by Alan Sipress
One veterinarian steered me toward a popular Chinese handbook, titled Medicine Pamphlet for Animals and Poultry, which provided farmers and livestock officials with specific prescriptions for amantadine use to treat chickens and ferrets with respiratory viruses. The manual, written by a professor at the People’s Liberation Army Agriculture and Husbandry University and issued by a military-owned publishing company, prescribed 0.025 grams of amantadine for each kilogram of chicken body weight. Farmers also used the drug to prevent healthy chickens from catching bird flu, giving it to their poultry at least once a month and often mixing it with Chinese herbs, vitamins, and other medicine.
After China’s misuse of amantadine was first reported in the Washington Post in June 2005, the Chinese government angrily denied the account. “This is groundless and isn’t in accordance with the truth,” the agriculture ministry said in a statement. “The Chinese government has never permitted farmers to use amantadine to treat bird flu or other virus-related disease.” But the government-owned China Daily acknowledged in a front-page article that some farmers had in fact used the drug in poultry. The newspaper said the agriculture ministry planned to send inspection teams across the country to halt the practice. I was never able to determine whether it was indeed brought to an end nor the extent to which it had been part of a concerted Chinese effort to conceal the outbreaks. In private, officials at WHO had also been asking the Chinese government about the improper use of antiviral drugs in livestock. They, too, were never given a satisfactory answer.
From China, the virus had ventured south. It stole across the border to Vietnam and began infecting poultry there no later than 2001, more than two years before the children in Hanoi’s National Pediatric Hospital started succumbing to the mysterious outbreak of respiratory disease in late 2003.
Vietnamese scientists knew the truth about the early poultry infections. These researchers had participated in a study that the CDC’s intrepid investigator Tim Uyeki had helped put together sampling various species of poultry in the live bird markets of Hanoi. Uyeki had suspected that the novel flu strain was still circulating in China even after Hong Kong’s mass cull of 1997 had expunged the virus from that city. But mainland China was, for all practical purposes, off-limits for the kind of scientific study he envisioned. So he tried the next-best thing: peering in from the distance by sampling birds south of the Vietnamese border. In the fall of 2001, the researchers discovered two geese with H5N1 in a pair of Hanoi markets. This strain was closely related to the isolate from the Guangdong goose. Lab tests revealed that this pathogen was devastating for chickens, killing every single bird inoculated with the agent within forty-eight hours.
Sometime in 2002 or the first half of 2003, a new variant of the H5N1 virus again slipped across the border from China. This one was later traced to China’s Yunnan province, just north of Vietnam. It was even more virulent. Veterinary officers working in the rural districts outside Hanoi later recounted how it decimated poultry in the province of Vinh Phuc half a year before the government first announced Vietnam’s outbreaks in January 2004.
Among the first farms stricken was a commercial operation run by Japfa Comfeed, an Indonesian conglomerate with operations in four Asian countries and whose president commissioner, a retired general, would later become Indonesia’s director of national intelligence. The die-off was never publicized. But Japfa’s annual corporate filings later disclosed that bird flu had been discovered in June 2003 and severely affected the company’s Vietnamese operations.
The first outbreak killed twenty thousand of Japfa’s chickens. The company suspected from the symptoms that it was bird flu and sent samples to the agriculture ministry’s veterinary department for testing. Government officials hushed up their findings, informing the company that the deaths were due to an “unknown agent.” But Van Dang Ky, an epidemiologist in the veterinary department, later admitted that “the first signs of an epidemic” were found in Vinh Phuc in July 2003. The timing was inconvenient. “Vietnam was preparing activity for the Twenty-second Southeast Asian Games, and we did not announce it for political and economic reasons,” Ky said.
