Swine Flu Strikes Pandemic Expert Laurie Garrett

As I type these words my brain is swarming with mind-twisting immune-system chemicals called cytokines: I am in day six of the swine flu. Yes, I wrote The Coming Plague in 1994 and have warned about pandemics for most of my life. (I also wrote "The Path of a Pandemic," the May 18 cover story of this magazine.) My diagnosis is unofficial: doctors are no longer testing for swine flu, but since it's the only strain now circulating in the U.S., it's the likely culprit. Colleagues have noted the irony of the fact that I find myself an early victim of what will likely be an enormous American epidemic. As we brace for an H1N1 outbreak that White House science advisers predict will sicken half the country before the end of the year, I am fighting trillions of nasty influenza RNA molecules. This bug is, in virology parlance, a "mild flu," but only somebody who hasn't been laid low by H1N1 would consider days of semi-delirium, muscle aches, fatigue, nausea, and stomach twisting to be "mild."

If the duration and depth of my personal illness are any indication of what's in store, and if scientists have correctly predicted that the bulk of infections in the U.S. will slam the entire nation long before vaccines are available, we are in trouble.

From the perspective of disease, we are all one people on this planet, divided by risk more on the basis of wealth than of geography. This flu will not be deadly for 99.9 percent of those it infects, and that's a good thing not only for infected individuals like me but for the world as a whole. Why? Because we have utterly failed the globalization test in our response to H1N1. The most effective tool in fighting flu is a good vaccine, and the pharmaceutical industry is working on manufacturing supplies right now. According to the World Health Organization, about 1 billion doses of H1N1 vaccine have been ordered worldwide. But more than 6½ billion people live on Earth. From the get-go, some 85 percent of the world's population will be excluded from what, were this a virulent influenza, would be the primary life-sparing medicine. Worse, those 1 billion orders have been prioritized, with the wealthiest nations at the top of the list. This effectively means that before New Year's Eve only about 5 percent of the world population will have been immunized.

This makes my stomach hurt—well, the H1N1 is making my belly ache, but this unfolding failure of globalization doesn't help. If this were a 1918-type influenza, the first test of disease globalization would not just be a failure—it would be a catastrophic one.

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