Mike Davis tried to warn us. Fifteen years ago, America's favorite Marxist truck driver turned MacArthur Fellow published The Monster At Our Door: The Global Threat of Avian Flu . In it, Davis argued that a global pandemic was not merely imminent but late : When you pack tens of millions of human beings into unprecedentedly dense, often unsanitary cities — then surround those cities with factory farms teeming with historically vast concentrations of pigs and chickens — you get a more fertile breeding ground for emergent disease than any our species has ever seen. Add in southern China's diverse wildlife population, wet markets, and lung-impairing air pollution — and a global economic system that tosses millions of humans across continents on a daily basis — and the mystery wasn't whether a novel virus would emerge in China and then take the world by storm but why one hadn't already done so . Davis implored humanity to capitalize on its good fortune while it still could. A lethal strain of avian flu had already become endemic in East Asian birdlife. But there was still time to build up the emaciated health-care systems of the developing world, subordinate competitive nationalisms to global cooperation on public health, scale back hazardous agribusiness practices, and wrest control of antiviral and vaccine production from Big Pharma's grubby hands.
Intelligencer spoke with Davis this week about what must be done to combat the COVID-19 pandemic and all the other monsters still to come. Maybe this time, we'll listen (or, failing that, maybe a few of us will check out his new book, Set the Night on Fire: L.A. in the Sixties , which has nothing to do with coronaviruses but is surely worth reading anyway).
As one of the small minority of humans who'd been anticipating a global pandemic for decades, has anything surprised you about the one we actually got or America's response to it thus far?
The virus has some very unusual qualities. But apart from that, it fits perfectly into the template that's been created over the last generation. In 2005, the Bush administration issued a national strategy for pandemic influenza. The World Health Organization (WHO), that same year, updated its rules for how all member-governments are to respond to a pandemic. We've been preparing for this for longer than my teenage children have been alive. And the Obama administration, particularly after it was confronted with Ebola, put a lot more investment into pandemic prevention and expanded international surveillance.
So, in a sense, everything was set to go. As you know, just a week before the inauguration in 2017, the Obama people who had been doing this planning got together with the incoming Trump people, their counterparts, and conducted this major simulation that demonstrated the weaknesses that still existed. And then, of course, president Trump proceeded to disband, dismantle, or defund most of the networks that had been set up in the previous two administrations and to ignore all of the reports and warnings that were produced in his administration, as well.
Given the resilient weaknesses that Obama's team identified and the manifold deficiencies in America's systems of public health and medical provision, how confident are you that a Democratic administration could have averted a catastrophe like this one?
Most epidemiologists believe that we live in an age of pandemics. Of course, avian flu, including its new variety, the H7 variety, is just as dangerous as coronavirus. And according to the WHO, an outbreak is imminent. But the difference in the Obama administration would have been, first of all, we would have had a better early-warning system. Just last year, Trump defunded a CDC-related program that monitors viruses present in wild and domestic animals that could possibly cross over to humans. That program was allied with the Wuhan Institute of Virology, which is the world's leading expert in animal-to-human coronaviruses.
So that would have been in place. And if Obama had received the warnings about critical shortages in personal protective gear and ventilators that Trump had, and if he had stocked the strategic stockpile, then I think our experience of this may have been closer to Germany's. And we may have avoided a catastrophic economic shutdown or at least gotten by with a much shorter one.
Having said all that, in this country, the pandemic has taken root in a medical environment characterized by continuous disinvestment, particularly at the county and state levels. There are 60,000 fewer employees in public-health departments than there were before 2008. So many [Great Recession–era] cutbacks haven't been undone. Meanwhile, since the election of Ronald Reagan, we've been converting hospitals into financial systems running on just-in-time inventory and keeping as few beds as possible.
Nursing homes are a similar story. They've become a big industry dominated by private-equity firms, which extract the highest profits they can out of the lowest costs. And from the very beginning of the outbreak at the Life Care Center in Kirkland, Washington, it was clear that nursing homes were going to turn into mortuaries. James Straub, who's the union representative for that nursing home, was telling me in March, "Look, the public-health people are not on top of this." You know, everybody thinks Washington is the most progressive state in the world. But not on these issues. The homes are very poorly regulated. And when the public-health officials went to collect the first bodies, they didn't bother to interview the nursing-home workers. These workers had no protective gear at all. They had minimal to no training in infection control. The officials didn't bother to interview them. These nursing-assistant jobs pay $10 an hour. The only way people can make ends meet is to moonlight. So a large minority of people who work in nursing homes also work at least part time in another nursing home. So you have this transmission belt that links all the nursing homes together in a given region. James told me in March, watch what happens in nursing homes — thousands of people are going to die. Well, 12,000 have died in them by the latest count (and that's absolutely an undercount).