The Southeast Asian Games came and went that fall, with the prime minister opening the sporting competition at Hanoi’s new national stadium and Vietnam racking up the mother lode of gold medals, and still there was no announcement of the outbreak. Vietnam wanted no rerun of the SARS drama earlier that year, which had tripped up the country’s humming economy. Senior Vietnamese officials hoped to quietly contain this latest epidemic before it delivered a new blow to tourism and trade. But the virus refused to cooperate. It quickly spread to other commercial farms in Vinh Phuc and then to neighboring Ha Tay province, the heart of Vietnam’s poultry industry.
Early on, disease also struck the Vietnamese flocks of the Thai conglomerate Charoen Pokphand. The first outbreak eventually confirmed by the government was a massive die-off of chickens at one of the company’s industrial farms in Ha Tay. CP, as it’s commonly known, is Thailand’s largest business enterprise. Started by a family of poor Chinese immigrants, it grew from a small Bangkok seed company into a sprawling multinational, with operations in twenty countries ranging from agribusiness and retailing to telecommunications. The family’s connections to Thailand’s senior ministers are legend, prompting allegations from critics in Thailand that CP used these to cover up flu outbreaks on its farms. (By November 2003, the virus had begun devastating flocks in Thailand itself, though the government in Bangkok concealed this until late January 2004.) The company’s chief executive denied that CP had helped spread the disease across Southeast Asia or cover it up.
During one of several trips to Ha Tay, I heard an alternate explanation. Nguyen Xuan Vui, the deputy director of a local animal-health office, described how tens of thousands of chickens were hauled every day from China into the markets of northern Vietnam by small-time traders. Family farmers also drove up to China and brought back nutrients to fatten up their flocks. These imports could easily have been contaminated. Vui’s account appeared to dovetail with the findings of microbiologists, who analyzed the genetic fingerprints of the virus circulating in northern Vietnam and concluded that it had been introduced from China on at least three separate occasions between 2001 and 2005. A single, even massive introduction by a multinational company would have left a different signature. But although the culprits were minor-league merchants, the impact was tremendous. Vui told me that 2 million chickens had been culled in his province at more than 175 different locations over the course of 2003 before the central government ever got around to acknowledging the first outbreak in January 2004.
For a brief period when the initial human cases were confirmed in early 2004, Vietnam opened its doors to dozens of WHO disease specialists. But after the first wave of human cases ebbed, Vietnam closed back up. This was a country that for years had depended mostly on its own wits and was finally discovering a modicum of prosperity after more than a generation of war and deprivation. Senior officials were deeply suspicious of foreign meddling. Dr. Hans Troedsson, WHO’s chief representative in Vietnam, publicly complained in the summer of 2004 that the government had not responded to a new offer of outside expertise nor provided virus samples for analysis. In private, he fretted that his telephone calls and urgent faxes to the health ministry were going unanswered.
WHO officials in Asia and Geneva acknowledged they were completely in the dark about the details of Vietnamese cases, how they arose, and even how many there were. “So basically, bugger all, we still don’t know what the numbers are,” wrote one agency official. The frustration would continue to mount through early 2005 as the rate of human infection in Vietnam accelerated and a pandemic seemed to grow closer. WHO’s office in Hanoi repeatedly tried to raise its “grave concerns” with the government but was again met with silence.
In Geneva, senior officials debated whether to admit in public that they were flying blind. They had neither accurate information from Vietnam nor the f
reedom to conduct their own field investigations. But WHO did not want to jeopardize its relationship with Vietnam’s health ministry, since they collaborated on a raft of public health issues. “We cannot openly blame Vietnam (at least not yet) but cannot also let people believe that we have access to all the data we need,” one senior WHO official said at the time. “At some point in time we may have to make a radical choice.” A second senior agency official warned that nothing less than the world’s ability to contain a global epidemic was at stake. “I am concerned,” he stressed, “that we are pretending to our Member States and also internally in WHO that we can assess the situation, are capable of detecting the emergence of a pandemic virus and initiating early interventions.” Without transparency, there could be no hope of containment.
