February 17, 2023, by Brigitte Nerlich
Bird flu – then and now
Current news about a world-wide bird flu outbreak brought back memories of 2005, dubbed then “The year of bird flu”. In an article I co-authored that year with Christopher Halliday, we noted that “[l]ately, fear of disease has been fuelled yet again by the emergence of a new highly pathogenic virus strain of avian influenza that could jump the species barrier between birds and humans, and, in a worst-case scenario, cause the next global pandemic of influenza.”
In this post I shall first write a bit about bird flu in general then go back to some of the things we wrote about in 2005 based on media analysis and interviews with affected people. I then ask whether we are prepared for the next pandemic, not only in terms of science but also in terms of society.
Bird flu, SARS and Covid
In 2003 the world was confronted with two disease outbreaks, one caused by a coronavirus, the other by the highly infectious H5N1 influenza virus. In 2003 the Severe Acute Respiratory Syndrome or SARS pandemic killed 774 people. An outbreak of avian influenza, avian flu or bird flu, which started around 2003 and peaked in 2005, resulted in 140 million birds dying or being killed. Between 2003 and 2022 456 cases of bird flu transmitted to humans were fatal. Interestingly, SARS had initially been taken for avian influenza when it had broken out in the Guangdong province of China in November 2002.
Spool forward twenty years and we find ourselves in a situation where yet another new strain of H5N1 has begun to circulate in animals alongside a pandemic of the SARS-CoV-2 virus that began in 2020 and has, so far, killed almost 7 million people. 2022 saw the largest ever outbreak of bird flu in the UK. Fears are growing yet again that this new avian flu virus may mutate and become a possible source of a pandemic similar to the 1918 Spanish flu caused by an influenza strain that was of avian origin and killed about 50 million people.
At the moment, just like twenty years ago, bird flu, especially the highly pathogenic H5N1 strain, is still a zoonotic disease. That means it can be passed from animals to humans but is not yet readily transmitted between humans. It has however already ‘spilled over’ from wild birds to farmed poultry to mammals, such as bears, foxes, otters, skunks, possums, racoons, seals and so on. There is a, rather remote, possibility that it has begun to spread between mammals, such as mink at a mink farm in Spain. Once that happens, things could become a bit hairy, as we are mammals too. However, it should be stressed that, at the moment, the virus is not well adapted to humans.
But, as ever, it’s prudent to be prepared, for example to accelerate vaccine research and development in general and perhaps also to focus on vaccine development that doesn’t rely on eggs, a dwindling commodity. Covid-19, caused by SARS-CoV-2, has demonstrated that other types of vaccines are possible, but it has also shown that new egg-independent mRNA vaccines might not be welcomed with open arms by everybody.
For me it was also time to look back at some old research on bird flu. First, I’ll look back at some things we found out about health and hygiene and then about fear vs complacency-mongering, if you like.
Health and hygiene
When thinking about vaccines, I read a story on bird flu by Sky News, entitled “Bird flu: Expert calls for work to start on vaccine with risk to humans ‘increasing’”. The news item focused on a poultry farms in Norfolk, a part of the UK that had also been severely affected by bird flu in 2005. Reading the story, an image jumped out at me. It was of a tractor on a dirt road passing a sign saying “Animal disease control zone ends”.
This brought back memories of similar signs and also of hygiene measures around poultry farms, such as wheel and welly washing, that made us think then: but what about the fact that the virus is, so to speak, ‘airborne’, i.e. carried by wild birds? Of course, poultry was then ‘locked down’ ‘inside’, but still.
Another article in the The Telegraph entitled “How worried should I be about avian flu?” was adorned with a picture of a yellow warning triangle surrounded by fluttering birds and said: ‘If you feel a sense of déjà vu descending, you are not alone. We have not yet been asked to sing ‘Happy Birthday’ twice while washing our hands, but large parts of Norfolk and Lincolnshire have been sealed off where outbreaks in poultry have been confirmed.” Memories of Covid mingle with memories of bird flu.
Looking back at early disease control measures relating to the spread of Covid-19, this made me think: Are we re-enacting what has been called ‘hygiene theatre’ in face of an animal ‘airborne’ virus and is this the right thing to do?
Hygiene and hand-washing etc. are, of course, important when faced by any virus, but this should not blind us to other issues around health in birds and in humans. We found in 2005 that DEFRA, the Department for Environment, Farming & Rural Affairs, was then carrying out research into making poultry healthier through various measures, such as lower stock density and stress reduction. However, their terms of disease prevention then still put the stress on “good hygiene practices” rather than health. As we pointed out: “Cleanliness and hygiene seem to be the two ‘magic’ formulae which are almost ritualistically invoked by policy makers and industry leaders.”