The criminal abdication of federal responsibility is implicated in this. From the very beginning, they should have known that thousands of people were going to die in these nursing homes. There should have been federal rescue efforts.
The coronavirus crisis has triggered a lot of critical discussion about the hazards posed by East Asian "wet markets" and the consumption of "bushmeat" in West Africa. Your book suggests that while these are indeed risky practices, they are also the products of broader pathologies in global capitalism. What are those pathologies, and how must we redress them if we wish to start feeding ourselves in a manner that isn't so conducive to pandemic disease?
I don't think there's much disagreement that the transmission of wild-animal diseases to humans has greatly accelerated. And it's being accelerated by three things. One is the clearance of tropical forests for livestock grazing. The second is the multinational logging companies, and the third has been the problem of high food prices that has driven people away from traditional sources of protein and towards consuming — in ever-increasing numbers — the flesh of wild species.
When I wrote the book in 2005, the study that really kind of knocked my socks off was an article that showed the interrelationship between factory fleets and overfishing in the Gulf of Guinea. Traditionally, coastal West Africans have relied on fish protein. Every little village strung out on the coast was a fishing village, and they were the ones feeding the broader population. But some time in the 1970s or 1980s, factory fishing fleets came into the Gulf of Guinea and basically vacuumed out half the fish biomass. And a lot of it went for animal feed, not human consumption.
This was disastrous for coastal fishermen. And it raised fish prices in the cities. At the same time, other multinationals were conducting immense logging operations in the Democratic Republic of the Congo, Gabon, and Cameroon. And their work crews required, of course, high-protein, high-calorie diets to perform hard labor. So they started living off of so-called bushmeat. It's been shown that no less than 70 mammal, reptile, and bird species entered the diet. Well, since this coincided with rising prices of fish protein, the city markets started attracting bushmeat. And what had started off as just little, ancillary operations for logging companies soon became a kind of big business in itself. So people were consuming all kinds of meat that was basically unfamiliar and only entered the diet because it was so cheap. So that's the political ecology that sponsored the emergence of HIV and Ebola.
There are obviously other factors. The prominence of exotic wild animals, including bats, in the diets of South China and in Chinese traditional medicine. The so-called "wet markets" where they're sold. That's obviously a huge problem. But it's a much easier one to deal with than the political ecology that I've sketched out for West Africa. Similarly, the Amazon is always a possible source of emergence. Which makes opposing rainforest destruction something other than just tree-hugging. The rainforest isolates us from wild animals that originate epidemic disease.
And then there's obviously the industrialization of poultry and livestock production. Enormous poultry plants were directly implicated in the spread of avian flu in China and Southeast Asia. And that's a problem everywhere. There's also the overuse of antibiotics in these huge livestock concentrations. I remember once being in Western Utah. And the horizon was just flattened sagebrush, but this awful smell hung over it. And I got closer, and it was this infamous plant in Western Utah that processes a hundred thousand pigs a year. And of course, larger poultry plants process as many as a million.
A final factor is poverty itself. Malnutrition, the absence of clean water, fecal contamination of household environments, coexisting infections (24 million people in sub-Saharan Africa have HIV) — all this combines to create a separate immunological humanity. In the United States and Western Europe, maybe 20 or 25 percent of the population has immune systems that are compromised, simply by age or some preexisting respiratory condition, diabetes, whatever. But if you go to parts of Africa or the slums of the world, that's kind of turned upside down. You might find 70 percent of the population whose immune systems are greatly compromised.
You've written about the horrific consequences that the 1918 "Spanish flu" had for the people of India and how their suffering has been obscured in the West's historical memory of that pandemic. What does India's experience in 1918 tell us about the perils facing the developing world in 2020 and what must be done to mitigate those perils?
Most histories of the Spanish flu, including John Barry's [ The Great Influenza: The Story of the Deadliest Pandemic in History ], concentrate almost entirely on the United States, Western Europe, and then a few sensational examples in the Pacific. But somewhere between 60 percent and two-thirds of the people who died, died in Western India. This was a situation where the British requisitioned grain from India on a huge scale to support their war effort. And this requisition coincided with a drought. Food prices started to go sky-high, and a famine ensued. So when the Spanish flu hit Western India, it encountered a population that was gravely malnourished, some on the verge of starvation. And people died like flies.
That's a warning to us today. Right now, if you're in Kenya, the cartons of medical supplies that used to come stamped with "To the people of Kenya, from the people of the United States," now say, "To the people of Kenya, from the people of China." Trump has made "America first" mean Africa last or the global poor last. There's an enormous need to scale up what is now a flagging effort, mainly from the European countries, to address the pandemic in Africa. In some countries, what is even more important than medical aid is debt relief. I think there are about 30 African countries that spend a larger part of their budgets on paying off loans they contracted in the 1980s and 1990s than they do on their public health systems. In so many countries, we simply have no idea what's happening because there's so few test kits.
