Why an issue of Multinational Monitor focused on bird flu?

The idea should only seem strange at first blush. The spread of the disease among bird populations and the prospect of a pandemic among humans raise questions about the role of multinational corporations in the agribusiness and pharmaceutical sectors, and about the functioning of the resource-starved global public and animal health systems.

A first matter addressed in the articles by Mike Davis and Devlin Kuyek, and to some extent indirectly in the piece by Dr. Leon Bennun, is the role of factory farms - especially, but not only, those controlled by Thailand's CP - in gestating and spreading bird flu. This is a matter of considerable controversy, with most governments and international agencies denying that large-scale chicken farms, where tens of thousands of chickens live in very confined quarters, have a significant role. In an interview in this issue, for example, Dr. Alex Thiermann of the World Animal Health Organization dismisses concerns about the role of factory farms.

A second topic highlighted in the Davis and especially Kuyek articles is how efforts to contain bird flu are impacting small farmers and benefiting big agribusiness. Small farmers in many countries are receiving inadequate compensation for chickens that are culled, Kuyek shows; and new rules and regulations intended to prevent the spread of bird flu may make backyard chicken raising impractical.

A third area of concern is the fragile state of U.S. and global public health and veterinary systems, weakened by decades of underfunding and a corporate-backed ideological attack on the public sector. Speaking of the U.S. public health system, Dr. Irwin Redlener of Columbia University says in an interview that "the problem is that the health system - I hesitate to even call it a system, it is such a mess - has been so undermined and distorted that its ability to respond when needed to a major emergency is extremely limited." Drs. Nabarro and Thiermann make the same point about the state of global systems of public and animal health. The World Health Organization is scrambling to put in place systems to prevent pandemic, as Dr. Nabarro explains, but the agency is forced to develop and execute plans on top of national systems in developing countries that are badly out of order.

Finally, there is to consider the role of the pharmaceutical industry in developing, manufacturing and selling vaccines and drug treatments for influenza. There is, globally, insufficient capacity to manufacture vaccines on short notice, raising the question of whether there should be an expanded public role in manufacture.

We focus in this issue on a separate issue: the manufacture of the branded drug Tamiflu (generic name: oseltamivir), which may work as effective treatment for avian influenza.

Roche, the Swiss company with global rights to make the drug, landed on our 2005 list of the 10 worst corporations of the year for misleading the public about the difficulty in manufacturing Tamiflu, and for refusing to issue an open license to produce the drug. Licensing others to make the drug was and remains important not primarily for reasons of price (though this is an important issue, too), but because Roche simply could not make enough to meet global needs to stockpile the drug.

In this issue, we speak about manufacturing oseltamivir with Dr. Yusuf Hamied, the chair of the Indian generic drug maker Cipla. Cipla announced in October 2005 that it would manufacture oseltamivir - showing that production was much more feasible than Roche had suggested - and it is now doing so. Subsequent to Cipla's announcement, Roche agreed to a limited licensing arrangement for Tamiflu.

On reflection, then, it is not so curious that we chose to focus on bird flu in this issue.

What is unusual about this issue of Multinational Monitor is the uncertainty surrounding core questions we examine.

Most important among these is the likelihood of an influenza pandemic. David Nabarro, the UN systems senior coordinator for avian and human influenza, reports that "the view expressed by the World Health Organization is that a pandemic is inevitable sometime in the future."

By contrast, consider the views of Dr. Edwin Kilbourne, one of the world's leading experts on influenza. Asked whether an avian influenza pandemic is inevitable, he says, "No. I don't know where people get these crystal balls from." Asked whether some form of influenza pandemic is inevitable, he demurs again: "We don't know that. Why do people say that?"

Given that experts are trying to project into the future, there appears no escape from this uncertainty.

At least two things do seem certain, however. First, avian influenza is decimating chicken populations in large parts of the world, with major social and economic impacts. Second, there is a non-trivial risk of a human pandemic, with very severe potential consequences.