The world needs to learn the right political lessons, too, and so far it has shown no sign of doing so. Instead, a scapegoat is being groomed. The WHO has come under intense attack for declaring a pandemic at all, and critics have even charged the pharmaceutical industry with influencing the decision. This is nonsense. The spring of 1918 saw a mild initial flu much like 2009 -- so mild, in fact, that the British Grand Fleet patrolling Europe's coast had 10,313 sailors sick enough to miss duty during war, but only four died. Yet several months later, Armageddon arrived. Aware of that history, the WHO was all but compelled to act as it did. If the criticism of the WHO makes it less cautious in the future, the world will become a more dangerous place.
The real over-reaction came not from the WHO but from the nations that ignored the accurate epidemiological and clinical information the WHO regularly released. These countries refused to adjust their response and implemented extreme measures, either out of irrational fears or for domestic political reasons.
The Truth From Mexico
The world needs transparency about disease, and Mexico, where the disease first appeared in humans, did tell the truth about H1N1. For this it was roundly punished. Since there was no possibility of containing the virus, WHO and FAO explicitly recommended against trade or travel restrictions. Yet at least 25 countries limited trade with or travel to Mexico. France demanded that the EU suspend all flights to Mexico, and although that did not happen the EU and the U.S. government did recomment canceling non-essential travel to Mexico -- despite the U.S. soon having more cases of H1N1. The World Bank estimated even this mild pandemic cost the Mexican economy 0.7 percent of GDP. Such political reaction makes the world less safe, since it makes countries less likely to tell the truth for fear of the repercussions.
Even more disturbing, a host of nations revealed themselves as determinedly and self-destructively committed to their individual political interests. It should surprise no one that the United States promised last September to give some vaccine to countries without any, then retracted the promise when vaccine production lagged, saying it first had to protect its own vulnerable population. But breaking a commitment sets a dangerous precedent, and the United States imports almost 70 percent of its vaccine. In a severe pandemic, political leaders of an exporting country could refuse to allow their manufacturers to ship supplies to the United States until its own population is protected, and cite this U.S. precedent.
National Irrationality
At least hoarding vaccine to protect your domestic population is rational. The pandemic also demonstrated the irrationality of nations. Egypt exploited the outbreak to slaughter all pigs, a popular act since Muslims don't eat pork. Several countries either lied or all but totally misunderstood the threat. Indonesia's health minister told his citizens they had no need to worry about H1N1 because they lived in a tropical climate. Chinese Health Minister Chen Zhu initially declared, "We are confident and capable of preventing and containing an H1N1 influenza epidemic." Yet this is, literally, impossible. In late September, with H1N1 already throughout China, he said his country would focus its vaccine effort on areas with greatest interaction with foreigners since it remained "a foreign disease."
Such actions neither encourage nor reflect transparency, and destroy trust between nations. They are counter-productive domestically, undermining a government's credibility. Above all, they make the world a more dangerous place.
In 2009 the world in effect took a test. At the scientific and technocratic levels, it did reasonably well. But at the level where politicians operate, too many countries failed, and failed miserably. That does not portend well for the future.
The H5N1 virus continues to infect and kill. It's still a threat as a pandemic, while HIV and SARS demonstrate that new infectious diseases can emerge at any time. Meanwhile, a sense of complacency seems to be settling over the world. Because H5N1 has not become a pandemic and H1N1 turned out to be mild, the idea that influenza is no longer a threat has become pervasive. Everything that happened in 2009 suggests that, if a severe outbreak comes again, failure to improve on that response will threaten chaos and magnify the terror, the economic impact, and the death toll. And it will come again.
John M. Barry, Distinguished Scholar at the Tulane/Xavier Center for Bioenvironmental Research, is the author of The Great Influenza: The Story of the Deadliest Pandemic in History (Viking, 2004). This study of the 1918 pandemic was named by the National Academies of Science the year's outstanding book on science or medicine. He has advised both the Bush and Obama administrations on influenza as well as other federal, state, and World Health Organization officials, and serves on advisory committees of Johns Hopkins Bloomberg School for Public Health and MIT's Center for Engineering Systems Fundamentals.
Copyright 2010 World Policy Journal
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