May 30, 2005

Preparing (for?) a pandemic

In response to my post on George Bush and Sally O'Reilly, where I (rather unfairly) hypothesized that "Nature's Paris correspondent is using anti-American and anti-Bush prejudice to promote awareness of an international public health issue", several European readers proposed other motivations.

For example, Moritz Schallaboeck argued that "the US market is larger than any other single  national market, if perhaps not larger than the European market taken as a  whole", or "maybe the author just felt like it, or had an  American acquaintance the story is loosely based on".

John Kozak suggested that Nature is "writing to an international audience which, for better or worse, will be collectively far more familiar with the verbal idiosyncrasies of the incumbent US president than any other statesman". (But John, isn't that what I said?)

Trevor at Kalebeul suggested that I've misunderstood "the role of the intellectual in European society, which is something like that of a Catholic bishop in the States". He quotes a character in a Max Aub novel to the effect that "an intellectual is someone for whom all political problems are fundamentally moral problems". His conclusion: "That on this basis George W Bush emerges as the greatest intellectual of our time has naturally led to some jealousy over here".

And Declan Butler, who actually wrote the piece, emailed to explain that his intention was to highlight the need for U.S. leadership on this issue, and to try to make the issues more real to that public who can perhaps most effectively bring about real change in the way the world handles this threat: the American public. On this account, Sally O'Reilly's fictional blog was in fact pro-America's capacity to influence world events for the better.

I'll confess to the obvious: I was being one-sided and provocative. Butler's explanation is entirely reasonable, and I might have made the same choice in his place. However, there's a tricky contextual dynamic here, in my opinion.

These days, many Europeans seem to see Americans as the main source of international agency, especially in respect to blame. If something goes wrong, the default explanation is that it's because of something that the Americans did, or something that they failed to do. If Americans take an initiative (like Google Print), it's interpreted as a challenge and even an attack. If Americans fail to take an initiative, as in the case of developing techniques for rapid vaccine development in response to new flu strains, or monitoring and rapid response systems for extinguishing the disease in animal reservoirs, then the threat to world health is seem as a primarily American failure.

In military matters, there's some objective foundation for this view. But the size and sophistication of Europe's biomedical R&D establishment easily rivals America's. European political opinion is more friendly to major government-funded R&D initiatives, outside of military and national-security areas. And European government budgets are somewhat less out of control than the American budget is. So all in all, Europe is arguably better positioned than the U.S. to launch a major new R&D initiative on responses to influenza pandemics.

Nature's editorial on the bird flu threat, as Declan Butler pointed out to me, implicitly highlighted the failings of the international community and all countries. However, the U.S. is the only country whose preparations are explicitly criticized in the issue, as far as I can tell, and Bush is certainly the only political leader to be ridiculed.

Luckily, Fortune has dealt Nature another opportunity to ridicule a politician for saying dumb things about bird flu, just three days after the publication of the recent special issue. And this one is non-fiction:

Réagissant à cet article, le ministre de la Santé Philippe Douste-Blazy a déclaré que la France est "le premier pays européen à avoir parfaitement préparé une éventuelle épidémie de grippe aviaire".

Reacting to this article, the Minister of Health Philippe Douste-Blazy has declared that France is "the first European country to have perfectly prepared (for?) a possible epidemic of bird flu."

Selon le ministre, "la France a parfaitement préparé une éventuelle épidémie en commandant en octobre 2004, aux laboratoires Roche, 13 millions de traitements de Tamiflu ... Le Tamiflu est un antiviral efficace sur l'ensemble des souches grippales".

According to the minister, "France has perfectly prepared (for) a possible epidemic by ordering in October 2004, from the Roche laboratories, 13 million treatments of Tamiflu ... Tamiflu is an antiviral effective against all strains of flu."

Cinq millions de traitements sont déjà en stock dans notre pays et la quasi-totalité des stocks sera constituée avant la fin 2005. La totalité le sera avant mars 2006, a précisé le ministre.
Il a souligné que "la France est un des rares pays avec les Etats-Unis, la Canada, le Japon et l'Australie, à avoir constitué de tels stocks, permettant un traitement précoce d'éventuels malades atteints de grippe aviaire durant la pandémie".

Five million treatments are already in stock in our country and nearly all the stock will be complete by the end of 2005. The whole order will be complete before March 2006, the minister explained.
He underlined that "France is one of the few countries, with the United States, Canada, Japan and Australia, to have established such stocks, permitting an early treatment of possible patients stricken with bird flu during a pandemic."

Before we get to the content of these remarks, there's an interesting linguistic point here. I'm surprised to learn that the French verb préparer can be used with the prepared-for threat or challenge expressed as a direct object. I thought that (as in English) one could prepare a meal, or prepare a patient for an operation, or prepare (oneself) for an ordeal; but apparently one can also prepare a pandemic. Curiously, the DAF doesn't seem to register Douste-Blazy's usage either.

With respect to the public health issue, Douste-Blazy's notion of "perfect preparation " is a stock of 13 million treatments of Tamiflu for the French population of about 61 million, a precaution that he compares in degree of perfection to the status of four other countries including the U.S. I'll look in the next issue of Nature for the appropriate editorial comment: "parfaitement préparé, mon cul!"

[Update: Declan Butler points out via email that Douste-Blazy's remarks fit well with the schema of common denial and attempts to reassure, described in this essay by Peter Sandman and Jody Lanard. He also observed that the stocks of Tamiflu in Britain, France and Canada, though sure to prove inadequate in the face of a pandemic with high mortality, are much higher than those in the U.S., which has some 2.3 million courses of treatment available. ]

Posted by Mark Liberman at May 30, 2005 07:45 AM