Duc Trung and Hoai Nam aspired to be Vietnam’s Woodward and Bernstein. Duc Trung, at age thirty-four, was the senior member of the team. He was a university journalism graduate who had been working at the Thanh Nien newspaper in Ho Chi Minh City for five years when I met him. He had been attracted by the paper’s reputation for investigative reporting. Lanky, with large, soft eyes and smooth skin, his tastes ran to pastel designer shirts, teal on the day we were introduced. He sported a gold watch, and his shoes were impeccably polished. He was well spoken and did most of the talking for the pair, choosing his words carefully.
Though a year his junior, Hoai Nam looked far older. He never reached university, instead spending five years in the Vietnamese army, retiring as a sergeant major. He was short and skinny with an uneven haircut, white sleeves rolled up to his elbows, shoes old and scuffed. He was quick to smile, a broad disarming smile, and when he did, the crow’s-feet would deepen around his eyes and the creases multiply on his cheeks.
“This guy looks like a chicken trader,” Duc Trung told me, patting his partner on the back. “I don’t look the part but he does. That’s why he was chosen for the project.”
A few months earlier, in the summer of 2005, the pair had swapped their office clothes for the soiled shirts and shorts of poultry traders and loitered around the livestock markets until their disguises soaked up the odor. Duc Trung poked a hole in his shirt, near the waist, affixing a tiny video camera barely an inch wide to the inside. Hoai Nam did the same. Posing as novice chicken sellers, the two men repeatedly filmed the illicit, predawn commerce at a Ho Chi Minh City slaughterhouse where merchants bought and sold forged health documents certifying that their birds were free of avian flu. Through these nearly invisible punctures, the reporters offered Vietnamese an education in the corruption and governmental misconduct that would continue to bedevil the country’s battle with the disease.
By the fall of 2005, it looked as though Vietnam had turned a corner. After a long internal debate and repeated delays, the agriculture ministry launched a campaign to vaccinate about 250 million chickens and ducks in all sixty-four provinces. New restrictions were imposed on the breeding, movement, and sale of poultry. To win more cooperation from farmers, the government promised to pay them greater compensation when their birds were culled. As the months passed, poultry outbreaks and human cases declined. Vietnam was widely praised by UN agencies. The U.S. Agency for International Development called its performance “remarkable.”
Yet if not an illusion, this judgment was certainly premature. The virus remained entrenched in the Vietnamese countryside. And every time Vietnam thought it had finally put out the fire, new outbreaks flared, first in ducks and then chickens in the Mekong Delta. “The situation is alarming,” reported Hoang Van Nam, a senior agriculture official. Soon the disease returned to farms across the country and eventually Vietnamese again fell sick. Hoang Van Nam attributed the resurgence to the failure of local officials to carry out the vaccination campaign and enforce a ban on hatching ducks.
Even during the brief lull in outbreaks, Duc Trung and Hoai Nam were documenting the rot inside Vietnam’s control efforts. Their reporting, which illuminated the disconnect between national policy and officials on the front lines, left little doubt the virus would resurface.
Their editors at Thanh Nien had decided to tackle bird flu soon after the government announced its new drive against the virus in 2005. Though the country’s television stations and newspapers, including Thanh Nien, were state-controlled, reporters had increasing latitude to dig into corruption, from crooked traffic cops to soccer referees fixing matches. Duc Trung and Hoai Nam had been tipped by sources that the government’s effort to keep sick poultry out of Ho Chi Minh City was a sham.
The pair headed to a livestock market near the city’s edge. There they asked around until they found a veteran chicken hawker who could tutor them on the poultry business. The merchant coached them on how to behave, what to wear, and what to say. They bought their cheap disguises and borrowed a cage for hauling chickens.
