My grandmother loved to tell me stories about the tough times after the First World War when she was growing up. As a ten-year-old I was more interested in guns and battles but I never forgot her remark that the Spanish flu in 1918 was actually more devastating than World War I in terms of casualties. That pandemic infected 40 percent of the world’s population, killed over 50 million people, and particularly affected young adults.

She had a natural worry about influenza in a way my parents’ generation do not. My parents’ complacency was natural, rational, and efficient. Despite two serious pandemics—Asian flu of 1957 and the Hong Kong flu of 1968, which took about two million and one million lives respectively, mainly amongst the elderly—since World War I there has not been such a devastating pandemic. But with increased globalization there is more of a risk of a pandemic than when I was growing up in the 1970s and 1980s.

The H1N1 swine flu emerging from Mexico that seemed to catch the world off guard in the last week spreads quickly and is similar to Spanish flu in that it mainly affects healthy young adults. Already a suspected 149 Mexicans have died (20 definitely caused by H1N1) and cases have been confirmed in the United States, Canada, Spain, and the United Kingdom, with Australia, New Zealand, Guatemala, Peru, and Brazil investigating suspected cases.

The World Health Organization (WHO) has claimed H1N1 has “pandemic potential” and has increased surveillance, as have national agencies, such as U.S. Centers for Disease Control and Prevention. This week Mexico’s Health Secretary, Jose Angel Cordova, said suspected swine flu cases in his country had risen to nearly 2,000. A public health emergency has been declared in the United States, where 40 people are confirmed to have caught the virus.

As airline and travel company shares reel from the news, shares in drug companies Roche and GSK, which make antiviral drugs Tamiflu and Relenza, have risen significantly. Stockpiles of these drugs are being readied and a small amount deployed (fortunately both appear effective for most patients against the swine flu). Even better news is that outside of Mexico, patients have exhibited only minor symptoms and made a full and rapid recovery.

Stockpiling drugs is useful, as are regular flu shots in the autumn, but no clinical intervention for flu is 100 percent effective or even close to that. Vaccines that are currently made and modified according to this year’s strain of regular flu save lives. Public health experts are debating switching resources away from them towards swine flu protection. But policy made on the urgent desire to be seen as acting on swine flu may lower the number of flu shots produced for the types of flu most of us will encounter.

Preparing for Pandemics

At a conference at the Chatham House think tank in London six weeks ago, I sat in on the session on preparing for pandemic diseases, especially bird flu. The strongest complaint I heard that day from representatives of the World Bank and WHO was that governments the world over, except the United States and to a lesser extent the United Kingdom, were not paying for the special efforts required to maintain constant vigilance against an outbreak of pandemic flu. Most speakers thought that preparations were reasonable in the richer nations but hopeless in the middle-income and poorest nations. 

Policy made on the urgent desire to be seen as acting on swine flu may lower the number of flu shots produced for the types of flu most of us will encounter.

It is the WHO’s mandate to operate on international crises such as swine flu and it is highly competent to do so. But the richer nations, which can clearly muster the wherewithal to manage an epidemic within their own borders, seem reluctant to fund such operations on behalf of the poorer ones. This is shortsighted because the infected may well travel to or through richer nations. Also, rich nations do not hold back from funding other activities at WHO—notably campaigns to tackle problems with no supra-national element at all, such as obesity or smoking, on which they will spend over $320 million this year alone. And although WHO will in 2009 spend $356 million on emergency response, including combating flu outbreaks, it is not enough. The result is that there are not enough WHO public health experts fluent in enough languages to help tackle a major flu outbreak. 

The current financial crisis has made funding even tighter for the poorer nations. As one Chatham House delegate said, the money has “gone to save the banks and the IMF!” With little funding, nations such as Thailand, Cambodia, Vietnam, and Myanmar are loath to continue culling birds that might be infected with bird flu; we shall have to see if Latin American nations will cull pigs to the degree required to prevent far greater animal-to-human transmission. 

Much of the focus is on making sure there are enough drug stockpiles in place. While drugs are useful, and work on much of the population, the failure rates are often quite high. More importantly, over reliance on drugs is misplaced. The best way to combat a potential flu pandemic is the same today as it was when my grandmother was young: quarantine the infected and dissuade people from traveling to and from known infectious areas; at a personal level, wash hands and face often and stay away from crowds. Unfortunately the public health agency funds needed to explain these simple precautions are sorely lacking.

Roger Bate is Legatum Fellow at the American Enterprise Institute.

FURTHER READING: Bate wrote “A Dangerous European Export” for The American on how several European nations are turning away from vaccination and are now spreading disease.