Who should worry about H5N1?

Ideally, not the public, ever. But there's much that needs to be done, now, to keep it that way.

My New York Times columns have returned to dealing with a range of topics, some I’d never have expected to write about, like the royals(!), and some of the usual such as software infrastructure and technical debt, generative artificial intelligence programs like ChatGPT, but a familiar one, too.

Emerging potential pandemics and how to stop them from being actual ones, namely the current H5N1 avian influenza outbreak—the biggest one historically. (Notice the price of eggs?)

Why write about it at all since the risk to humans is so low to be quite negligible at the moment? (Mostly: don’t pick up dead birds for the rest of us who don’t work on poultry or mink farms.)

Because something unprecedented happened — H5N1 infected minks, and then a mutant version likely spread among them. The first mammal-to-mammal transmission. That is a big deal.

The pace of developments has been disquieting. Until 2020, when the new H5N1 strain began to spread extensively among wild birds, most big outbreaks occurred among poultry. But now, with wild birds acting as conduits, it’s not just the biggest outbreak ever among poultry, causing the death of at least 150 million animals so far, but it is also steadily expanding its reach, including to mammal species like dolphins and bears.

In 2006, when scientists discovered that H5N1 had not spread easily among humans because it settles deep in their lungs, Kuiken of Erasmus University Medical Center warned that if the virus evolved to bind to receptors in the upper respiratory tract — from which it could become more easily airborne — the risk of a pandemic among humans would rise substantially. The mink outbreak in Spain is a signal that we might be moving along exactly that path.

All this makes it time for the authorities to act really aggressively to counter this threat so that we don’t have to think about it, as ordinary people. Will they? I wish I could be confident they will quietly get the job done, and we don’t have to think about it at all.

Minks have an upper respiratory tract quite similar to humans, and their very close cousins, ferrets, are used as human proxies in experiments with respiratory viruses exactly for that reason. During the early days of the COVID pandemic, in 2020, before there was any new variant that had taken hold in the human population, minks in farms in Denmark got infected from humans, generated new variants which then found their way back into the human population: reverse zoonosis to minks to an uncontrollable spread which generated new variants and then zoonosis back to humans. Not good. Denmark quickly culled 17 million minks: another tragedy, really, on top of the tragedy of keeping otherwise solitary hunter carnivorous mammals — minks and ferrets aren’t rodents — in crowded, packed industrial facilities only to kill them at six months old for their fur. It’s bad enough to keep herd animals in industrial settings; it seems exceptionally cruel to keep solitary ones.

American Mink, by Akulatraxas, Creative Commons licensed

You can read the piece here, including about the state of vaccines for H5N1. We have them, which is great, but not in enough numbers for a serious outbreak. The plan is to mass produce them if and when there is one. Well, there is a twist, though.

Worryingly, all but one of the approved vaccines are produced by incubating each dose in an egg. The U.S. government keeps hundreds of thousands of chickens in secret farms with bodyguards. (It’s true!) But the bodyguards are presumably there to fend off terror attacks, not a virus. Relying on chickens to produce vaccines against a virus that has a 90 percent to 100 percent fatality rate among poultry has the makings of the most unfunny which-came-first, the-chicken-or-the-egg riddle.

The only company with an F.D.A.-approved non-egg-based H5N1 vaccine expects to be able to produce 150 million doses within six months of the declaration of a pandemic. But there are seven billion people in the world.

My piece was on what authorities should do about vaccinating poultry and pigs, shutting down mink farms, developing faster and non-egg based platforms for H5N1 vaccines, stepping up the surveillance globally to detect an outbreak quickly so we can crush it before it goes anywhere. The online commentary had a lot of people who wanted instead wanted to talk about…  lockdowns, masks, social distancing, vaccine mandates, etc. etc. 

Ouch. That feels like people wanting to yell at their TV because they were annoyed about how the weather reporters behaved during the last hurricane, even as a potential new one is bearing down. The new one doesn’t care.

One feedback I got was why I didn’t talk enough about the role vaccine hesitancy may play in a potential H5N1 pandemic. One key reason, of course, is space. Not everything fits into a single column.