In the hours before dawn, in a teeming quarter of the city, they approached the Manh Thang slaughterhouse, cited months earlier by the city for health violations. Barefoot, like other retailers, they entered the building. It was chaos, chickens screeching, traders shouting over the roar of the plucking machine. “It was risky for us,” Duc Trung recalled. “The people at the market and the people at the slaughterhouse would threaten us if they knew what we were doing. And we were exposed to all those chickens and their virus.”
On a table, they spied two baskets stacked with health certificates, called quarantine papers, which were already stamped and signed. A staff veterinarian told the reporters they could buy the papers for just twenty cents. There was no need to examine their chickens. The document would allow them to claim their birds were free of disease, and it could be used over and over. Four more nights, the pair returned to the slaughterhouse. Each time, the reporters obtained government-issued certificates without any question.
They also turned their lenses on three of the city’s main roadside inspection stations, this time using a video camera concealed inside a plastic bag. The stations were little more than shacks erected along the highways entering the city. The infection had been widespread in the surrounding countryside. At each post, inspectors were to check that truckers hauling live animals had health certificates for all their livestock and that the number of animals matched the figure on the license.
But the reporters discovered that officials were at best taking a cursory glance at the paperwork, never inspecting the trucks themselves. “At least they should check the papers thoroughly,” Duc Trung said. “But whenever we observed them, the inspection activities were so neglectful.” At the post on the Hanoi highway, the reporters found that the officer serving on the front line of defense for the city, and potentially for the world beyond, was actually asleep in the yard behind the station.
Their revelations hit the streets under the headline, QUARANTINE PAPERS ARE SOLD LIKE VEGETABLES! Immediately, the owner of the slaughterhouse stormed into the newspaper’s offices, demanding a meeting with the reporters and their editor. He was furious and menacing. “We showed him our evidence,” Duc Trung recounted. “We know we’ll be threatened when we start an investigation and we’re ready to face the threats.”
Thanh Nien’s findings were also publicly challenged by the city’s veterinary agency. But members of the People’s Council, essentially the city council, were troubled enough by what they read that they ordered officials to look into the reported irregularities. The article had concluded ominously: “Facing the risk that bird flu might break out, the authorities of this crowded city should have the feeling they were sitting on fire. But according to how the work of inspections is carried out, the prospect of bird flu breaking out is unavoidable.”
At almost the very moment the virus had struck the farms of northern Vietnam in the middle of 2003, Indonesian chickens began to die two thousand miles to the south. And Indonesian officials, like their counterparts in Vietnam, would wait half a year to confirm the arrival of the virus. That delay allowed the scourge to spread to nearly one-third of Indonesia’s provinces with
out any official resistance and become entrenched. Human deaths were only a matter of time.
The Indonesian virus, like that in Vietnam, had its origin in China. But while scientists traced the Vietnamese subtype of H5N1 directly back to China’s southern province of Yunnan, the provenance of the Indonesian strain was Hunan province, farther to the east.
At first Indonesian poultry experts were stumped by the abrupt die-off of nearly ten thousand chickens at a commercial farm in Pekalongan, a town in Central Java known mostly for making batik. Soon after, another outbreak burned through a poultry farm hundreds of miles away in a suburb of Jakarta. The National Commission for Eradicating Poultry Disease was divided over whether the cause was bird flu or a less virulent ailment, Newcastle disease. So they called in Chairul A. Nidom, an Indonesian microbiologist at Airlannga University.
Nidom reported that the carcasses showed unmistakable signs of avian flu. Their combs had gone blue, their legs tattooed with red stripes. Those suspicions were reinforced by the separate findings of a pathologist, who cut open a stricken bird soon after the initial outbreak and discovered abnormal brain tissue consistent with bird flu. Within two months, Nidom’s lab research determined it was indeed that virus and moreover a strain genetically related to the H5N1 pathogen identified in southern China seven years earlier. He urged an aggressive response. “When the outbreak began in Pekalongan, if the government had acted to stamp it out and closed the case and did it properly, it would not be going like now. It would be finished,” Nidom told me about two years later as the virus continued to rage.