By DemFromCT, cross-posted from Daily Kos

The Fatal Strain: On the Trail of Avian Flu and the Coming Pandemic
Alan Sipress
Viking Adult
Hardcover, 400 pages, $27.95 list
Kindle Edition $13.49
November, 2009

Money quote: CDC and WHO epidemiologist Tim Uyeki is in Indonesia, collecting flu specimens from a very sick bird flu patient who is deeply suspicious of westerners and his own country’s doctors (he’s already fled from a local hospital because family members died there.) So suspicious, in fact, the family will not permit blood samples or protective gear other than a respirator and gloves.

Uyeki squatted beside him and leaned right in. The doctor’s eyes were just inches from those of his patient. Uyeki lifted the swab. Then, he carefully inserted it through the open mouth and down Dowes [Ginting]’s throat.

The sensation must have tickled. For at that very moment, Dowes coughed. And when he did, it was right in Uyeki’s face.

Uyeki didn’t blanch. But inside, his stomach dropped. “Oh, this is not good,” Uyeki fretted to himself. Despite the mask, most of his face was exposed. His mind raced. He instantly thought about his unprotected eyes.

Basic Premise: The author follows the emergence of bird flu in Southeast Asia, including near miss outbreaks, the response of the local population and national governments, and WHO’s struggle to conduct surveillance against a backdrop of mistrust and lack of cooperation. All of those problems continue to exist, and the next pandemic may well be more severe than this one.

Author: Alan Sipress is a deputy business editor and former foreign correspondent at The Washington Post. In the past, he’s primarily written about national security and foreign affairs. In 2005, the Post team that he anchored was awarded the Jesse Laventhol Prize for Deadline Writing for coverage of the South Asian tsunami. This is his first book.

Readability/quality: Compelling and unnerving medical detective story. See the money quote about the epidemiologist who gets a cough in the face while sampling a bird flu victim. Full disclosure: I know Tim Uyeki, and that excerpt unnerved me.

The author brings depth to the topic (see interview) beyond just the science aspects (one example is witch doctors, live bird markets and cock fighting and their relationship to disease prevention and treatment.)

Who should read it: Anyone who wants to know what it’s like to to be a medical detective in developing countries (and learn more about how the medical system works there); anyone who wants to know why there’s an emphasis on vaccine production for pandemic planning; anyone interested in the food chain origin of human disease; anyone interested in the politics and culture of Southeast Asia, including Indonesia.

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I met the author, Alan Sipress, for the first (and only) time at a pandemic preparedness conference three years ago when we served on a media panel together (I was the “blogger”, back then an exotic instrument the audience was mostly unfamiliar with.) I was impressed with the background Alan brought to this topic and, coming at it from a different angle than the medical and science writers, he brought extensive travel and work experience as well as great insight into the countries in Southeast Asia that are the topic of this book. This is a topic and an area of the world he knows well. He’s kindly agreed to answer a few questions for us on those very topics.

Interview with the author:

Daily Kos: What’s the Jesse Laventhal Prize and how did you wind up with the award?

Alan Sipress: Regarding the award, the Jesse Laventhol Prize for Deadline Writing is awarded by the American Society of News Editors, which is a professional non-profit that promotes quality journalism and press rights. The award is among the premier journalism prizes given out each year. In our case, the award was for the Post’s coverage of the 2004 tsunami that devastated Sumatra in Indonesia, Sri Lanka and other countries bordering the Indian Ocean. I anchored that coverage, which involved reporters around the region, and wrote the main article the day after the tsunami. A day later, I headed to Aceh, where I was among the very first foreign journalists to arrive following the catastrophe.

Daily Kos: You were not primarily a science reporter. You’ve written about national security and foreign affairs, and now are a business editor. What got you interested in influenza?

