International Herald Tribune

Philip Bowring: Fear is the new pandemic
By Philip Bowring International Herald Tribune
MONDAY, NOVEMBER 7, 2005

HONG KONG 'Irrational exuberance" is an occasional trait of stock markets; "irrational fear" seems increasingly endemic in the popular and media mind. So much so, when it comes to viruses and terrorism, that it may be time to apply Franklin Roosevelt's dictum: "The only thing we have to fear is fear itself."
 
The most infectious of fears is that of the unknown. In the case of bird flu, health authorities and others may be spreading that fear by talking up the possibility of a major pandemic killing millions. Asia in particular is being bombarded with such warnings, even though a flu pandemic is unlikely to make geographical distinctions. The daily warnings may spur governments to what their authors hope is preventive action, but they also spread irrational fear.
 
Before changing or travel or eating habits in response to the "bird flu threat," perhaps we should remember SARS. Justifiably feared when it first appeared and its infectiousness uncertain, it eventually caused fewer than a thousand deaths worldwide. Most of those were of the elderly. SARS now appears to have vanished, but it left behind a trail of personal anxiety and economic loss throughout Asia and beyond, which affected countries that had not a single case.
 
Bird flu does kill humans, and every effort should be made to limit its spread by culling flocks and so forth. But there are plenty of other often fatal diseases that fall into a similar category, killing perhaps a few hundreds worldwide each year. For example, Hong Kong has had recent deaths from a pig-meat infection that is endemic in China. Dengue fever and encephalitis are regular killers in Southeast Asia, and hepatitis B is endemic in the region.
 
Is there really a good reason now to suggest that we are threatened with a flu pandemic of the proportions of 1918 or worse? For sure, some such pandemic is probably inevitable sometime, just as last year's Asian tsunami was always predictable "sometime." But is there really much evidence to suggest that we are in more danger now from a pandemic of a new and more dangerous flu virus than we were two or five years ago?
 
The H5N1 virus is very dangerous but has been around for several years. It killed six people in Hong Kong in 1997 - but just one here since. Most cases since then have been in Vietnam and Thailand. Of course, it "might" morph into a virus easily transmissible between humans. But is there any reason to suppose that this is more likely now than it was in 2000? Is it not at least as likely that the virus itself will attenuate gradually? Or that in becoming capable of human-to-human transmission it will lose much of its potency? Generally, viruses become less virulent over time.
 
The fact is that we do not know the future of this or any other flu-type virus. So we can plan in a general sense to keep a close watch, to develop new vaccines and treatment drugs, to have public health plans in place for responding to an epidemic. Fine.
 
But in addition we are now treated almost daily to "estimates" about the possible losses from bird flu. The World Bank claims that a human pandemic triggered by bird flu could cost the world economy as much as $800 billion. The Asian Development Bank estimates that regional output would fall by 6.5 percent on the assumption that an epidemic hit 20 percent of the population and killed 0.5 percent. One could equally well argue that the next flu virus will kill 20 percent of the world's population - the approximate percentage of Europeans killed by the Black Death in the 14th century - or, at the other end of the scale, that it will cause no more deaths than SARS.
 
It is not clear why the development banks are so keen to come up with their guesstimates, other than to be seen to be addressing the tabloid headline issues rather than focusing on environmental hazards that are killing tens of millions slowly and which - unlike the evolution of viruses - the banks are actually capable of addressing.
 
There is one issue the banks don't address - the economic cost of spreading fear. One can already see the seeds of the fear mentality that gripped Asia during SARS. Stock markets are down "because of bird flu." Bird flu stories dominate the local news. Nervous governments have warned of the bird flu risks of travel. Australians are advised to consult their doctor before going to Hong Kong, among other destinations. In Hong Kong itself there has even been talk of such futile exercises, reminiscent of 19th-century plague quarantines, as closing borders.
 
Of course there are risks of a flu pandemic. But there always were. Official responses at present, however, suggest that, to quote one epidemiologist, "humans tend to amplify virtual risk while ignoring real risk." For now, the flu risk is minimal compared with that involved in driving a car - and the risk of that debilitating disease, fear itself.
 
 


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