Homeland Insecurity - The Monster at Our Door: The Global Threat of Avian Flu - page 57

Certainly the leading influenza researchers, from 2001 onwards, were doing their utmost to alert med-
ical colleagues worldwide to the urgent threat of avian flu, as well as outlining the immediate steps that
the Bush administration and other governments needed to take. As befitted his position as “pope” of in-
fluenza researchers, Robert Webster tirelessly preached the same sermon: “If a pandemic happened today,
hospital facilities would be overwhelmed and understaffed because many medical personnel would be
afflicted with the disease [the lesson of SARS]. Vaccine production would be slow because many drug-
company employees would also be victims. Critical community services would be immobilized. Reserves
of existing vaccines, M2 inhibitors, and NA inhibitors would be quickly depleted, leaving most people
vulnerable to infection.” 248
Webster stressed the particular urgency of increasing production of the neuraminidase (NA) inhibitor
oseltamivir (Tamiflu). * Because a vaccine was unlikely to be available in the early stages of a pandemic,
Webster urged that “NA inhibitors [e.g. oseltamivir] should be stockpiled now, in huge quantities.” Be-
cause this strategic antiviral was “in woefully short supply”—made by Roche at a single factory in
Switzerland—Webster and his colleagues underlined the need for resolute government action. “The cost
of making the drugs, as opposed to the price the pharmaceutical companies charge consumers, would not
be exorbitant. Such expenditure by governments would be a very worthwhile investment in the defence
against this debilitating and often deadly virus.” Failure to act would mean intense competition over the
small inventory of life-saving Tamiflu. “Who should get these drugs? Health-care workers and those in
essential services, obviously, but who would identify these? There would not be nearly enough for those
who needed them in the developed world, let alone the rest of the world's population.” 249
Webster was not calling for a new Manhattan Project, just prudent action to ensure an adequate an-
tiviral stockpile. But for almost three years he and other influenza experts were ignored, as were those
who argued more generally that “the best way to manage bioterrorism is to improve the management of
existing public health threats.” 250 The Bush administration instead fast-tracked vaccination programs for
smallpox and anthrax, based on fanciful scenarios that might have embarrassed Tom Clancy. In reality,
Project BioShield was designed to build support for the invasion of Iraq by sowing the baseless fear that
Saddam Hussein might use bioweapons against the United States. * In any event, Washington spent $1
billion expanding a smallpox vaccine stockpile that some experts claim was already quite sufficient. Hun-
dreds of thousands of GIs were forced to undergo the vaccinations, but frontline health workers—the
second tier of the smallpox campaign—largely boycotted the administration's attempts to cajole “volun-
tary” participation.
In spite of this fiasco and millions of doses of unused vaccine, the administration pressed ahead with
the development of second-generation smallpox and anthrax vaccines, as well as vaccines for such exotic
plagues as Ebola fever; it continued to reject the “all hazards” strategy recommended by most public-
health experts in favor of a so-called “siloed approach” that focused on a shortlist of possible bioweapons.
In testimony before the House of Representatives, Tommy Thompson explained that while “private in-
vestment should drive the development of most medical products,” only the government was in a position
to develop those products that “everyone hopes . . . will never be needed” as a protection against “rare yet
deadly threats.” The government, in other words, was willing to spend lots of money on biological threats
that were unlikely or far-fetched, but not on antivirals or new antibiotics for the diseases that were actually
most menacing. As Project BioShield morphed into the biggest show in town (growing from $3 billion in
fiscal 2002 to more than $5 billion in fiscal 2004), Thompson's wayward logic soon had perverse impacts
that confounded the hopes of the biodefense boom's early enthusiasts. 251
For example, instead of spurring a welcome trickle-down of money for research on big killers like
influenza, malaria, and tuberculosis, BioShield stole top laboratory talent away from major disease re-
search. With the National Institutes of Health's research budget barely keeping pace with inflation (after