Americans today are well aware of the threat posed by pandemics. Novelists and filmmakers have created fictional accounts of viral catastrophes. Michael Crichton’s The Andromeda Strain, Stephen King’s The Stand, and Richard Matheson’s I Am Legend deal with the aftermath of mysterious viruses attacking a virgin population. Scott Z. Burns’s film Contagion deals with a pandemic originating in Hong Kong when bats drop virus-laden feces into a pigpen. The bat and pig viruses mutate, and the resulting virus destroys the social order, killing twenty-six million people worldwide until a vaccine finally halts its spread. (So far, scientists have not reported any recombinations of bat and pig viruses.)35
Some fictional accounts deal just with flu pandemics. In the Twilight book series by Stephenie Meyer, which was also made into movies, the parents of one character die of “Spanish flu” in 1918; he is saved by being turned into a vampire. The Internet, too, has heightened awareness of influenza. A 2017 search of Google yielded 280,000 hits for the phrase “Spanish flu epidemic” and 1.7 million for “flu epidemic history.” Since 2000, there have been at least twenty-three novels dealing with the theme of flu pandemics.
Fictional scenarios, shocking as they may be, pale in comparison with what we could expect from a full-blown H5N1 pandemic. “The world just has no idea what it’s going to see if this thing happens,” says Scott Dowell, a virologist working in Thailand. “We are past ifs. Whether it’s tomorrow or next year or some other time, nobody knows for sure. The clock is ticking. We just don’t know what time it is.” Virologist Robert Webster agrees. Humanity is sleeping on a time bomb, he told an interviewer, “and there will be no place for any of us to hide. Not in the United States or in Europe or in a bunker somewhere.”36
Should H5N1 bird flu adapt to humans, it would engulf the planet not in weeks or months, as the devil virus did, but almost overnight. Our world in the twenty-first century is in an era of globalization, more closely connected than ever before. Every day, many thousands of travelers cross oceans and continents aboard jet airliners. As a result, humankind is ready-made for crowd diseases, particularly influenza. A single infected passenger could pass H5N1 to everyone aboard a plane. Upon landing, those travelers would infect others, and so on, until the disease raged everywhere. According to a 2009 U.S. Defense Department study, H5N1 would sicken about 90 million Americans and cause about 2 million deaths.37
Researchers examine a rooster. (2015) Credit 94
The pandemic would have a cascading effect. Always eager for a sensational story, the media, particularly television, would spread panic. The labor force, because of sickness, fear, or having to tend to sick family members, would not report for work. Soon the economy would come to a standstill as industries shut down, businesses closed, and unemployment soared. Growing shortages of vital goods, from food to fuel to medical supplies, would bring chaos. Government would cease to function. Hospitals, mortuaries, and cemeteries would overflow as in 1918, only more so. Taken by surprise, drug companies would not have the time, or the healthy scientific personnel, to develop a new generation of vaccines. A vaccine against H5N1 would not become available for months after work got under way. By the time the pandemic burned out, civilization as we know it would have collapsed, leaving in its wake famines and wars claiming millions of additional lives.38
This is a grim picture, but there is more. Without intending to, scientists may have already brought the catastrophe closer.
ENGINEERING DOOMSDAY
Dr. Ron Fouchier is a virologist at the Erasmus Medical Center in Rotterdam, Netherlands. Like Jeffery Taubenberger, he became fascinated with influenza early in his career. Fouchier knows that viruses do not depend on scientists to gain new mutations; they mutate all the time in nature. So he decided to focus his research on whether H5N1 might mutate into a form that easily spreads among humans and what that form might be. This was dangerous work, and he had to take special precautions to keep his virus samples from escaping. Fouchier’s superiors agreed and built a 1,000-square-foot laboratory just for him. It is really a fortress, where everyone works in space suits in sealed compartments with filtered air to protect them from infection.
