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The next pandemic

Bird Flu: A Virus of Our Own Hatching

Lantern Books: 2006. 416 pp. $30, £21.99 1590560981 | ISBN: 1-590-56098-1

I am often kicked around by American authors in books about influenza. How dare a Limey suggest that the Spanish influenza A H1N1 virus arose in a gas-infected, pig-ridden and bird-infected army camp of 100,000 people in France in 1916, when the whole world knows it started in Dorothy's home state, Kansas? But I felt less bruised than usual. Perhaps I am getting used to it.

Is this your Christmas dinner? Farmed flocks of poultry could become infected with H5N1 flu. Credit: R. STEVENSON/AP/EMPICS

Bird Flu by Michael Greger pulls and pushes the reader along, and every virologist under the Sun is thrown into the mix. We are projected back to pandemics in 1918, 1957 and 1968. But mostly the searchlight illuminates the current and worrying spread of H5N1, the recent theories of pathogenesis, mutation and spread. Greger covers the science rather well, and his descriptions of the polymerase chain reaction, innate immunity, cytokine storms and virus evolution are as clear as crystal. He also provides hundreds of references to burrow into.

But does the book really deliver on its title? It certainly goes to town on the subtitle, burning the bridges that link us to the great international avian reservoir. With the exception of virologists Graeme Laver and Robert Webster, we have only recently realized that influenza A is an avian virus securely seated in the 50 billion ducks, geese and swans that migrate across our planet. Periodically the virus makes the leap to infect humans. But not many of us stroke the feathers of a banded goose, so the virus first moves laterally to domesticated birds and then to their keepers.

The bridge leads to the industrialized chicken industry. I sympathize here. Unbeknown to the UK Department for Environment, Food and Rural Affairs, my wife keeps seven precious chickens at the bottom of the garden. Every autumn they are covered up to avoid the virus-spewing migratory geese who pass overhead. I have slowly cottoned on to why we pour grain into their hungry mouths. We don't like seeing chickens used as fodder, being scalded to death, chopped up alive or, worse, dying of H5N1. There can be no more unpleasant death than a neurological disease that kills a bird in 72 hours. The book is a hydrid, and the trick is to balance a scientific exposition about influenza with a cry from the heart about industrialized farming and how it demeans us. The author notes that “it may take a pandemic with a virus like H5N1 before the world realises the true cost of cheap chicken”.

Greger is a clever writer. The book is a zinger, not deep like John Barry's The Great Influenza (Viking, 2004; see Nature 429, 345; 2004), but more worldly, broader and more scientific. It is also more global in its approach than most US books, but I suppose it has to be as the United States has not yet experienced H5N1.

Fortunately, the world has woken up to the threat of H5N1. The US government has thrown $9 billion at the problem, much more than against smallpox and polio combined. Every related research programme in the United States will benefit. The ripples have even reached Britain. There is now an axis of flu research, but will we join it? Yes please!

However, the book fails to confront the question I am asked daily: “Why are you so worried about 151 deaths from H5N1?” Well, go back to 1916, to Etaples in northern France, where a form of flu causing heliotrope cyanosis (a characteristic lavender coloration of the face) with a case fatality of 60% was beginning to spread. There were 145 cases. At some point in the next two years it mutated to become more infectious and 30 times less virulent. Then it killed 50 million people. Doesn't this ring a nasty bell?

Greger focuses on the chicken industry. His descriptions of how awful it is make for tearful reading. I really mean this. He would do well to fire a few extra missiles at the political class. In 1916 their political antecedents were also preoccupied with war and other vainglorious affairs. They were too busy to read the warnings in The Lancet that a new disease was lurking. Even in Edwardian times, governments could have prepared themselves. The scientists of the day reacted quickly enough; they made pneumonia vaccines, used masks, hygiene and social distancing, and many died in the attempt. Today we are well served in Britain and the rest of the European Union, but many nations in the world deserve better. They will face the next pandemic truly naked and bereft.

I am not as pessimistic as Greger. I like Churchill's attitude: “Give us the tools and we will finish the job.” Well, for the first time in our history, we have them, and we will.

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Oxford, J. The next pandemic. Nature 444, 1007–1008 (2006).

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