But also there’s a reason why people who remember the pre-vaccine era — seniors — are so much friendlier to vaccination, even if they are not otherwise, say, liberals.

The H5N1 current fatality rate among known cases is 56% though it’s important to note an eventual human version (which I hope never comes around) would likely be much less. That number comes from the few hundred detected cases over the past two decades, and who knows how many we’re missing. The good news so far about H5N1 is that while people can get infected through very close contact with birds, often poultry workers in farms, but it doesn’t seem to go anywhere else. There may well have been many more cases, lowering that rate.

Still, though, lower than 56% has a long way to go before one can brush it off. The death rate among the infected minks was about 5%, a much lower number than 56% but… a catastrophic number, really. In Wuhan, without any treatment or vaccine, the initial case fatality rate was about 1.4%, and that was catastrophic. And that’s just deaths. In addition, COVID severity was exponential with age. Influenza is less steep a curve, even though it also tragically affects the elderly more. In addition influenza also tends to claim a lot more children. This isn’t downplaying one virus against the other, obviously, but the mortality rates and profiles do generate a different political space for the opportunists.

Many of the anti-vaccine players seem to be playing a game of lucrative grift usually via outright misrepresentation — and some are even MDs, which is atrocious. Some of this made possible by the fact that our vaccines are so, so good and most people are sensibly vaccinated — especially children against so many terrible childhood diseases. The resistance seems to be towards new vaccines, but it is slowly seeping into existing vaccines. If that spreads, the problem will likely be self-limiting in the sense that the catastrophic outcomes will quickly provide the corrective, but at a great cost. Same likely would happen with his, but again at a great human cost.

And, yes, I really did write about the brouhaha around Prince Harry’s memoirs — but it’s not about the royals, really. I wanted to counter the tendency to dismiss it as a mere celebrity kerfuffle when, in fact, it was an opportunity to talk about something quite insidious: the politically-influential British tabloids and their ugly but effective campaigns. It’s not just the UK, either.

Sometimes, it’s the famous people that provide insight into an important dynamic, and both the book and the documentary deal with a lot more substantial topics than media coverage would indicate — but yes, feel free to ignore the purely celebrity aspects which do get a lot of (boring to me) coverage.

So I wrote the piece because I think the case around Prince Harry and Meghan Markle provides an insight into much else, including Brexit.

The way the tabloids can spread unhinged claims, generating a sense of urgent threat to create a social frenzy, can be used for targets other than a stray royal.

During the run-up to the Brexit vote, among other outright big lies, British tabloids screeched that, thanks to a secret conspiracy being cooked up in Brussels, the European Union would allow hordes of Turks to invade Britain, commit crimes, have too many babies and bankrupt the social services. Turkey isn’t even a member of the E.U. and is nowhere near becoming one. Brexit narrowly won, with damaging consequences still unfolding for Britain.

But at a human level, too, what has been happening to the couple is terrible, and inexcusable. The UK tabloids churn out awful multiple pieces about them, day-after-day, now for years. And also journalists who are treated as respectable ones also participate in this, in the most awful manner, often without any repercussions.

But, I must say there was something refreshing about the aftermath of that piece. It was a change of pace! No more discussions about legacy code or vaccines!

Instead, there was a huge amount of swirl, on social media and on Reddit, by monarchists and royalists —I suppose? — who decided I was evil incarnate for talking about the way the royal family and the British tabloids collude in a terrible manner, and that I was in the pay of Harry and Meghan (obviously 100% false), including very large numbers of people trying to carefully dig through my CV to prove my status as a puppet of the Duke and Duchess of Sussex. (The Markle-hate Reddit group where most of this took place had 40 thousand people in it!)

A bunch of them were expressing that they would carefully watch my future writings, and keep doing investigations to prove that I was in the pay of Big Montecito, I guess, where the couple now reside.

Anyway, I hope they enjoyed my next column, on H5N1.

And we shouldn’t farm minks, even if this threat passes. It’s cruel, unethical, unnecessary and dangerous.