Ferrets are sometimes used by scientists to study influenza in humans. (Date unknown) Credit 95
Fouchier tried to transfer bird flu from one ferret to another. To do this, he explained, he “mutated the hell out of H5N1”; that is, by using various advanced technologies, he changed the order of two of the segments in the virus’s eight genes. When he injected the genes into ferrets, nothing happened; the animals were as frisky and ornery as ever. Then, Fouchier said, “someone finally convinced me to do something really, really stupid.” On a hot July day in 2011, he squirted mutated H5N1 virus into the nose of one ferret. Success! And when that ferret got sick, he put infected mucus from it into the nose of a second ferret. After repeating this ten times, airborne droplets of H5N1 infected healthy ferrets in cages next to the sick ones, and three out of four of them died. Fouchier had “taught” H5N1 to spread from ferret to ferret on its own.39
In September 2011, Fouchier attended the annual meeting of the European Scientific Working Group on Influenza. “This virus is airborne and as efficiently transmitted as the seasonal [flu] virus,” he announced, adding, “This is very bad news.” The astonished scientists sat in silence, hardly believing their ears. What Fouchier had done was truly bad news—the stuff of horror fiction. Ferrets catch the flu in the same way as humans; that is why virologists prefer them for experiments. Now Fouchier had used this knowledge to make H5N1 contagious, without its having to combine with other viruses in a pig mixing vessel.40
Fouchier’s announcement set off a storm in the international flu research community. One group of virologists defended his experiments. Yes, he had made H5N1 contagious in the laboratory, they argued, but nature could do the same, given enough time. By discovering what genes had to change to make this happen, Fouchier had created an early-warning system, they said. Now scientists could look out for such changes and, if they found any, rush development of vaccines before a pandemic got under way.41
Critics praised Fouchier’s zeal for protecting the public’s health. But they thought him reckless, too. His mutated virus was too unstable, too stealthy, to keep in check, they declared. “This research should never have been done,” growled Dr. Richard H. Ebright, a weapons expert at Rutgers University in New Jersey. Mutated H5N1 would “inevitably escape, and within a decade.” When this happened, warned Dr. Donald A. Henderson of the University of Pittsburgh, H5N1 “would be the ultimate organism as far as destruction of population is concerned.” But these critics had spoken too soon; Fouchier had not created the ultimate killing agent. Another research team did that.42
Virologist Yoshihiro Kawaoka, who, in the interest of scientific discovery, created a new variation of the flu virus that has no known vaccine. (2013) Credit 96
Dr. Yoshihiro Kawaoka, a virologist at the University of Wisconsin’s Institute for Influenza Viral Research, wanted to improve flu vaccines. To do this, Kawaoka decided he first needed special viruses to test the vaccines on. So he took H1N1 genes from a strain related to the 1918 devil virus, then blended them with H5N1 genes, creating an entirely new virus. For good measure, Kawaoka mutated the new virus four times, until he got what he called “a real humdinger of a virus.”43
That was an understatement. When Kawaoka announced the results of his experiments in 2011, fellow scientists and the media pounced. What he had created was a supervirus, a thing not found in nature. His virus not only can spread quickly through the air but is deadlier than any known virus, because it evades the human immune system. Should it ever escape from his laboratory, it would find humanity defenseless. No wonder critics called Kawaoka’s work “absolutely crazy.” “It’s madness, folly,” said virologist Simon Wain-Hobson of the Pasteur Institute in Paris, a major research center. “What the F are you doing?”44
The publication of researchers’ findings in scientific jou
rnals is crucial to the search for truth. Publication makes ideas and experiments available to scientists the world over. It allows them to keep up with developments in their field, repeat experiments, verify or refute others’ findings, and discover additional things about a subject. Freedom of the press, too, is a core principle of democracy, because the public must get the information it needs to check abuses by government officials. As a practical matter, though, we must strike a balance between the right to know and the right to live. No one, for example, questions the federal government’s right to keep secrets relating to national defense. Similarly, sharing scientific findings can endanger countless lives.