Alan Sipress: I became fascinated by flu after the Washington Post dispatched me in 2002 to Southeast Asia as a foreign correspondent based in Indonesia. When I first set out for Asia, I’d expected I would be spending most of my time writing about terrorism – like the Bali nightclub bombings that I covered shortly after I arrived – and political turmoil. But once avian flu broke out in Vietnam and Thailand, I realized we were facing an even greater menace. And it wasn’t just the huge stakes for humanity that made the virus so compelling. On one hand, the science of influenza is amazing. This virus is like few other microbes: ever changing, shifting shapes and swapping genes.  At the same time, there are these vast realities in Asia – like dramatic economic changes, rampant political corruption and age-old customs like cockfighting – that conspire to breed the disease and accelerate its spread. So, if you will, I was bit by the bug and went on to track it across nine Asian countries.

Daily Kos: You’ve travelled extensively through Southeast Asia. Indonesia, in particular, is a focus because of its size and cultural diversity. Do Indonesia, Vietnam, China and other Asian countries have the will and the resources to deal with emerging infectious disease? If they do centrally, does that translate locally?

Alan Sipress: Time after time, governments in Asia covered up their bird flu outbreaks. Chinese government scientists, for instance, knew that bird flu was sickening livestock outside Hong Kong as early as 1996. But Chinese officials refused to acknowledge the outbreaks and even encouraged farmers to keep them hidden by giving their poultry antiviral drugs that were meant strictly for humans. Indonesian officials at the highest level of government also lied about their initial outbreaks. The country’s director of animal health told me that this cover- up was designed to protect the economic interests of large, politically connected farming conglomerates. By the time Indonesia came clean, the virus had spread across much of the country. Today, Indonesia is perhaps the most likely source of  any new pandemic flu strain. So yes, while central governments can have trouble getting local officials to tackle infectious disease, a more daunting problem may be the determination of government officials – especially agriculture officials – to promote farming interests over public health.

Daily Kos: In 2003, WHO advice to curtail tourism to Toronto because of SARS had a significant negative effect on Canada’s GDP. Are there echoes of that now in the response of counties of Europe and elsewhere to H1N1?

Alan Sipress: There’s no doubt that outbreaks of infectious disease can throttle a country’s economy. These outbreaks can affect trade, tourism and other economic activities. Back in 2005, some of the world’s top flu hunters had lab results from Vietnam showing that a highly lethal pandemic flu strain might have already erupted there.  But the results were not yet conclusive, and the World Health Organization and Vietnam both kept this utterly secret for several years. Why? The news could have decimated Vietnam’s economy, and the whole region could have suffered. Multinationals might suspend their operations. Foreign governments might evacuate their nationals. Airlines might cancel routes, leaving countries isolated and visitors marooned. Stock markets would plunge. More recently, with H1N1 swine flu, it was Europe’s turn to worry about the fallout. We know, for instance, that WHO accused the British government in private conversations last year of intentionally understating the size of their swine flu outbreak. The British, it seems, were afraid of the stigma.

Daily Kos: What do westerners need to know about Asia’s claim that vaccines are too expensive for them, while they supply the viral raw material?

Alan Sipress: At this moment, humanity could be at risk because Indonesia and potentially other countries are reluctant to share their bird flu samples with international scientists. A couple years ago, Indonesian officials were outraged to learn that flu samples taken from sick Indonesians and freely supplied to WHO were in turn being given to foreign drug companies. These companies intended to use the samples in making vaccines. Indonesia would have to pay for these vaccines, and they’re not cheap. Already, Indonesia doesn’t have nearly enough money to address all its other public health problems, like malaria, dengue, parasites and recently even polio. Indonesia called this an injustice and stopped sharing the virus samples. But here’s the rub. The world needs those samples. Without them, we can’t track how the virus is evolving and how the pandemic threat is shifting. We also need them to develop accurate tests for identifying bird flu cases and to develop vaccines ahead of what could be a devastating pandemic. Until now, the standoff continues.

Thank you, Mr. Sipress.

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