Finally, the World Health Organization, whose role is to be the coordinator of combined international efforts, has been completely sidelined. From the very beginning, nobody did what they had promised to do. The most extraordinary case is actually in Europe. The European Union has a long-standing convention and emergency bureau to coordinate joint action during disasters, including cross-border disease. The Italians begged for the implementation of this, which would have mandated the sharing of national stockpiles of medical equipment and the sending of doctors. It was all supposed to operate through this disaster emergency body that was created. And every member of the E.U. — without exception — refused. And that shadows the future of the E.U. It would not be at all surprising if Italy decides in the next year to leave like Britain did.
Your book indicts the Chinese government's handling of various influenza outbreaks in the early years of this century. Both Donald Trump and Joe Biden have accused the Chinese government of suppressing information about the novel coronavirus. Do you think the Xi Jinping government deserves as much blame for this crisis as American political leaders have ascribed to it?
Initially, I joined the chorus of people condemning China. And it's certainly the case that within Wuhan and Hubai, there was great repression, even violence against the whistleblowers and an effort to cover up the extent of the outbreak, including possibly covering it up from Beijing. So that's all true. But as far as the allegation that Beijing did not inform the international community in a timely manner, this seems to be an entirely different story. China detected the first unusual pneumonia outbreaks at the beginning of December. They announced that an unknown virus was responsible in a little more than a week. They sequenced the whole genome of the virus. The WHO was informed about this almost immediately. Trump doesn't seem to understand the number of Americans who work for the WHO and who were in almost instant contact.
The "smoking gun" that's usually brought in evidence against the Chinese was a false social-media message that denied the existence of human-to-human spread. But the Chinese government immediately followed that with an official statement that said yes, there is human-to-human spread. So I'm very confused about that. I don't see the evidence that the Chinese scientific community or the WHO covered that up. The problem, in January through early February was that nobody seemed to believe that this could be as bad as it was. Fauci, in the beginning, was saying this posed a very low risk to the United States.
But by playing the "yellow fear," Trump is destroying the alliance — the medical and scientific alliance — that is absolutely most important, and that's the cooperation between the scientific communities of the United States and China. That's where most of the cutting-edge research is going to be done. And the research community has probably broken all records for cooperation since the pandemic began. People are publishing and providing information that ordinarily would be proprietary. That's been a silver lining in all of this.
Speaking of proprietary research, why do you believe that the way we fund pharmaceutical development — principally, through the granting of patent monopolies to private-sector firms — is inadequate to the needs of pandemic prevention and mitigation?
The reasons for this are pointed out very eloquently in a report from Trump's own Council of Economic Advisers. The report pointed out that a drug company has no incentive to manufacture something that will only be used once, when it could invest in other areas that offer constant profits over many years, such as medication for heart disease or sexual dysfunction in elderly males like myself.
If you look at the big picture of how vaccines are developed, most of the key research that gets capitalized for private profit is actually produced on the public's dime. Either in public universities, or private universities where the research is federally funded; maybe some of the faculty will spin off a little biotech company with an intense emphasis on research and development. Meanwhile, Big Pharma are basically a bunch of rent collectors who spend much more money on advertising than they do on R&D. On the whole, they're interested in patents. And this became a huge battle during the second avian-flu outbreak in 2003, 2004, because there's an antiviral that's been very successful in preventing avian-flu cases from becoming critical called Tamiflu. And India wanted to manufacture it generically. So the Indian government asked the World Health Organization to support them. This was when it looked like the avian-flu outbreak might become pandemic in a matter of weeks.
And the WHO — which is forced to seek 80 percent of its budget from philanthropic organizations like the Gates Foundation, from the most powerful states but also from pharmaceutical companies — decided not to endorse this position. And in exchange for keeping its mouth shut about generic production, Big Pharma provided the WHO with a stockpile of Tamilfu large enough to last about two or three weeks.
Four of the big pharmaceutical companies are doing vaccines at the moment. But the real research isn't being done by them. It's being done by small and medium-size firms whose work the big companies will then buy. So Big Pharma is basically a rent-collection agency based on holding patents and the exercise of immense political lobbying. It is unnecessary in this whole chain of innovation and production. I much admire Elizabeth Warren for having submitted a bill for the public production of prescription drugs. I think that's what progressive in the U.S. should demand. I don't mean nationalization, because the smaller and medium-sized companies that do provide and develop new drugs should be kept in the loop. But there's no reason for Big Pharma anymore. It's become a fetter on the translation of a genuine revolution in biotechnology into public health in this country and around the world.
