The Great Flu Cover-up

How governments concealed the extent of the H1N1 pandemic and risking the outbreak of a virus that's even more deadly.

As swine flu was spreading around the globe this spring, a senior disease specialist from the World Health Organization (WHO) held an urgent conference call with top British health officials. In the conversation this May, later described as "aggressive" by sources familiar with the discussion, the WHO official accused the British of concealing the extent of their country's swine-flu outbreak. Among those with swine-flu symptoms, Britain was only counting people who had traveled to places that, like Mexico, had already confirmed an outbreak of the virus, known to scientists as H1N1. Their method left much to be desired in a country where the virus was already spreading fast. Countless Britons fell sick and were intentionally left uncounted.

Governments, of course, have a long history of concealing outbreaks, and this year's flu pandemic, while the first of this particular century, was certainly not the first to be brushed under the rug. The consequences of cloaking swine flu weren't disastrous on this occasion, but the result will not always be so benign. In fact, at this very moment, another virus -- with the potential to be far more devastating -- is continuing to seed infections, frustrating efforts to root it out. That virus, H5N1, or avian flu, is a far more lethal strain. And you guessed it: front-line countries' records in candidly reporting the disease's spread don't bode well.

If there's one thing past pandemics have taught, it's that curing the world of flu is impossible unless countries are upfront about their outbreaks. Armed with that vital information, health officials can take steps to slow the spreading infection and, if containment fails, ramp up emergency medical care and other vital services. Without timely disclosures, it's much harder for virus hunters to discover how an emerging disease attacks its victims and transmits to others; it's also much tougher to get virus samples for study in the lab.

Given all this, why would governments try to keep down their official infection tallies? Most likely, fear of stigma and all the economic consequences that follow. When the WHO placed its call to London last spring, the agency was still weighing whether to raise its state of alert and declare that the swine flu epidemic was a full-blown pandemic, a dramatic step that would signal all countries to ready themselves for the brunt of the new virus. It was clear that the virus was spreading in the Western Hemisphere, especially in the United States and Mexico. But under the agency's criteria, a pandemic could be declared only if "community-level outbreaks" were confirmed in more than one region of the world. If Britain acknowledged that the virus was spreading widely, that would add Europe to the list and push the outbreak across the pandemic threshold.

London's concerns are understandable. The epidemic of 2009 might have been dubbed the British flu, just as the Spanish flu of 1918 got its name not from its place of origin but from one of the first countries to honestly report the epidemic's arrival. (In 2009, perhaps having learned their lesson, the Spanish also withheld information about their swine-flu outbreaks, according to sources familiar with Spain's reporting.)

Of course, some countries do get high marks on swine flu, including the government of Mexican President Felipe Calderón, which has won international credit for sharing information about the epidemic in his country and acting very aggressively to contain it. Even China has been open this time, having been burned by criticism of a completely opaque epidemic of Severe Acute Respiratory Syndrome (SARS) that went on for three months in 2002 before the epidemic was confirmed.

But the world hasn't changed. And the H1N1 flu experience recalls concerns over the emergent H5N1 strain, which is still circulating silently in Asia and Africa. For most people sickened by swine flu, it's no worse than the regular, seasonal bug. But avian flu kills more than half of those who catch it. Until now, bird flu hasn't gotten the hang of passing easily from one person to another. But it might take only a few genetic tweaks for this virus to become highly contagious. Tens of millions could die.

Already, a number of Asian governments have covered up their bird-flu outbreaks. Part of the reason for the opacity is that bird flu mostly afflicts chickens and ducks, not humans. That puts the disease squarely in the purview of agriculture officials, who often have an interest in protecting farming businesses and promoting exports rather than publicizing outbreaks that could spook consumers, precipitate culls, or prompt export bans. In many countries, those agriculture officials wield huge government budgets and associated patronage that can easily outmuscle their technocratic counterparts at health ministries.

Chinese government scientists, for instance, were aware that bird flu was sickening livestock in Guangdong province as early as 1996, but agriculture officials over the following years refused to acknowledge repeated outbreaks. Beijing responded furiously after international researchers a decade later identified southern China as the source of several waves of infection that had spread both westward toward Europe and south into Southeast Asia. In Vietnam, local livestock officials and veterinarians at the agriculture ministry had proof in the summer of 2003 that H5N1 had struck commercial poultry farms outside Hanoi. But only after people started dying did Vietnam confirm the outbreaks early the next year.

