TCS Daily

The Andromeda Strategy

By James Pinkerton - October 20, 2005 12:00 AM

How much of a threat is the avian flu? We don't really know. The future is like that: it's unpredictable in its specifics. But the future is completely predictable at a more general level. Bad things happen. The good times no longer roll. Night must fall. That's a truth as old as Aesop; nothing will ever repeal the need to be vigilant and to be prepared. And right now, we are not prepared, for the current epidemic, or for the epidemic next time.

When the prospect of disaster looms small on the horizon, when it is no bigger than a fist on the periphery of our sightlines, it's easy to be overconfident, even smug. After all, our recent history is full of doomy media sensations that never amounted to much. Remember global cooling? Or swine flu? Or Y2K? Even the recent SARS breakout proved to be dangerous but not devastating.

Or conversely, and perhaps even more dangerously, the prospect of dread can make us cynical and fatalistic; we're all going to die anyway, so what's the big deal -- why not just ride it out? If our number is up, so goes such thinking, our number is up. Indeed, such nihilism is a pathogen that can't be contained by science, because it burrows into the human soul; there such nothingness rests, throwing its lulling nightshade over action, turning it into inaction. And thus the glory of humanity -- our capacity to change our circumstance through hard work and hard thought -- is extinguished.

So once again, it could be that the bird flu is the Next Big Nothing. But since we know that history has a way of repeating itself, it's a cinch that we have calamitous epidemics in our future, as we did in our past. From the Black Death of the 14th century to the Spanish Flu of the 20th century, we can see a long and dolorous epidemiological chain. And in the future, we can see more such epidemics. Perhaps it will be like The Andromeda Strain, in some future century as yet undetermined. Or perhaps it will be the bird flu, after all -- which means that disaster draws near.

With those historically informed thoughts in mind, let's consider a strategy for dealing with the next big danger, whenever it comes. That strategy might be summed up in four M's: Monitor, Manage, Manufacture, and Mobilize.

As we shall see, bits and pieces of this strategy are in place. That's the good news. The bad news is that the missing pieces -- most obviously, a comprehensive and long-term plan for producing more life-saving drugs -- stare at us like the hollow eyes of a skull.

As for Monitoring, there's a lot of that going on now. We can all watch the grim progression of the avian flu, as it advances from Asia into the edges of Europe, toppling dominoes of complacency as it edges closer.

Sir Liam Donaldson, chief medical officer of the United Kingdom, warned recently that if a new flu strain hit his country, 50,000 would die. He added that a death toll 15 times that great was "not impossible."

And Klaus Stoehr, director of the World Health Organization's influenza program, observed, "The virus has the potential to change and mutate and thus spark a terrible pandemic." Once again, uncertainty; as Stoehr continued, "We don't know whether a pandemic will break out in the coming weeks, months or only in years. But there's no question that if such a pandemic occurs we'll be looking at hundreds of thousands or even millions of deaths worldwide."

In the meantime, as we wait for perspective on what might come, we can monitor the past, too; we can look back, most urgently, to the killer Spanish Flu. Here's a letter dated September 29, 1918, written from the US Army's Camp Devens, Mass. World War One was raging in Europe, but American doughboys faced greater danger at home, far from the Kaiser's bullets:

        "These men start with what appears to be an ordinary attack of LaGrippe 
        or Influenza, and when brought to the Hosp. they very rapidly develop 
        the most viscous [sic] type of Pneumonia that has ever been seen. 
        Two hours after admission they have the Mahogany spots over the cheek 
        bones, and a few hours later you can begin to see the Cyanosis extending 
        from their ears and spreading all over the face, until it is hard to distinguish 
        the coloured men from the white. It is only a matter of a few hours 
        then until death comes, and it is simply a struggle for air until they 
        suffocate. It is horrible. One can stand it to see one, two or twenty 
        men die, but to see these poor devils dropping like flies sort of gets on 
        your nerves. We have been averaging about 100 deaths per day, and still 
        keeping it up."

But monitoring is mostly passive -- not good enough by itself. If all we do is watch and wait, and then do nothing, we might as well just have a party, like the one Edgar Allen Poe described in "The Masque of the Red Death". Here's a spoiler for the time-pressed: Poe's macabre tale does not have a happy ending.

So next we turn to that most American of virtues: Managing. In the wake of the management snafus of Katrina, President Bush was asked about the avian flu threat at his October 4 press conference; he offered a thoughtful answer which shows, at least, that no hapless Michael Browns will be in charge of a Viral Big One. Yet once again, we don't know the future; we don't know whether the US government's response will be equal to the challenge. But some distant early warning indicators are not so promising; one of Uncle Sam's scenarios envisions shortages of food, medicine and electricity, followed by mass riots and the ultimate death of 1.9 million Americans.

In other words, as we stare into the tiny grains of the flu virus, we could be looking at Katrina multiplied by a thousand. This is the best we can do? The richest country in the world? Clearly, what we have seen over the past few decades hasn't been management, but rather malpractice.

But even before we get to the management blame game, we should be looking toward the manufacture of a cure. Unfortunately a cure doesn't exist -- a future action item if there ever was one, which we will come back to later. For now, we do have an anti-viral medicine, called Tamiflu, but we don't have enough. Indeed, at present, so parlous is our condition that even if we wanted to start manufacturing more right away, it would still take years to build up an adequate stockpile.