As for H5N1 bird flu, many scientists wanted to keep Fouchier’s and Kawaoka’s methods and findings secret. “It’s just a bad idea for scientists to turn a lethal virus into a lethal and highly contagious virus,” said Dr. Thomas Inglesby, director of the Center for Health Security of Pittsburgh Medical Center. “And it’s a second bad idea for them to publish just how they did it so others can copy it.” On January 11, 2012, the journal New Scientists carried an alarming headline: “One Mistake Away from a Worldwide Flu Pandemic.” Dr. Michael T. Osterholm, an infectious disease expert, took the matter personally. “Those researchers have all of our lives at the end of their fingers,” he said. What if their work got into the wrong hands?Fanatics could use the virus for bioterrorism, terrorism involving the use of toxic biological agents.45
Wearing surgical masks and gowns, technicians make small openings in eggs to prepare vaccines. Credit 97
The U.S. government had a say in the publication debate because tax dollars helped fund Fouchier’s research and Kawaoka’s institute. In December 2011, the National Science Advisory Board for Biosecurity, an independent government advisory group, took up the question. At first, it recommended censoring the virologists’ reports, omitting key information, before publication. However, the board reversed itself the following year, because, members felt, the benefit of alerting the scientific community to the research outweighed the risk of someone putting it to evil use. The journals Science and Nature duly printed articles with full details of the experiments. It remains to be seen how dangerous this information is. We know that anyone with the skill and will, money and equipment, can create a mutated H5N1 supervirus. In October 2014, the White House had second thoughts. It announced that the federal government would stop funding studies aimed at increasing the deadliness and transmission of influenza viruses, at least for the time being. The decision, however, may have come too late.46
We live in an age of globalism and terrorism. Globalism brings people together, while terrorism uses violence to create widespread fear to advance a political, social, or religious cause. Terrorists kidnap innocents, explode bombs in crowded places, and hijack airplanes. On September 11, 2001, hijackers crashed two airliners into the twin towers of the World Trade Center in New York City and another plane into the Pentagon, the nation’s military nerve center, in Arlington, Virginia. A fourth plane, on its way to the Pentagon, the U.S. Capitol, or the White House, crashed in a field in rural Pennsylvania.
A New York police officer stands near a wanted poster in the financial district of New York City one week after the terrorist attacks of 9/11. Printed on a full page of a New York newspaper, the poster features Saudi-born militant Osama bin Laden. (September 18, 2001) Credit 98
The nineteen 9/11 hijackers were members of al-Qaeda, a radical Muslim group led by a Saudi extremist named Osama bin Laden (later killed by Army Special Forces). Unlike the vast majority of Muslims, those inspired by bin Laden think it a religious duty, commanded by God, to exterminate “infidels.” In their eyes, unbelievers are entirely evil—“the scum of the human race,” “the rats of the world,” “brothers of apes and pigs,” the “Party of Satan.” Thus, bin Laden said, “we do not have to differentiate between military or civilian. As far as we are concerned, they are all targets.” In an essay titled “Under the Shade of the Lances,” Sulaiman Abu Ghaith, al-Qaeda’s official spokesman, declared: “We have the right to kill four million Americans—two million of them children—and to exile twice as many and wound and cripple hundreds of thousands.” Furthermore, terrorists preach that “Muslims who don’t hate America sin.” These are not mere words, spoken for effect; those who use them mean what they say. Who else today crucifies Christians, beheads them, and drowns them? Who else burns Muslims who disagree with them alive in iron cages? Who else promises to kill every Jew in Israel?47
According to terrorist logic, any weapon is legitimate if used in “God’s cause.” A book by a bin Laden follower, titled A Treatise on the Ruling Regarding the Use of Weapons of Mass Destruction Against Infidels, sets no limits upon the use of weapons of mass destruction. Since the 1980s, terrorist groups have tried to get hold of nuclear, chemical, and biological weapons. “Nuclear War,” they insist, “is the Solution for the Destruction of the United States.” Biological weapons, however, could do the job more thoroughly.48
