I spent the last two weeks in Washington DC, watching with great interest how the US is dealing with the current outbreak of A(H1N1) flu. My own near brush with the virus came on the flight back to Sydney from San Francisco when, as a consequence of health status forms that the Australian Government required to be filled out, and diligent questioning by the cabin stewards, it emerged that there were five people on our flight who admitted to having flu-like symptoms.
As punishment for their cardinal sin in getting on a plane with such symptoms after all the media hype of the past few weeks, these people were forced to exit first from the plane, in a parade of shame down the aisles, wearing face masks and herded by an efficient quarantine person. The rest of us sat in silence, no doubt all contemplating the possibility of an enforced quarantine period together.
And in case anyone was tempted to resist the push to reveal their current health status, the new heat (read: fever) detecting cameras acquired as a consequence of the SARS epidemic were in operation as we finally headed off the plane.
Although the swine flu story is far from over, it is clear that both in the US and Australia the systems set in place as a consequence of earlier threats from SARS and avian flu have served us well, if imperfectly, in terms of early alerts, public awareness and education, coordination of services, and control over the spread of infection.
However a major flaw in the US strategy for managing a flu pandemic has been exposed. The US plans assume that such a pandemic will originate elsewhere in the world, with a delay before the infection reaches the US, and that this delay provides the opportunity to trigger all the required alerts and ramp up all the needed services.
How ironic that the country that so often sees itself at the centre of world power and innovation did not imagine a situation that would see itself at the epicentre of a flu pandemic. Particularly ironic given that it is very likely that the deadly 1918 flu strain originated in the US, despite the fact that it is often referred to as the “Spanish flu”.
Yet it now appears possible that the first cases of this new A(H1N1) “triple re-assortment” virus combining human, swine and avian flu genes, were first seen as early as 2005 in the American Midwest. And even if this turns out not to be the case, the porous US — Mexican border means that a flu virus originating in Mexico might as well be American.
The Australian pandemic flu plans have the same flaw — the assumption that threats from new flu viruses will come from outside the country. But the early work of the late Professor Graeme Laver, who isolated flu viruses from migratory birds on the islands in the Great Barrier Reef, shows how easily the necessary gene re-assortment to produce a virulent flu strain could occur in northern Australian and nearby territories.
We should hope that the inevitable reviews and updates of current strategies for dealing with pandemics in both Australia and the US will take into account this lack of egocentricity and imagine a world where epidemics don’t originate only in less-developed countries.
The processes of gene re-assortment and antigenic drift have no respect for global status in power, economics or health care systems.