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the disease and behavior of the virus have created multiple opportunities for a pandemic virus to emerge,”
and that gradual genetic drift, rather than reassortment, might be sufficient to unleash H5N1 on humanity.
The Secretariat, underlining the “unprecedented opportunity to enhance preparedness,” worried that vac-
cine development had not advanced “with a speed appropriate to the urgency of the situation.” 319
Some of the rich countries represented on the thirty-two-member executive board, however, were
seemingly more concerned to protect pharmaceutical industry profits than to increase the availability of
vaccines and antivirals. When Thai delegate Dr. Viroj Tangcharoensathien proposed (with the precedent
of AIDS medications in mind) that the poor countries on the frontline of the avian flu battle be allowed
to override drug patents in order to produce affordable quantities of Tamiflu, the American and French
delegates vehemently objected and ultimately forced the meeting to adjourn without a vote. Dr. Anarfi
Asamoa-Baah, the head of the WHO's communicable disease division, gloomily noted that “as a global
community we are still ill prepared—and as long as one of us is not prepared, none of us is prepared.” 320
At a conference in Ho Chi Minh City a month later, this “alarming lack of commitment” from Japan,
Europe, and the United States was again a top agenda item as Asian health officials responded to a
warning by the WHO's Omi that the region was facing “the gravest possible danger of a flu pandemic.”
Shocked conferees heard one researcher after another outline fatal flaws in the underfunded avian flu sur-
veillance system. The Japanese National Institute of Infectious Disease, which had retested blood samples
from the Pasteur Institute in Ho Chi Minh City, reported that some of the negative results were in fact
positive: suggesting that avian influenza, although perhaps not as lethal as suggested by confirmed cases,
was actually more widespread and thus statistically closer to reassortment with human influenza. For its
part, the Oxford University team in Ho Chi Minh City added fuel to the fire with a case-study of a four-
year-old whose GenZ infection imitated acute encephalitis without respiratory symptoms. (Decades earli-
er, some scientists had associated a strange epidemic of sleeping sickness, encephalitis lethargica, with
the 1918 H1N1 virus.) How many other similar cases had been misdiagnosed? Disturbingly, the child's
stools were also full of H5N1—a warning that avian flu, like SARS two years before, might spread via
poor sanitation. There was also nervous discussion of “insect vectors” after a startling announcement by
Japanese researchers that they had found H5N1 in flies following the 2004 poultry outbreak. 321
The gravest concern, however, was focused on the first flu deaths in Cambodia, a country with a cor-
rupt government, primitive health services ($3 per capita annually), and no facility for the sophisticated
serological analysis required to identify GenZ. Indeed, the outbreak only came to light when twenty-four-
year-old Tit Sokan from Kampot province sought treatment in Vietnam. Earlier, her fourteen-year-old
brother had died after Cambodian doctors threw up their hands at his condition. “He had a fever and
couldn't breathe normally so we took him to the hospital. The doctors gave him two bags of saline solu-
tion, then they told us to take him home. They said maybe we'd done something to offend our ancestors,
and we should make an offering to them.” Tit Sokan herself was too ill to be saved by antivirals, and after
her death WHO investigators learned of border villages full of sick pigs and infected chickens. (In mid-
April, another young woman from the same province died of suspected bird flu.) 322
At the beginning of March, evidence was emerging of a second human-to-human transmission: this
time in a Hanoi hospital where two nurses attending a critically ill avian flu patient, and both nurses de-
veloped the infection. Warning of the “perfect storm now gathering,” The Lancet urged the European
members of WHO to help Vietnam shut down small-scale free-range poultry production. “If the greatest
pandemic in history is indeed on the horizon, that threat must be met by the most comprehensive public-
health plan ever devised. That plan presently does not exist.” 323 Meanwhile influenza authorities like Al-
bert Osterhaus (University of Rotterdam) and Nancy Cox (CDC) were pleading in the pages of Science
for the big Western labs to help Vietnam organize a broader, more accurate testing program in response to
the troubling “information gap” about the evolution of GenZ. 324
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