As you argued in 2005, a global pandemic of some kind was all but inevitable. The novel coronavirus is a terrible scourge. But it is much less lethal than some of the avian-influenza strains that have come within a few mutations of achieving human-to-human transmissibility. Given this, one might see a silver lining in the fact that the first major pandemic of the 21st century poses relatively little risk to children. We will still pay a horrific toll for our governments' myopia and negligence. But at least we will emerge from this having finally learned our lesson. And when the next, potentially more lethal bug hops the species barrier, we will be prepared. Do you find solace in such reasoning?
Let me start with an analogy. Let's take the case of wildfires and earthquakes, which I write about a lot, at least insofar as they affect California. In both those cases, the learning curve is either flat or negative. There may be some slight reform that comes out of it. But at the end of the day, we repeat the same bad policies. We keep doing the same things that made people vulnerable to the previous fire or to the previous earthquake. And that's because of the huge inertia built into the system. Right now, in San Diego County where I live, we've had two of the largest wildfires of the 21st century. And there's 100,000 homes in development in high- or critical-fire-risk areas.
The last great earthquake of the 1990s led to only minor improvements in structural safety. So there are these inertial interests that oppose lesson learning and reform on a serious scale. Now, the record with epidemic disease is mixed. But go back to SARS. SARS initially created a greater scare than the avian flu had. One guy got it at an airport hotel. Everyone he came in contact with got infected, and within 24 hours this thing had appeared in five different countries. So there was research done. There were two candidate vaccines developed for SARS. But there was no money to take them any further. And so these vaccines sat in refrigerators. There was no profit to be had from them. Those vaccines might confer cross-immunity to the current coronavirus. But we'll never know.
And that's what tends to happen: When world trade or the lives of people in rich countries is threatened, you see this huge flurry of activity. But once the threat declines, the money or funding disappears.
We've disinvested in public health. The private sector has been unable to develop the lifeline medicines that we need. In terms of international coordination, I don't think the WHO is going to exist in the present form a year from now, not after the withdrawal of American support.
During the Cold War, both the United States and the Soviet Union put a lot of effort into world public health as part of their respective efforts to influence nonaligned countries (ex-colonial countries). So the U.S. launched its famous malaria campaign, and the Soviet Union, in 1958, launched the campaign that eventually rendered smallpox extinct. After the Cold War ended, there was no geopolitical or foreign-policy reason to pay that much attention to public health in the poorer part of the world. Now who's going to rebuild an international infrastructure to raise the capacities of poorer countries to detect and respond to diseases? To ensure that the stockpiles are adequate to meet the challenge anywhere on the globe? I don't see anybody doing that.
The United States has abdicated. China is very equivocal about this. Although they are now the first responder in 18 or 20 countries, they've been very equivocal about investment. They never put that much into the World Health Organization. They never stepped into America's shoes. Will they now? That's totally unclear. Because nationalism is everywhere. And it's defeated international public-health cooperation in this outbreak. So we're going to be left with a research community that is more spirited and international and willing to cooperate with each other than at any time in history, but with governments that have turned their backs on all the post-World War II institutions [of global cooperation]. Except for the World Bank and IMF, of course. And it's the World Bank whose structural-adjustment programs destroyed health systems throughout the debtor world in the 1980s and 1990s.
So out of this mist, can you find a silver lining? Is there any indication that the destruction of tropical rainforests will stop? That we will stop eating the beef that destroys the forests that protect us from emergent viruses? That we will end factory farming on its present scale? That we will invest a trillion dollars to provide potable water and sanitation to everybody on Earth?
No, of course not. None of this will happen.
The voices demanding for it to happen will grow louder. But I haven't seen a lot of international solidarity in this country, even amongst the left. You know, I'm a Sanders supporter, 110%. But I can't recall him ever talking about issues of international inequality, health, debt, or any of it. The left, in a way, is following its own version of "America first." And the philanthropic and religious organizations that have played a vital role can't deal with the scale of the challenges ahead. They represent an old form of philanthropic internationalism that's everywhere on the wane and everywhere being defunded. So I guess we'll have to rely on Bill Gates being Superman and going into a phone booth, putting on his cape, and saving the health of 8 billion people.
The silver linings are all in terms of the possibilities that exist to accelerate this biotech revolution. And the prospects for that are incredible. But I can't see any way they get translated into public health for everybody. I mean, the battles that will occur over the distribution of the COVID-19 vaccine are going to be — suffice to say, if there is a vaccine, the White House is not going to be pushing for it to be distributed equally to all countries in need.
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