Five Questions With: Laurie Garrett

Senior fellow working in Global Health at the Council on Foreign Relations talks about the H7N9 flu. More

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Five Questions With: Laurie Garrett

"I don’t think anybody is prepared for a true pandemic. As a global community, and inside the U.S., we handled the comparatively benign H1N1 swine flu of 2009 poorly.."
Posted 4/29/13

Laurie Garrett is a senior fellow working in Global Health at the Council on Foreign Relations. She has written extensively about influenza and was in China for much of the SARS epidemic in 2003. Her piece, “Is this how a pandemic would start?” published on April 7 in The Denver Post, was one of the first to raise warning signs about what was happening in China, reporting on the massive pig die-offs and bird die-offs that preceded the spread of H7N9.

Providence Business News asked Garrett to talk about the current situation in China and the need to develop a new vaccine for H7N9 flu.

PBN: How serious do you think is the potential threat of a global pandemic? According the team at Epivax, their analysis of the viral coat and protein structure of the new flu suggests that there may be limited protection afforded by previous flu vaccines.

GARRETT: We are dealing with evolution, and with an exceptionally unusual influenza virus. So it is not possible to quantify the threat – to say 50/50 odds or any such thing. What I think we can definitely say is that the threat of a pandemic exists, and it would be folly to pretend otherwise. As the Boy Scouts say, “Be prepared.”

Preparation is tricky, however, because human beings have never dealt with an H7N9 virus, so far as we know. We have to assume that most of humanity has only very weak immune protection.

The two key proteins – the Hemagglutinin and the Neuraminidase – are unlike the H and N proteins seen on the recently circulating flu viruses. Few people will have specific neutralizing antibodies, and recent vaccines will offer no specifically targeted protection.

PBN: How reliable are the health official reporters coming out of China? In a recent Reuters report, it said: “In a bid to calm public jitters over the virus, Chinese authorities have detained a dozen people for spreading rumors about the spread of bird flu.” Is that as ominous as it sounds?

GARRETT: I was in China through most of the SARS epidemic of 2003, and I know what a lying, stonewalling China looks like. This time, the government is behaving in a comparatively highly responsible fashion. There are individuals within the government that have misbehaved – such as Col. Dai Xu, who claims the entire flu scare was created by the U.S. government to destabilize China.

But overall, I think Chinese health and vet officials are trying to do the right thing. We are in uncharted waters with this virus, so no government, including ours, would be feeling terrific right now, trying to understand what is going on with H7N9.

Having said that, a lot of Chinese Weibo [a Chinese microblogging website] users are darned ticked off, and seeing fellow microbloggers hauled off to jail for spreading “fear” has deeply angered many in the country.

PBN: Do you think that the U.S. Centers for Disease Control and Prevention is prepared for a potential pandemic?

GARRETT: I don’t think anybody is prepared for a true pandemic. As a global community, and inside the U.S., we handled the comparatively benign H1N1 swine flu of 2009 poorly.

Although the virus emerged first in the U.S., it wasn’t noticed until it claimed lives in Mexico. The Mexican government acted swiftly and responsibly – and paid dearly, as most of the world treated the country and its population like pariahs.

Mexico took enormous financial losses. A message went around the world from that [which said]: Tell the world you have an epidemic, take tough measures, and you will pay the price.

By far the majority of the world’s population never received a H1N1 vaccine, and most that did – including Americans – got it after the outbreak in their area had passed. Too late.

Moreover, vaccine and drugs [are] concentrated in the rich countries of the world, and there is still genuine resentment in poorer nations. The WHO pandemic alert system failed. And, there remains conflicting evidence regarding the effectiveness of most epidemic control measures: school closures, masks, gloves, limitations on public congregations and the like.

PBN: Do you think that the CDC needs to move quickly to endorse alternative flu manufacturing techniques, such as those developed by Epivax, to meet the potential threat?

GARRETT: It’s not up to the CDC. Wrong agency. The problem with alternative manufacturing techniques is how can the U.S. Food and Drug Administration certify [its] safety?

Every mass vaccine program we have executed – going back to the vacuolation executed by George Washington on the revolutionaries – has sparked conspiracy claims and accusations of side effects. Every one.

You have to assume lawsuits, false claims, and the like. You also have to assume a tiny minority of recipients will have genuine side effects, though very minor. If the FDA cannot find a way to test and approve novel vaccines, the U.S. government will be reluctant to promote the product and insurance companies will balk at coverage.

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