The same pattern of CDC/WHO involvement has been followed in the U.S.-fueled worldwide overreaction to H5N1 avian influenza. This bird flu cannot routinely affect humans in its current form (114 deaths to date in nine years). But the priority being placed on it as a potential threat to humans is obscuring diseases that are already worldwide killers: malaria, which kills more than 1 million people a year; tuberculosis, more than 2 million; and HIV/AIDS, more than 3 million. As the worldwide health network grows, promoted by U.S. health care officials but involving public health agencies all over the world, I am concerned that there will be a simultaneous export of the American obsession with certain diseases while others are excluded.
Worldwide spending on AIDS was $8.3 billion in 2005, with almost half of this coming from George W. Bush's Emergency Plan for AIDS Relief. But a 2005 WHO/UNAIDS report estimates that AIDS treatment coverage is $18 billion below global needs for 2005-07, with a projected $22 billion annual requirement by 2008. The WHO has not come close to its goal of treating 3 million AIDS patients by the end of 2005. Currently just over a million are receiving antiretroviral therapy.
Meanwhile, here in the United States, Bush has proposed cutting $15 million in AIDS research at the National Institutes of Health, while increasing funds for studying avian flu and bioterrorism. Bush's proposed 2007 budget calls for increasing by 0.3 percent funding for the NIH's Institute of Allergy and Infectious Diseases. The money will be targeted for avian flu and biodefense. Bush is also calling for a 6.2 percent increase for other NIH biodefense projects, according to the American Association for the Advancement of Science's analysis of the President's budget. This is in addition to the $5.6 billion already being largely wasted on Project Bioshield, which is supposed to help provide medical countermeasures against a chemical, biological, radiological or nuclear attack, with much more to come in Bioshield II. Almost $1 billion has gone to the manufacture of 75 million doses of anthrax vaccine, for example, despite the fact that anthrax is not contagious and has not recurred since the 22 cases in 2001 thought to be linked to terror.
Some public health officials have argued that avian flu should be at least as high a priority as AIDS because of the theoretical worst case, in which it could cause a severe human pandemic, but it is not even clear that the money allocated for bird flu will be used effectively for real prevention. Ron De Haven of the Animal and Plant Inspection Service of the Department of Agriculture says that although H5N1 is still a major threat to birds, only $4.4 million of his department's $1.1 billion budget for 2005-06 was earmarked for biosecurity outreach, to keep infected birds from coming here. And though $3.6 billion already has been approved for emergency pandemic preparedness against bird flu, with an additional $2.6 billion proposed, Dr. Andrea Gambotto, the creator of a new bird flu vaccine using modern genetic techniques (adenovirus) that has been effective in mice and birds, has been unable to get NIH funding to test this vaccine in humans. Newer approaches could lead to more potent vaccines with a quicker turnaround time -- a much more effective tool for reacting to a pandemic as it is happening than current attempts to anticipate one that may never happen. But the president's new budget cuts 4.5 percent from the CDC's core programs while adding no funds for NIH. There is clearly no priority for key research programs.
Overseas, the biggest health problems that could benefit from our attention are malnutrition and the lack of clean water and proper sewage. Diseases like schistosomiasis and malaria thrive because of poor public health conditions. But our outreach does not emphasize them. Our public health system appears to be much more concerned about a disease like bird flu transforming into something that could threaten us than it does in helping the world with diseases that already threaten poor people everywhere. More than 16 million people die every year of malnutrition. Eight hundred million people worldwide currently suffer from hunger and malnutrition. How many people who survive mainly on poultry will have this food taken from them if worldwide health authorities -- their perceived need to act in a hurry fueled by media reports -- continue to kill domestic fowl indiscriminately whenever H5N1 appears?
A TV movie that aired in May, Fatal Contact: Bird Flu in America, capitalizes on fear by depicting a crippling loss of basic services and mass graves. This movie wasn't made in a vacuum -- many scientists and journalists have been doomsaying on bird flu to such an extent that they have created a fear terrain even Disney could exploit. Sadly, hyperbole is not a method of discourse exclusive to TV drama; a public health blog for bird flu fanatics recently suggested the United States should pull out of Iraq and use the resources we save for bird flu preparation. On the surface this sounds like a terrific idea. On further reflection, it seems clear that going into Iraq in the first place was based on the same kind of argument -- in which a remote but scary risk is exaggerated so it appears to be looming -- that has characterized the public health reaction to bird flu.
Marc Siegel, MD, is a practicing internist at the New York University School of Medicine and author of Bird Flu: Everything You Need to Know about the Next Pandemic. This article first appeared in The Nation (www.thenation.com).