In Thailand, it took several months of private sleuthing by an elderly virologist at Mahidol University to force the Bangkok government to confirm that bird flu was burning through the country's flocks in early 2004. Senior Thai agriculture officials had been reassuring farmers that the poultry deaths were just a minor case of fowl cholera, complicated by bronchitis and aggravated by an abrupt change in the weather. Indonesian agriculture officials were notified of bird-flu outbreaks in mid-2003 too, but by the time Jakarta acknowledged them in early 2004, the virus had spread throughout much of the archipelago. The country's director of animal health later said that eight of the country's largest farming conglomerates lobbied top agriculture officials and even then-president Megawati Sukarnoputri to keep the outbreaks quiet. Today, the virus is endemic across almost all of Indonesia, making the country perhaps the most likely source of any new pandemic bird flu strain.

Chastened, some Asian governments have become serious about eradicating bird flu, in particular Vietnam and Thailand. But the virus keeps coming back, and there are still many reasons to doubt that agricultural authorities are reporting each new outbreak.

It's not just in Asia or the developing world that agricultural interests wield such influence. This year, the U.S. pork lobby successfully convinced Washington policymakers to stop referring to swine flu by that name, though the virus almost certainly came from a pig. At the same time, the U.S. Department of Agriculture, allied with the U.N. Food and Agriculture Organization and the World Animal Health Organization, successfully prevailed on the WHO's leadership to drop the label swine flu for the unwieldy designation of "Pandemic (H1N1) 2009."

With their livelihoods on the line, farmers and their government advocates from Cambodia to Kansas are wary of efforts to identify new virus strains in their flocks. Meanwhile, most of the previously unknown diseases that have struck people in recent decades have originated in animals, ranging from SARS and West Nile virus to HIV/AIDS and Ebola. The link between animal and human health remains largely ignored. We believe swine flu originated in pigs, but no one detected the virus before it infected people. And as bad as swine flu may prove to be, the next infectious disease to jump from livestock to people could be far worse. We need to be able to see it coming.



Faux Realism

Spin versus substance in the Bush foreign-policy doctrine.

The Bush administration has coined a foreign-policy doctrine. President George W. Bush, National Security Advisor Condoleezza Rice, and Secretary of State Colin Powell herald "the new realism." Think you know what they are up to? OK, then fill in the blank: The "new realism" is ________. If you find the blank hard to fill, don't worry; so would most of today's international-relations scholars. Indeed, one fundamental problem with the Bush administration's new doctrine is that "realism" no longer has any real intellectual coherence.

Until recently, realism was a venerable school of thought with a distinct thrust. Realpolitikers such as E.H. Carr, Hans Morgenthau, and Kenneth Waltz visualized world politics as an anarchic realm in which the struggle for survival required prudent management of material (generally military) resources, and where the balance of power ultimately determined outcomes. Realists chastised "liberals," "legalists," and "idealists," who believe that material and military power are secondary to factors such as the form of domestic government (democratic or authoritarian), the mutual advantages of economic interdependence, the functional benefits of international institutions, and the sway of national and transnational beliefs.

Yet a funny thing happened on the way past the Cold War. While still attached to the realist label, many realists have abandoned their distinctive realpolitik precepts. International-relations scholars today are far more inclined to accept that major trends -- European integration, global trade liberalization, the surprising power of small countries in limited wars such as Vietnam, the impact of human rights and environmental norms, and the spread of a "democratic peace" -- are not shaped simply, or even primarily, by power. Balance-of-power calculations are often trumped by imperatives rising from economic globalization, political democratization, particular belief systems, and the role of international law and institutions.

Realists have broadened their definition of "realism" in an attempt to embrace this smorgasbord of factors. But the consequence has been conceptual incoherence. Why does the Bush administration associate itself with an academic theory that no longer seems to mean anything in particular? Aside from the chance that George W. Bush has not been keeping up with International Security, two broad possibilities stand out:

One is that "realism" gives good spin. The administration employs the term as if its opposite were "idealism," "self-delusion," or, as Rice would have it, "romanticism" (as practiced, of course, by the previous administration). The implication is that realism is primarily about seeing and telling the hard truth -- a conceit common among realists of the 1930s and 1940s. Peripatetic pessimist Robert Kaplan updates this view of a realist theory that can "grapple with how the world actually works" and confront the "unrelenting record of uncomfortable truths." This tough talk dovetails with Dubya's own rhetorical style. As the president states, "I'm a straightforward person [and]... represent my country's interests in a very straightforward way."