That ritualism seems to have also characterised human disease management during Covid and might have to be rethought in light of what happened then. In case of bird flu, which is not yet endangering human health, one should perhaps get away from the ritualistic invoking of hygiene alone and move towards a ‘One health‘ approach. This might, in the long run, also help with reducing the threat to humans.
Alerting and alarming
Reading some news coverage of the current bird flu outbreak, a second point of comparison between then and now sprang to mind. It’s related to how scientists frame their worries and warnings relating to the virus. In 2005 we found that some scientists overstated the threat, mostly in order to break through political complacency, and many navigated a difficult tight-rope walk between fear and reassurance.
In the current situation, scientists seem to be much more open about uncertainties but also about their worries and fears, especially as this fear has been, literally, hovering over them for several decades – see quotes collected in this article by Helen Branswell. However, pronouncements made two decades ago are not forgotten and it might be good not to forget that when dealing with the new outbreak.
Take for example this tweet based on people’s memories of both the 2005 bird flu outbreak and the Covid pandemic: “Ferguson’s 2005 dire claims, ‘200 million deaths worldwide’ -turned out 282! Another excuse to [emoji for vaccine]?” Neil Ferguson was very active during the Covid pandemic and is also starting to talk about the current bird flu outbreak, I’d say in a more circumspect way. However, the management of potential vaccine uptake will have to take long memories into account.
Similarly, Helen Branswell quotes Michael Osterholme as saying: “I will never, ever, take H5N1 for granted…I just don’t know what it’s going to do.” This contrasts quite starkly with what he and others said in 2005, showing that communication about outbreaks seems to have changed, perhaps in light of Covid experiences, something that needs more research, however. And still, a dilemma, also well-known form climate change communication, persists, namely, how to balance alerting with alarming.
Informing and misinforming
Another comment I read was even more worrying then the tweet I quoted above, and made me realise that the communication situation around pandemics seems to have dramatically changed between 2005 and now.
The first comment underneath a Daily Mail article, which was actually quite a good summary of the state of affairs regarding bird blu, demonstrates the rise of conspiracy thinking: “So scientists have created the leap from birds to mammals and are now working on how to make the jump to humans in the same way as Covid ‘jumped’ from bats to humans through bioengineering in labs in Wuhan that were employing American and Chinese scientists among others. We had Covid 1 followed by Covid 2, North American scientists were working on Covid 3 as a bioweapon in early 2022.”
This echoes one of probably many tweets saying: “Maybe they should stop playing in the lab to make things more infective with their gain of function research on H5N1 all the way back to 2012.” Memories persist.
What is the best way to respond to comments and tweets like this? When we did our research around 2005 we looked at how the media reacted to the spread of viruses and the spread of messages about the virus, but we didn’t have to deal with the rapid spread of dis/misinformation that now characterises how pandemics unfold. Much more research is needed here or at least a good summary of what’s out there already.
Pandemic preparedness and people
Covid has shown that the social sciences need to be part of pandemic prepared, as a letter to the World Health Organisation has pointed out referring to the WHO’s own statement that it is necessary to “intensify and target risk communication, strengthen community engagement, empowerment and support, addressing community concerns, combating misinformation and building trust”. However, when listing relevant social science fields, the letter leaves out communication studies or communication sciences: “anthropology, psychology, health promotion, behavioural economics, sociology, marketing, design thinking and more”. Perhaps they come under ‘more’.
It can’t be overstated though how important understanding communication processes is in dealing with any viral pandemic which, nowadays, is always accompanied by an infodemic.
One expert quoted in the Branswell article, influenza epidemiologist Keiji Fukuda, said: “What has become clear to me over time is that the big challenge is not the viruses. That’s not what gives me a pit in my stomach,” he said. “The real challenge is whether people, whether governments, whether policymakers have the ability to actually address the challenge in the way that needs to be done. And I don’t see so much which encourages me, to be blunt. That’s what gives me a pit in my stomach.”
Following the outbreak of bird flu around 2005 my colleagues and I have written a series of articles. Some explore the interplay between science, the media, and societal attitudes towards the disease; some focus on the role that metaphors and metaphor scenarios play in shaping public understanding and discourse around avian influenza and other diseases; some explore the knowledge claims and attitudes of the UK poultry industry towards avian influenza and biosecurity. Most of the articles have been summarised in this article:
Brown, B., Nerlich, B., Crawford, P., Koteyko, N., & Carter, R. (2009). Hygiene and biosecurity: The language and politics of risk in an era of emerging infectious diseases. Sociology Compass, 3(5), 811-823.
Image: Colorized transmission electron micrograph of Avian influenza A H5N1 viruses (seen in gold) grown in MDCK cells (seen in green), Wikimedia commons
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