Posted: October 21, 2007
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The bird flu / pandemic flu confusion

Written for the CIDRAP Business Source Weekly Briefing
and the CIDRAP Business Source website
(Never published by CIDRAP)
logo, link to CIDRAP Source
We have told people to worry about a “bird flu pandemic.” No wonder they think the danger comes from birds.

A fall 2006 Harvard School of Public Health survey link to MS Word document asked U.S. adults whether they thought a human bird flu death was likely in the U.S. in the next 12 months. 44% thought it was “very” or “somewhat” likely, while 53% thought it was “not too” or “not at all” likely. Only 3% had no opinion.

The next question asked about the term “pandemic flu.” 41% said they “know what the term means.” 33% said they “have heard of it, but are not sure what it means.” Fully 25% conceded that they “have never heard of the term ‘pandemic flu’ before.” The survey didn’t go on to ask the first two groups what they think the term means. But it’s a safe bet that some of the first group and most of the second think that pandemics come on the wings of diseased birds. Of course the third group also thinks diseased birds are the problem; they just haven’t (mis)learned yet that this bird flu problem is called a pandemic.

It’s our fault

How did the public get this profound misimpression? They got it from us – from officials, from experts, from journalists, from risk communicators, from everybody who has been talking, carelessly, about what we all too often call a “bird flu pandemic.”

Most readers of this newsletter understand the distinction between bird flu, which has already afflicted millions of birds plus a few hundred stunningly unlucky humans, and pandemic flu, which may someday afflict millions of people. We understand that the connection between the two is a genetic mutation or reassortment that hasn’t happened yet. We understand that bird flu is a major veterinary issue but a minor public health problem, and that any virus that can launch an influenza pandemic will no longer be a bird flu but a human flu, passing all too easily from person to person in places where there are no sick birds.

Calling both of these problems “bird flu” has been a monumental mistake.

Calling both of these problems “bird flu” has been a monumental mistake. We tell people that many experts are incredibly worried about bird flu, which could be a public health disaster, overwhelming hospitals and disrupting just-in-time supply chains. And we tell people that bird flu is spreading inexorably from country to country and will almost inevitably get to our country too. We are less than clear that these two sentences, both true, are about different bird flus.

Understandably, people over-react to the risk from poultry when the first H5N1-positive bird is found in their country (or their neighborhood). And understandably, people under-react to the risk of a pandemic until the first local bird is found. We have taught them, mistakenly, that it’s about the birds.

A typical example

Here’s an all-too-typical example, a February 28, 2006 Daily Mail (London) business story by Tessa Thorniley. The confusion starts with the headline, “Deutsche says bird flu threat is overcooked.” Anybody want to guess which bird flu threat Thorniley is talking about? As you read the article’s first four paragraphs, keep guessing. My guesses are in brackets and in italics.

As ever, brokers are taking a pragmatic approach to bird flu. Deutsche Bank has even drawn up a list of those companies most likely to be struck down with the virus. [Agricultural companies devastated by bird flu in poultry? Non-ag companies devastated by a human pandemic? No way to tell.]

Experts reckon it is a case of when, not if, the killer HN51 strain reaches our shores. [Well, so far H5N1 is a killer strain almost exclusively in poultry. We must be talking about bird flu in birds.] France is in a flap and has started a mass vaccination programme [that’s in poultry; there’s no human vaccine in distribution yet] after the flu was found in a turkey farm. The flu has already affected poultry in Germany, Italy, Austria and Greece.

Bracing investors for a pandemic – and the ensuing disruption to international trade, goods shortages, crumbling stock markets, air travel grinding to a halt – would be too alarmist. [Okay, now we’ve switched to talking about a pandemic. It’s even pretty clearly signaled.] Instead, Deutsche says the risks to equity markets are clear but is forecasting a mild impact.… [Got it: Deutsche Bank is predicting a mild (human) pandemic.]

With the worst of the virus confined to Asia, long-haul airlines and big international hoteliers are far more exposed than domestic ones. [Here’s an unheralded switch back to (bird) bird flu; obviously there’s no reason to expect the worst of a (human) pandemic to be in Asia.] Cadbury would suffer as ‘impulse driven’ buying is reigned [sic] in. [Wait a minute, bird flu (in birds) isn’t going to hurt candy and beverage sales; we must be back in (human) pandemic territory.] The bank most at risk is Standard Chartered…, which has a big presence in Asia. [If we’re in Asia this must be (bird) bird flu again.]

Maybe Thorniley understood the distinction between bird flu and pandemic flu, but failed to make it clear in what she wrote. More likely she doesn’t get it. Some of her sources may have been similarly confused; others undoubtedly understood the distinction but were less than careful about explaining it.

There aren’t lots of news stories in which experts explicitly say that the risk of a pandemic will increase when a local H5N1-positive bird is found, and we’re pretty safe till then. Explicitly dead-wrong stories are rare. But equally rare are stories that explicitly explain that there are two bird flu problems not one, that the current small health risk from sick birds is distinct from the much larger future pandemic risk.

Industry makes it worse

The U.S. poultry industry sometimes compounds the problem by falsely implying that we are safe as long as our chickens are safe. Though a pandemic is unlikely to start in a U.S. battery farm, it will quickly reach the U.S. population if it starts in a backyard farm in Asia or Africa, transmitted thereafter not by birds but by people.

This false implication is dangerous to the poultry industry itself, because it suggests that if U.S. birds start getting sick, our pandemic risk will escalate rapidly … and the source of the risk will be birds. Then, as chicken sales plummet, the industry will belatedly try to explain that a few U.S. flocks infected with H5N1 don’t increase people’s risk significantly. The logic of “you’re safe because we don’t have any sick birds” is inescapably also the logic of “now that we have some sick birds you’re no longer safe.” Industry statements that imply the former will have trouble morphing into statements that deny the latter.

But I’m less worried about the fortunes of the poultry industry than the progress of pandemic preparedness. The confusion of bird flu and pandemic flu is dangerous because it suggests that there is little reason for U.S. citizens to prepare for a pandemic until U.S. birds start getting sick. We need to correct the confusion. The first step is to stop compounding it.

Copyright © 2007 Regents of the University of Minnesota. Reproduced with permission.

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