Home » Laurie Garrett: What Can We Learn from the 1918 Flu? (Transcript)

Laurie Garrett: What Can We Learn from the 1918 Flu? (Transcript)

Laurie Garrett, author of “The Coming Plague,” gave this talk in 2007 to a small group of TED University audience. This talk and her insights are suddenly more relevant than ever. Read the full text of Laurie Garrett’s talk below:


Laurie Garrett – Author

So the first question is, why do we need to even worry about a pandemic threat? What is it that we’re concerned about?

When I say “we,” I’m at the Council on Foreign Relations. We’re concerned in the national security community, and of course, in the biology community and the public health community.

While globalization has increased travel, it’s made it necessary that everybody be everywhere, all the time, all over the world. And that means that your microbial hitchhikers are moving with you.

So a plague outbreak in Surat, India becomes not an obscure event, but a globalized event — a globalized concern that has changed the risk equation.

And Katrina showed us that we cannot completely depend on government to have readiness in hand, to be capable of handling things. Indeed, an outbreak would be multiple Katrinas at once.

Our big concern at the moment is a virus called H5N1 flu — some of you call it bird flu — which first emerged in southern China, in the mid-1990s, but we didn’t know about it until 1997.

At the end of last Christmas, only 13 countries had seen H5N1. But we’re now up to 55 countries in the world, have had this virus emerge, in either birds, or people or both.

In the bird outbreaks we now can see that pretty much the whole world has seen this virus except the Americas. And I’ll get into why we’ve so far been spared in a moment.

In domestic birds, especially chickens, it’s a 100% lethal. It’s one of the most lethal things we’ve seen in circulation in the world in any recent centuries.

And we’ve dealt with it by killing off lots and lots and lots of chickens, and unfortunately often not reimbursing the peasant farmers with the result that there’s cover-up.

It’s also carried on migration patterns of wild migratory aquatic birds. And there has been this centralized event in a place called Lake Chenghai, China.

Two years ago, the migrating birds had a multiple event where thousands died because of a mutation occurring in the virus, which made the species range broaden dramatically. So that birds going to Siberia, to Europe, and to Africa carried the virus, which had not previously been possible.

We’re now seeing outbreaks in human populations — so far, fortunately, small events, tiny outbreaks, occasional clusters. The virus has mutated dramatically in the last two years to form two distinct families, if you will, of the H5N1 viral tree with branches in them, and with different attributes that are worrying.

So what’s concerning us?

Well, first of all, at no time in history have we succeeded in making in a timely fashion, a specific vaccine for more than 260 million people. It’s not going to do us very much good in a global pandemic.

You’ve heard about the vaccine we’re stockpiling. But nobody believes it will actually be particularly effective if we have a real outbreak.

So one thought is: after 9/11, when the airports closed, our flu season was delayed by two weeks.

So the thought is, hey, maybe what we should do is just immediately — we hear there is H5N1 spreading from human to human, the virus has mutated to be a human-to-human transmitter — let’s shut down the airports.

However, huge supercomputer analyses, done of the likely effectiveness of this, show that it won’t buy us much time at all. And of course, it will be hugely disruptive in preparation plans.

For example, all masks are made in China. How do you get them mobilized around the world if you’ve shut all the airports down? How do you get the vaccines moved around the world and the drugs moved, and whatever may or not be available that would work?

So it turns out that shutting down the airports is counterproductive.

We’re worried because this virus, unlike any other flu we’ve ever studied, can be transmitted by eating raw meat of the infected animals. And so we’ve seen transmission to wild cats and domestic cats, and now also domestic pet dogs.

And in experimental feedings to rodents and ferrets, we found that the animals exhibit symptoms never seen with flu: seizures, central nervous system disorders, partial paralysis.

This is not your normal garden-variety flu. It mimics what we now understand about reconstructing the 1918 flu virus, the last great pandemic, in that it also jumped directly from birds to people.

We had evolution over time, and this unbelievable mortality rate in human beings: 55% of people who have become infected with H5N1 have, in fact, succumbed.

And we don’t have a huge number of people who got infected and never developed disease.

In experimental feeding in monkeys you can see that it actually downregulates a specific immune system modulator. The result is that what kills you is not the virus directly, but your own immune system overreacting, saying, “Whatever this is so foreign I’m going berserk.”

The result: most of the deaths have been in people under 30 years of age, robustly healthy young adults.

We have seen human-to-human transmission in at least three clusters — fortunately involving very intimate contact, still not putting the world at large at any kind of risk.

All right, so I’ve got you nervous.

Now you probably assume, well the governments are going to do something. And we have spent a lot of money. Most of the spending in the Bush administration has actually been more related to the anthrax results and bio-terrorism threat.

But a lot of money has been thrown out at the local level and at the federal level to look at infectious diseases.

End result: only 15 states have been certified to be able to do mass distribution of vaccine and drugs in a pandemic. Half the states would run out of hospital beds in the first week, maybe two weeks.

And 40 states already have an acute nursing shortage. Add on pandemic threat, you’re in big trouble.

So what have people been doing with this money?

Exercises, drills, all over the world. Let’s pretend there’s a pandemic. Let’s everybody run around and play your role.

Main result is that there is tremendous confusion. Most of these people don’t actually know what their job will be. And the bottom line, major thing that has come through in every single drill: nobody knows who’s in charge.

Nobody knows the chain of command.

If it were Los Angeles, is it the mayor, the governor, the President of the United States, the head of Homeland Security? In fact, the federal government says it’s a guy called the Principle Federal Officer, who happens to be with TSA.

The government says the federal responsibility will basically be about trying to keep the virus out, which we all know is impossible, and then to mitigate the impact primarily on our economy.

The rest is up to your local community. Everything is about your town, where you live. Well how good a city council you have, how good a mayor you have — that’s who’s going to be in charge.

Most local facilities would all be competing to try and get their hands on their piece of the federal stockpile of a drug called Tamiflu, which may or may not be helpful — I’ll get into that — of available vaccines, and any other treatments, and masks, and anything that’s been stockpiled.

And you’ll have massive competition.

Now we did purchase a vaccine, you’ve probably all heard about it, made by Sanofi-Aventis. Unfortunately, it’s made against the current form of H5N1. We know the virus will mutate. It will be a different virus. The vaccine will probably be useless.

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