reason to believe that these doses would be misused if delivered. Nearly 20,000 doses had been delivered to China in 2006 to be used for first responders and healthcare teams assigned to directly work in close proximity to any suspected H5N1 virus. Instead, numerous reports surfaced from China in late 2006, indicating that the vaccine doses had been given to national and regional Chinese Communist Party leadership. In 2008, China did not have any capacity to produce a flu vaccine.

Secondly, the WHO pandemic threat level was raised from phase 3 to phase 4, citing undisclosed information from Southeast Asia as the cause for the elevated threat level. This announcement provoked an immediate response from Chinese officials demanding the source of the information, and once again, completely denying the presence of an outbreak in Qinghai. The Chinese blamed the United States and several European countries for strong-arming the WHO to elevate the pandemic phase threat level in an attempt to undermine the 2008 Summer Olympics and ultimately tarnish China’s reputation. Neither the WHO, nor accused nations responded to the charge.

Next, the WHO activated an accelerated vaccine production plan that would increase production of the current H5N1 vaccine, to meet a 1 billion new dose minimum by early fall 2008. Additionally, all seasonal flu vaccine production capability would convert over the next few months to producing the H5N1 vaccine. Initially, this action was viewed as a major gamble, since scientists had yet to determine if the current H5N1 vaccine would be effective against the new strain. As a final precaution, many countries began to stockpile anti-viral medications like Tamiflu, although their effectiveness against H5N1 was in question.

Three weeks after the first intelligence surfaced from China, scientific virus data was obtained from a new source, and CDC virologists confirmed that the current H5N1 vaccine would be effective against the new human-to-human H5N1 strain. Frighteningly, CDC and WHO virologists also determined that the H5N1 strain currently widespread in the Qinghai province had all of the genetic markers to indicate a highly pathogenic virus, easily transmittable from human-to-human. The WHO immediately raised the pandemic threat level to phase 5, and the world was now locked in a silent race to produce H5N1 vaccine in a quantity sufficient to prevent a worldwide disaster.

The final and most controversial step was adopted by a nearly unanimous coalition of nations within a mere week of receiving CDC and WHO confirmation of the new strain of human-to-human H5N1. Travel restrictions were instituted, severely limiting any air, sea or railway travel for passengers departing or heading to China. Regional Restricted Transit Centers were established in several nations surrounding China to screen passengers departing China by air. All air passengers originating from China were required to pass through these RRTCs for screening. Initially, these new restrictions triggered a few tense aerial standoffs, when Chinese commercial passenger jets, escorted by Chinese MiGs, attempted to force landings at unauthorized airports in Singapore, South Korea and the Philippines. The United States deployed two additional Carrier Battle Groups to the region to assist with enforcement of the travel restrictions. Despite Chinese protest of the restriction, soon all aircraft departing China were peacefully routed through the RRTCs. Sea and railway travel proved more difficult to control.

Simultaneously, with credible scientific evidence of the new strain of H5N1 in hand, numerous United Nations members called for an immediate summit with the Chinese to discuss the unfolding events and to urge China to integrate full-scale international involvement into their efforts to contain the spreading avian flu disaster. United Nations leaders also stressed the importance of cooperation in order to ease tensions and avoid an unnecessary worldwide economic disaster.

Chinese government officials were now receptive to outside assistance, likely due to the fact that they could no longer conceal the sickness of nearly 2 million Chinese citizens. Most of the illness was reported in the Qinghai, Sichuan and Guizhou provinces, with several large-sized cluster outbreaks spread throughout the rest of China, including the coastal cities Shanghai, Hong Kong, Shenzhen, Guangzhou and Fuzhou.

The coastal industrial region, Guangdong, suffered from a massive outbreak, confirming a suspected southeasterly surge of cases, from the middle-western regions of China to the coastal areas surrounding Hong Kong. Despite hiding these outbreaks from the international community for nearly one month, Chinese health officials, with massive and heavy-handed military assistance, had managed to quickly and effectively quarantine the major epidemic areas, drastically limiting human traffic from infected areas.

Although the flu pushed southeast regardless of these efforts, solid intervention and containment activity to the north prevented the flu from any large-scale sweep toward Beijing and kept the H5N1 strain from reaching its full deadly potential in China. Unfortunately, for those trapped inside the quarantined areas, the highly pathogenic H5N1 strain showed no mercy. By the spring of 2009, nearly 20.3 million Chinese died within these areas alone. Casualties throughout the rest of China reached 9.8 million. Fortunately, the 2008 case fatality rate for the H5N1 strain turned out to be lower than predicted. During the 2005 outbreaks, H5N1 case fatality estimates in Asia ranged from 40-60%. For 2008-2009, the rate was closer to 8-10%.

While Chinese and WHO officials scrambled to contain the epidemic in China, the rest of the world continued to support quarantine travel restrictions for China and started to closely monitor their own populations for signs of the H5N1 flu. Governments began to distribute H5N1 vaccine according to national vaccination protocols and to ship limited supplies of vaccine to countries with no vaccine production capacity, as outlined by standing international protocol and pre-purchased vaccine arrangements. As of 2008, only nine countries reported vaccine production capability, with France, Germany, England and the United States providing nearly 65% of the total capacity.

In late May 2008, the summer Olympics in China were officially canceled, and in the beginning of June, the first cases of the new H5N1 strain started to surface internationally. The first significant virus clusters appeared nearly simultaneously in Siberia, Mongolia, India, Japan, Korea, Singapore, Indonesia, Australia and other countries along the western Pacific Ocean rim. However, hundreds of confirmed and suspected cases, or contained mini-clusters had already been reported worldwide.

The world braced for the seemingly unavoidable pandemic. New cases and confirmed virus clusters continued to appear worldwide, starting and spreading mostly in Southeast Asia during June and July, and eventually surfacing in the Americas, Africa and Europe by early August. Although isolated cases or mini-clusters appeared on all continents during late May and June, the spread of significant virus clusters progressed slowly over the summer, reaching all corners of the globe by early August. These significant clusters of flu cases represented the largest virus footholds and posed the greatest pandemic containment challenges. Consequently, these clusters received the bulk of WHO resources and attention.

However, as nations scrambled to contain the growing threat within their own borders, resources began to focus inward, leaving less fortunate nations with a drastically reduced capacity to handle the containment and treatment of the H5N1 pandemic.

Despite these shortcomings, the avian flu of 2008 was marked by a strikingly lower case fatality rate than expected, exhibiting a lower virulence than the previously seen strains. Additionally, it proved to be less contagious. These two key features, combined with both an effective international response and expansive vaccine program, produced a lower than expected worldwide transmission rate.

Nature’s gifts aside, contingency plans had been formulated by the WHO and funded by the international community since 2006, providing several key safeguards that mitigated the deadly effects of the 2008 H5N1 virus. Most effective were the severe and strictly-imposed travel bans with known or suspected areas of infection. The initial restriction against Chinese travel, imposed and robustly enforced by major world governments, made later restrictions throughout the world easier to impose and execute.