Such realist rhetoric makes for great sound bites. (The English theorist Herbert Butterfield once remarked that realism was more often a boast than a philosophy.) But it signifies little. Realism cannot just be a commitment to being "realistic" about the world, pursuing the national interest, and being willing to say so. What president has not claimed that mantle, even if each perceived reality with a different emphasis?

Properly understood, realism offers clearer answers: Reality is material power, and the national interest is to accumulate and balance that power. Yet, as was the case with its immediate predecessor, the Bush administration's global threat perception has little to do with power balancing. Where in W's world are the great powers that could tip the global balance: countries like Britain, France, Germany, Japan, Indonesia, and India? Among great powers, the administration singles out only China (with finger waving at Russia), throwing it in the rogues' clubhouse with North Korea, Iraq, Iran, Cuba, Afghanistan, and Libya. These picayune foes are targeted not because they are the most powerful -- or even minimally powerful -- but because they are the least democratic and propagate the most hostile ideologies. This choice of adversaries unites the current administration and its predecessor against the only remaining pure "realists" in America, who huddle around publications like The Weekly Standard and the National Review fearing that the United States will find itself militarily unprepared for a coming battle for global hegemony with great powers such as China and a united Europe.

A second and more thoughtful reason the Bush administration may be attracted to the realist label is that the administration does indeed place a greater emphasis on accumulating and wielding military power. While the threat perception of the Bush team is based largely on ideology, it remains skeptical of strategy and tactics not closely linked to military dominance. The two improbable pillars of the administration's policy -- national missile defense (NMD) and the Powell Doctrine -- are linked in this way. Other examples include the administration's commitment to NATO expansion; departure from the long-standing policy of strategic ambiguity on Taiwan; initial unwillingness to help broker a solution in the Middle East; a stated interest in pulling U.S. troops out of the Balkans; the discounting of the foreign public relations effects of stridently self-interested rhetoric; the slashing of funds to secure Russia's loose nukes (and loose nuclear scientists); and the president's declaration that Africa "doesn't fit into the national strategic interests."

Most striking, however, is not the Bush administration's defense of realist tactics per se, but its belief that such tactics foreclose other promising means of promoting the national interest, among them, democracy promotion, economic integration, nonmilitary foreign aid, adherence to human rights, or multilateral cooperation. Consider the quick quashing of a deal, all but reached by South Korean President Kim Dae-Jung, for a far-reaching détente on the Korean peninsula, including significant restrictions on the North Korean nuclear program. Unfortunately, such a deal, designed to spur a positive evolution in North Korea's behavior, fit neither the administration's reliance on military deterrence nor its justification for NMD. The administration may indeed have adhered to a minimalist notion of realism, but at a significant potential cost.

If the academic debates between "smorgasbord" realists and their critics have one thing to teach us, it is that realism's simple solutions to policy dilemmas are misguided. The empirical research that has undermined academic "realism" demonstrates that complex, multicausal processes underlie most important events. Power still matters. But countries do not consistently bend to great-power desires, even when backed by a credible deterrent; an indirect approach of persuasion, negotiation, and, above all, the encouragement of positive domestic change, are also potent tools of statecraft. Any policymaker who relies only on the "realist" management of military power reveals a greater faith in simplistic theories than do academics themselves.

So don't be surprised if the "new realism" starts to look a bit different this autumn. Newborn administrations tend to exhibit steep learning curves as their staffs fill out, they reach bureaucratic compromises, and practical solutions to complex global realities displace simple campaign promises. The Clinton administration moved in the opposite direction, pulling back from some bold international rhetoric. By the end, it pursued (and this is one of the leading criticisms Rice and others make of their predecessors) a highly pragmatic policy. If the Bush administration remains attuned to global reality, it is likely to become more pragmatic as well, expanding tactical options beyond decisive and unilateral military action. Bush and company may continue, of course, to label their hybrid doctrine as the "new realism." But outside the academy, at least, a misleading label is a small price to pay for a sensible foreign policy.