The Titanic Paradigm - The Monster at Our Door: The Global Threat of Avian Flu - page 66

Shanghai 16.4

Manhattan & central Tokyo 13.4

Mexico City 11.7

World urban average 6.6

London 4.5

Los Angeles 2.4

(One of Ewald's signal theoretical contributions to the study of pandemics, by the way, has been to
show that pathogens do not always become less virulent and more well-behaved over time, as some text-
books still claim. Offered the unprecedented menu of huge slum populations, a new pandemic influenza
might not be as easily tamed as some of its ancestors. As Ewald explains, “If predator-like variants of a
pathogen population out-produce and out-transmit benign pathogens, then peaceful coexistence and long-
term stability may be precluded much as it is often precluded in predator-prey systems.”) 289
But there is also a fourth, negative element that closes the ominous circle of influenza ecology: the
absence of an international public health system corresponding to the scale and impact of economic glob-
alization. Such a system, as Laurie Garrett emphasizes in her much-praised topic, Betrayal of Trust: The
Collapse of Global Public Health, “would have to embrace not just the essential elements of disease pre-
vention and surveillance that were present in wealthy pockets of the planet during the twentieth century,
but also new strategies and tactics capable of addressing global challenges.” Nothing like this, of course,
now exists, and Garrett paints a dark, almost despairing portrait of how the worldwide HMO revolution
(which, in addition its effect into the United States, has also had a surprisingly broad impact on developing
countries) has promoted cost-containment at the expense of saving lives. The WHO, “once the conscience
of global health,” Garrett adds “lost its way in the 1990s. Demoralized, rife with rumors of corruption,
and lacking in leadership, the WHO floundered.” 290
Richard Horton, the editor of The Lancet, the premier British medical journal, offers an equally bleak
view of world public health. “UNICEF and WHO have largely abandoned the world's children to die in
poverty. For example, spending on immunization by UNICEF totaled $180 million in 1990. By 1998, the
figure had fallen to around $50 million.” Some 11 million children under the age of five die each year,
and “99 per cent of these deaths occur in setting of acute poverty.” Horton accuses the WHO, even under
the supposedly enlightened tenure of Director-General Gro Harlem Brundtland, both of being subservient
to corporate elites and “of censorship when criticism was made of the pharmaceutical industry.” He also
damns the Bush administration's sordid crusade to defend Big Pharma's monopoly over drugs treating
chronic conditions. “Once again,” he wrote after a 2002 U.S. veto of Third World efforts to obtain cheaper
generic pharmaceuticals, “access to vital drugs to treat health emergencies among those living in poverty
will be restricted solely to protect profit. And WHO has nothing to say on this issue.” Many of the most
effective artemisinin-based antimalarial drugs, for example, are priced out of reach of the poor people
whose infants and small children die in such shocking numbers every year in sub-Saharan Africa. 291
Many Third World governments, meanwhile, are disinclined to spend much on public health when the
alternative is feeding their generals' bottomless appetites for new weapons. Delhi, for instance, spends
16 percent of its budget on defense, but only 2 percent ($4 per capita per annum) on health. 292 Other
poor countries are too shackled by structural adjustment and debt to have any choice. “Kenya,” Alex de
Waal complains, “finds itself unable to offer jobs to several thousand unemployed nurses because of a
cap on public-sector employment, while Zambia is in the extraordinary position of being required to lay
off health-sector employees, even while many districts have no health professionals at all.” 293 In sub-Sa-