Alan Sipress - The Fatal Strain

It was late one morning in May 2005 when this lanky, good-humored veterinarian arrived at an elderly woman’s farmhouse partway up the slopes. Clad in the tan uniform of a civil servant, Suparno announced he’d come to inoculate her chickens against bird flu. While a human vaccine had so far proven elusive, workable poultry vaccines were already in production, and several Asian countries, including Indonesia, had made them the centerpiece of their efforts to contain the virus. Suparno knew the woman kept some chickens. Nearly every family in her village did.

“How many do you have?” he asked her.

“Twenty-five,” she answered. The woman motioned initially toward a low, concrete barn out back where she kept some of them. Then she swept her right arm in front of her, indicating the rest were wherever he might find them.

Suparno led his team around the side of the house into the cramped backyard. Crouching on the dirt, he set down the small, pink pail that held his gear. He took out a plastic bottle of vaccine, then slowly drew the fluid through a tube into an automatic needle. His colleagues produced five black hens from the barn, one by one, and clasped their wings and legs tightly while Suparno injected half a milliliter of vaccine into their breast muscle.

After only a few moments, he rose to his feet and got ready to leave.

“What about the rest of the birds?” I asked him.

“Too hard to catch,” he responded. They might be hiding in the trees or in the crawl space beneath the house.

Then, changing the subject, Suparno and his fellow officers agreed it was time to eat. He invited me to join them. With no irony intended, they suggested a local joint specializing in chicken.

I had come to the province of Central Java to spend several days observing Indonesia’s much-publicized effort at fighting the infection that had been coursing through the country’s flocks for more than a year. Central Java, as its name implies, is at the center of Java island, which, in turn, is home to the majority of Indonesians and has always dominated the country’s politics. My base would be the old royal city of Solo, host to one of Java’s two main sultanates. Solo remains the premier seat of Javanese culture and tradition. So I’d figured, given the political, cultural, and geographic centrality of the city, that the surrounding countryside would be at the forefront of the national campaign to root out the disease.

At first I was encouraged. The chief livestock officer in one nearby district, Sragen, told me how she’d set up a twenty-four-hour bird flu command center. Sri Hardiati, a gregarious yet autocratic woman with a stylish haircut and piercing dark eyes, described how her office monitored poultry outbreaks and even had a small diagnostic lab for dissecting stricken birds. But as I toured the countryside with my assistant, we discovered that containment efforts were just public relations. We had asked to see the vaccination campaign at work. Yet in district after district, livestock officials declined. They said they had none to show us. Finally, after some pestering on our part, Hardiati asked us to accompany her chief vet, Suparno. He made only one stop, pausing long enough to vaccinate the woman’s five black hens. When he bypassed all the other homes in the village, I realized the outing had been simply for my benefit, little more than a photo op.

Over the coming days, we would learn the extent of the ruse. Indonesia’s central government was claiming it provided millions of free vaccine doses for small and midsize Javanese farms and that 98 percent of these had already been used. But local officials and peasants told us this was fiction. “Maybe the farmers get the vaccine. The percentage who use it is small,” said the chief livestock officer in neighboring Karanganyar district. In Boyalali district, the chief livestock officer told me he had a hundred thousand doses in a refrigerator, but no one had asked for any in months. He was content to let them sit there.

As we continued to drive the narrow byways of the Javanese countryside, we were also starting to learn from villagers and local veterinary officers that die-offs among chickens had been occurring much longer than we’d believed. Indonesia had officially confirmed its first poultry outbreak in January 2004, not long after Vietnam and Thailand initially reported theirs. But the local accounts we were hearing contradicted the version we’d been provided back in the Indonesian capital, Jakarta. We were fast realizing that Indonesia’s central government had covered up the mounting epidemic for almost half a year, since mid-2003, until it was too late to reverse the tide.

Now, as we explored Central Java in May 2005, Indonesia had still to confirm its first human cases. But that too would change within months when death struck a suburb of Jakarta and Indonesia joined the growing list of countries with casualties. It wouldn’t be long before the death toll in Indonesia outstripped that of anywhere else on Earth.

Yet Indonesia wasn’t alone in concealing the disease. I would come to learn that every Asian country with major outbreaks in livestock had hidden them from view, for months or even longer. The fatal strain’s progress across East Asia had been a journey veiled in secrecy and blessed with neglect. This microbial killer, born in the deep south of China, had repeatedly slipped across international borders over the previous decade, evolving and increasing its virulence until the toll on both people and poultry could no longer be denied.

But even then, when it became untenable for governments to keep up the lie, they often chose to discount the danger rather than mount a serious campaign to defeat it. Instead of attacking the virus, they too often went after the scientists, journalists, and other whistle-blowers who tried to reveal the threat.

The virus exploited this opportunity to put down roots. It became entrenched in Asia’s poultry, thus posing a long-term menace to humanity. While some Asian governments eventually intensified their efforts to contain the disease, total eradication was now a distant prospect at best. Not a single one of these frontline countries—China, Indonesia, Thailand, and Vietnam—had adopted the most powerful disease-fighting weapons: truth and transparency.

Later, when I arrived on my first trip to Geneva, a senior WHO official gave me a piece of advice. He counseled me that influenza is all about politics. And those antiquated politics have proven every bit as intractable as the virus itself.

This tale of death and deception begins in the coastal Chinese province of Guangdong, close to where the first human cases were confirmed in Hong Kong back in 1997. The H5N1 flu strain, which went on to ravage farms on at least three continents, infect hundreds of people, and pose the most serious threat of pandemic in a generation, was first isolated in a sample taken from a sick goose during a Guangdong outbreak in the summer and early fall of 1996. That was more than seven years before China first acknowledged any infection in its flocks. By the time Chinese officials went public in early 2004 and stepped up efforts to contain it, the virus had already seeded outbreaks in the country’s neighbors.

Molecular biologists were later able to identify the Guangdong pathogen as the common ancestor of all subsequent H5N1 viruses by analyzing the eight segments of RNA that all flu viruses contain. Each of the segments in a single virus has its own signature, a specific sequence of basic building blocks called nucleotides that make up the RNA. As viruses evolve, these segments mutate. They can even be completely replaced as the promiscuous flu strains swap genetic material. In the lab, genetic genealogists determine the pedigree of viruses by looking for similarities in their RNA. Isolates that share the same pattern are often related and descended from the same specific virus.