The global politics of swine flu

By M H Ahssan

We may be at the incipient stage of swine flu's deadly spread across the globe, but already signs of new trans-Atlantic fissures over the European Union's (EU) travel advisory to the United States and Mexico as well as airport screening of US travelers can be found aplenty. This puts a premium on what United Nations secretary general Ban Ki-moon has called for in response to this virus, namely, international solidarity.

Mexican health officials suspect that the swine flu outbreak has caused more than 159 deaths and roughly 2,500 illnesses in the country where the it first emerged.

The World Health Organization (WHO) says at least 105 cases have been confirmed worldwide, including 64 in the United States; six in Canada; three in New Zealand; and two each in Spain, the United Kingdom and Israel. On Monday the WHO raised its alert level from three to four on a six-level scale. This means the virus is thought to be capable of significant human-to-human transmission - a step toward a pandemic.

Swine flu is a contagious respiratory disease that usually affects pigs. It is caused by a type-A influenza virus. The current strain is a new variation of an H1N1 virus, which is a mix of human and animal versions.

"Hysterical", "unwarranted", "overreaction" and "ineffective", were the top choices of words used by US officials in reaction to the EU health officials' alarm bells discouraging "all non-essential travel" to the US.

History often repeats itself, albeit in unexpected fashion, and the stern US responses to the Europeans' health disaster response reminds one of China's similar response when, in April 2003, the US Center on Disease Control (CDC), put this statement on its website in response to the early reports of the severe acute respiratory syndrome (SARS) epidemic in Asia: "Don't go to mainland China, Hong Kong, Singapore and Hanoi unless you really have to."

In historical retrospective, given the eventual semi-global spread of SARS and its limited impact on the US, the CDC travel advisory in 2003 appears entirely timely and appropriate, irrespective of negative reactions by the Chinese government, which was accused by Western governments and world health officials of "deception" about the extent of the deadly disease.

Still, US experts such as Michael T Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, have described some countries' travel warnings and bans on some imported foods from the United States and Mexico as "hysterical".

But with the medical community still in a frantic search to understand this new strain of influenza virus and its potential for "new sub-systems" via mutations and "reassortments", the US government may have under-reacted, given President Barack Obama's assurance on Monday that the swine flu was a cause for concern but "not alarm".

As a result, unlike president George W Bush, who in April 2003 signed Executive Order 12452 adding SARS to the list of communicable diseases, for which the US government can quarantine individuals, forcibly if necessary, Obama has refrained from taking a similar initiative. As a result of which, voluntary self-isolation and "social distancing" on the part of flu victims has for now replaced a robust and systemic prevention through mandatory quarantine systems, epidemical check-points and surveillance mechanisms.

In the event the flu's growth in the US in the coming days and weeks leaps in the less than sanguine direction of a full epidemic, instead of a small-scale one as is the case at the moment, then inevitably questions may arise as to what the Obama administration could have done to stem the tide - other than by simply issuing a travel advisory for Mexico.

Hundreds of US flights to and from Mexico have continued unabated since the swine flu outbreak, and there has not been any attempt by the US government to either close some borders with Mexico or even reduce the substantial human traffic crossing those borders, fearing the adverse economic impacts in today's climate of global economic recession.

This may turn out to be short-sighted if, indeed, the ominous forecasts of potential trans-border transmission of the disease are realized, as any belated US effort would be a remedy too late.

The trick is undoubtedly not to make policies based on worst-case scenarios, but then again there is also the grave risk of avoiding a painful "great reshuffling" of policies called for by a potential pandemic, to paraphrase Andrew Nikforuk in his book, Pandemonium.

"A severe pandemic might encourage us to rethink the deadly pace of globalization and biological trade in all living things," wrote Nikforuk, wise thoughts that sound fresh several years later as the world grapples with the looming specter of a new natural disaster that has already wrought havoc on the failing state of Mexico.

The country has been mired in an uncontrolled war on drug cartels, and the latest setback promises to make Mexico even a more unstable country as the country loses some of its precious resources in fighting a disease. Clearly, Third World Mexico's lack of an integrated strategy to combat the infectious disease with adequate resources has a lot to do with the flu's high mortality rate compared to its impact in US and Canada.

As usual, the North-South gaps reveal themselves with glaring and oppressive clarity in such outbreaks of public illness.

At the same time, by posing the US as a "risk society", a whole new fertile field of discourse on America's (health) identity has been opened by the threat of swine flu, given the stigma of Europe's travel advisory and some European nations' bans on the import of US pork.

An imagined pandemic may sting the US nearly as much as a real pandemic and the sheer indeterminacy of the flu's potency and future growth simply adds to its dispensation of a new unhealthy image for the US. Swine flu points at the growing linkage between foreign policy and health policy, as well as the nexus between health and security, seeing how prominent a role the US Homeland Security plays nowadays in the government's reaction to the unexpected flu epidemic, reflecting a further medicalization of US security.

At the epistemological and policy levels then, in addition to providing a new venue for global health partnership and multilateralism, the obverse side of cooperative behavior is, as stated above, a new rise of national protectionism that is also at the nodal points of North-South divide. This is as we witness the huge disparities and fluctuations in access to preventive medicine in less developed countries, which are keenly concerned about a lack of adequate health financing.

The disease's proliferation in Africa would be especially devastating as the continent is still struggling with the exorbitant ramifications of other infectious diseases. Irrespective of such a scenario, the mere threat of this new disease will escalate the demands of developing and least-developed nations for greater access to vaccine-manufacturing plants, affordable medicine, etc.

Much depends on the scope of the swine flu's global spread and its lethal punch and. Should it turn out that we are merely witnessing its first phase of attack, which is pregnant with multiple subsequent waves causing greater and greater disruptions in world trade, transport and trans-border human movement, something impossible to pre-calculate at this stage, then a whole new logic of de-globalization may be inevitable.

On the other hand, this flu has the potential to be labeled as a "metropolis disease" that does not contaminate much of the the Third World, in which case it will lead to new theorizing about what is referred to these days as the "global network society".

On the whole, swine flu can take one of two directions, it can either act as a circuit-breaker for a renewed globalization in terms of collective response, or a potent source of "international solidarity" as envisioned by UN chief Ban. Or, finally, it may have the contradictory effect of pushing both chariots simultaneously, at least in the short run.