On December 7, 2011, Secretary of State Hillary Clinton marked the seventieth anniversary of Japan’s attack on Pearl Harbor with a speech. During the Biological Weapons Convention in Geneva, Switzerland, she cautioned against the threat of bioterrorism. “There are warning signs,” she said, “[that al-Qaeda] made a call to arms for—and I quote—brothers with degrees in microbiology or chemistry to develop a weapon of mass destruction.” She especially noted that Western laboratories were “making genetic material widely available. This obviously has many benefits for research, but it could potentially be used to assemble the components of a deadly organism.”49
For “deadly organism,” read “H5N1 bird flu.” Unscrupulous scientists might sell samples of the virus to terrorists, just as Abdul Qadeer Khan, Pakistan’s leading physicist, sold nuclear-weapon plans to North Korea, Libya, and Iran. Easier yet, anyone can download Ron Fouchier’s article from a certain website for $31.50. Extremists are also skilled in using the Internet and social media to circulate instruction manuals with titles like Biological Weapons. If we may use an Internet term, such writings have “gone viral.”50
Mutated H5N1 may be the ultimate terrorist weapon, cheaper to make and easier to use than atomic bombs. Those weapons, awful as they are, require large missiles and airplanes to deliver them to their targets. Bird flu is far more lethal. Terrorist leaders already inspire suicide bombers to kill as many “unbelievers” as possible. In doing so, “human bombs” seek “martyrdom,” touted as a sure ticket to paradise. Similarly, a fanatic might seek martyrdom by voluntarily becoming infected with mutated H5N1, then boarding a jumbo jet. This would be the worst place to be in the presence of any flu virus. In 1977, for example, when a crowded airliner lost its ventilation system for several hours, an “ordinary” flu virus spread through the cabin with stunning speed; nearly everyone became infected from one sneezing passenger.51
Imagine what would happen if a bird-flu “martyr” boarded a jumbo jet today. The disease could spread to everyone aboard, then to everyone those travelers met, and so on, until the pandemic rolled across the globe, killing up to half the human race. The dead would also include innocent Muslims, and even terrorists and their loved ones. Yet to the fanatic, any price is worth paying to rid the world of infidels and assure victory to “God’s cause.”
A FINAL REFLECTION
Life is neither all good nor all bad. Everyone suffers misfortunes but also has bright moments, however brief they may be. Similarly, we may say that we are worse off today than in 1918, but we are also better off. Scientists’ tinkering has made influenza viruses more lethal and capable of spreading from person to person. On the other hand, knowledge of influenza, of what causes it and how it acts, has made us better able to treat it, predict pandemics, and develop vaccines to avoid their worst effects.
The chief lesson we can take from this terrifying disease is the need for humility in the face of nature. Historians Dorothy Pettit and Janice Bailie say it best: “We must treat this micro
scopic ‘mass murderer’ with the utmost respect and never doubt its exceptional ability to adapt.”52
Influenza is what it is. The strains of viruses that cause the disease will keep adapting, keep changing—usually as seasonal annoyances, though still lethal for some victims. Scientists will continue to study flu viruses, while organizations like the World Health Organization and the Centers for Disease Control and Prevention will search for genetic changes pointing to the likelihood of a pandemic. When the next pandemic comes, as it surely will someday, perhaps we will be ready to meet it. If we are not, the outcome will be very, very, very dreadful.
PROLOGUE: THE GREAT-GRANDDADDY OF THEM ALL
1. John M. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (New York: Viking Penguin, 2004), 96.
2. Carol R. Byerly, “The U.S. Military and the Influenza Pandemic of 1918–1919,” Public Health Reports, vol. 125, Supplement 3 (2010): “Influenza Pandemic in the United States,” 82–91, www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337.
3. Nancy K. Britsow, “ ‘It’s as Bad as Anything Can Be’: Patients, Identity, and the Influenza Pandemic,” Public Health Reports, vol. 125, Supplement 3 (2010): “Influenza Pandemic in the United States,” 136, www.ncbi.nlm.nih.gov/pmc/articles/PMC2862342.
4. Dorothy A. Pettit and Janice Bailie, A Cruel Wind: Pandemic Flu in America, 1918–1920 (Murfreesboro, TN: Timberlane Books, 2008), 1. Italics added.
5. Paul W. Ewald, Evolution of Infectious Disease (New York: Oxford University Press, 1994), 36.
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