What's more, as Waldemar Ingdahl has noted here at TCS, since 1970, the number of companies producing vaccines has fallen by 80 percent. Which is to say, while the need has been going north, the supply has been going south.

What explains this wrong-way trend? One reason is that the government has practiced a kind of malign neglect toward vaccines and toward the innovative side of the pharmaceutical industry. Consider the fate of Merck. The New Jersey-based company is currently being clobbered by costly Vioxx lawsuits, based on junk science, as the federal government watches passively. Yet even so, Merck has persevered on a vaccine for the human papilloma virus, which accounts for perhaps 70 percent of the world's cervical cancers. It would be a tragic shame if Merck were knocked out of the innovation box by big lawsuits, before its vaccine, Gardasil, ever reaches the women who need it. What national interest would that serve? We need to rethink our approach to manufacturing, because at present, US government mismanagement -- tolerance for predatory lawsuits -- is undercutting the productive and lifesaving fundaments of the pharmaceutical industry.

Indeed, motivated by a strange mix of desperation and calculation, many governments around the world are considering compounding past mismanagement with still more mismanagement. Here's how: Hans Hogerzeil, acting director of the department of essential drugs and medicines policy at the World Health Organization, demanded recently that Roche, the maker of Tamiflu, cut its price and waive its patent rights, so that anybody, anywhere, could make the drug. Hogerzeil's comments stand in sharp contrast to those of his boss, Lee Jong-wook, who, mindful of the enormous investment needed to make medicines, has said that it is bad policy to weaken drug patents, since they are the cornerstone of production. But of course, it's Hogerzeil's flamboyantly anti-corporate populism that grabs the attention of the controversy-crazed world media.

If any of this legal-medical jousting sounds familiar, it should. Because the same Hogerzeil and the same WHO had the same bright idea about AIDS drugs. Working closely with NGO activists, the world's public health-ocracy cooked up a scheme to "pre-qualify" copycat AIDS drugs, manufactured in India, onto the market. But "pre-qualification" proved to be a synonym of "non-quality." So great was the danger of these pseudo-drugs that they had to be withdrawn from the marketplace. It was a humiliating for the neo-Naderite "H Team" of genericists, but evidently not so humiliating that the H-ers aren't up to the same trick again.

So what to do? Roche made mistakes. It obviously underestimated the demand for Tamiflu and/or failed to sound the epidemiological alarm bell. But at the same time that Roche was falling down on the manufacturing side, the governments of the world were failing to monitor and manage.

Now there's only one thing to do: manufacture more. Roche is frantically trying to expand capacity for Tamiflu. Is that a good enough plan? It's hard to know, but Tyler Cowen of George Mason University has an idea: why not offer a prize to Roche if it successfully ramps up production? Why not? After all, incentives work; prizes work.

Moreover, Roche has even indicated that it is willing to contract out its patent to qualified drug manufacturers, but not to the Indian generic-makers, such as Ranbaxy and Cipla. Yet if the flu flaps its deadly wings closer to humans, the pressure to override Roche and turn the whole flu-vaccine project over to the Indians will only intensify.

If that happens, not only will Tamiflu production be jeopardized, but the entire future of the pharmaceutical industry will be undercut. If it costs close to a billion dollars to make a drug, and if future profits are non-existent -- well, it doesn't take much management expertise to see that future discovering and manufacturing will be non-existent, too.

Obviously these sorts of concerns will keep coming to the fore. We can continue to think of the problem as a matter for monitoring, managing, and manufacturing, but something is missing -- the sense of urgency that should come from a truly grave threat. And so to the fourth M: Mobilization. If we now understand that this is an urgent priority for America, we should act accordingly. We've mobilized in the past, and it's time to do so again.

I have written elsewhere that we need to think of natural disasters as a kind of war, and that we need to call out the military when needed -- because if it's a matter of life and death, we should use all our resources.

But our greatest resource is our collective will to solve problems -- to apply the lessons of the past to the threats of the future. We have been caught unawares many times before -- the Great Mississippi River Flood of 1927, Pearl Harbor, 9-11, and now Katrina. In each instance, our system failed us. But our past record suggests that we have the capacity to institute new mechanisms and safeguards to prevent repeat disasters. And while the great chronicler Edward Gibbon might have been right when he wrote that history is "little more than the register of the crimes, follies and misfortunes of mankind," we should continue to act as if America is different -- can be made different. So when we see a headline in The Indianapolis Star -- "Flu pandemic will happen eventually, experts say/Some form of the virus will sweep the world and take a high toll, but it may not be avian" -- we should view those words as an injunction to action, not as a death sentence.

We don't know what we face in the future. But we can be reasonably sure that the sorry saga of natural diseases will soon enough be supplemented by new chapters of unnatural epidemics, inked inadvertently in industrial accidents, or written purposefully by malevolent scientist-terrorists. The specter of new "superbugs" -- imagined by science-fiction writers today, created in laboratories tomorrow -- haunts our normal revelry, like Poe's Red Death.

Thus the absolute necessity of the Four M's -- the need for constant monitoring, managing, manufacturing, and mobilizing. If we implement these Ms, we will be as equipped as we can be for the Andromeda-level threats that are sure to come. And if we don't, well, then we will suffer and die as we have in the Gibbonesque past.


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