By Simon Uzenat
Passage au crible n°7
So far, the WHO (World Health Organization), has counted nearly 8.000 deaths – 650 of them in Europe – caused by the influenza A virus (HINI). For its part, France has recorded 750.000 medical consultations merely for the period from November 16 – 22, 2009, an increase of 72% relative to the preceding week. An acute respiratory illness, the HINI flu is different to the normal seasonal flu. Although the symptoms are similar to those of the seasonal virus, the more severe cases of HINI infection are treated with antiviral medicines such as Tamiflu. This new strain which includes genes of porcine, avian or human origin is propagated by coughing, sneezing and sputtering. Although it is extremely contagious, this ailment often remains benign, but its propagation has considerably accelerated throughout the entire world.
> Historical background
> Theoretical framework
> Analysis
> References
The epidemic began in Mexico in spring 2009 and immediately aroused anxiety. This is heightened by traces of several preceding flu epidemics which have been very persistent in the collective memory. Firstly, in 1918, the Spanish flu killed tens of millions at a time when population movements were less frequent than today. Mention should also be made of the global alerts concerning SARS in 2003 and avian flu in 2004. Moreover, while some countries were short of vaccines, the virus underwent genetic mutations, which only increased political tensions, social pressures and scientific quarrels. Finally, on June 11, 2009, the WHO decision to move up to alert level 6 – the maximal limit corresponding to the pandemic threshold – further reinforced this climate of anxiety or even panic.
The international strategy for fighting the first pandemic of the 21st century was based on two interdependent principles which underline “the immense difficulty of the nation-state to predict, organize and control the risk”, as the German sociologist, Ulrich Beck, put it.
1. Health as an instance of Global Public Goods. The process of the globalization of the world market economy has lead to the re-appraisal of the scale of the conditions of realization of health policies. Besides, the implication of an ever-increasing and more diversified number of actors intervening on an international scale demands a global approach to the issues, which until now had been limited to the national level.
2. Human safety. This notion refers to human rights, notably the right to live in a protected health environment. It implies challenging the territorialization of sovereignty by encouraging a double breach of the state’s sphere of action: a) from above, with the necessity of protecting the major global equilibria which require a global governance which is still under construction; b) from below, with attention granted to individuals rather than to states. Today the legitimization of human safety is to be seen in the reinforcement of judicial norms and the capability to enforce them. The role played by the WHO is to be approached within this framework, as should be the epistemic communities and more or less international networks of practitioners.
This epidemic illustrates the process of globalization through the intensification of mobility, the acceleration of exchanges and the modernization of the means of communication. Marc Barthélemy, a researcher at the Atomic Energy Commission (AEC), has thus estimated that air transport dictates the rhythm of propagation of the illness. More generally, the metropolization phenomenon accelerates the speed of the propagation of infectious diseases. Admittedly, these diseases can originate in rural areas, but urban areas remain crucial to their dissemination and their transformation into epidemics, or even pandemics, as was demonstrated in Mexico. In this megalopolis, several cumulative factors were observed, such as the massive importation of products, the presence of a highly mobile population, the existence of shanty towns, with their populations which were ill-equipped to understand the health messages, and a large number of non-residents in transit.
As for the financial crisis which indiscriminately weakened the tools of prevention, it should incite us to question state rationality. Bernard Vallat, Director General of the World Organization for Animal Health (OiE), has pointed to a decrease in the portion of public budgets dedicated to animal health, while, at the same time, the amounts invested in efficient monitoring remain derisory, compared to the cost of the belated management of health crises.
The influenza pandemic highlights and underlines international discrepancies in terms of development. For instance, it has reactivated certain ancient beliefs in the national cultures of developing countries: in China, the wholesale price of garlic, – a plant reputed to prevent the HINI flu – has been multiplied by fifteen since March, automatically becoming the target of speculators. The debate over the relevance of vaccination, on the other hand, has above all concerned the developed countries. The good health cover of their populations – institutionalized and financed by public authorities – has indeed played a part in the reduced social perception of the risk. Aware of these discrepancies, the WHO has put into motion an essentially symbolic set of actions, as materialized in the 2005 International Health Regulations, a normative measure which defines the responsibilities and obligations of the state. As far as the pharmaceutical companies are concerned, the move to maximal alert status had the consequence of compelling several of them, including Sanofi Pasteur and GlaxoSmithKline (GSK), to undertake to donate 100 million and 50 million doses of vaccine to poor countries. Acting on the same principle, nine countries – including the United States, France and the United Kingdom – put 10% of their stock at the disposal of the WHO.
The HINI flu has facilitated strategic re-configurations and the partial transfer of authority from the public to the private sector. In this respect the rapid development of vaccines from the prototypes elaborated for the H5NI avian flu virus constituted a major element. It must be remembered that France alone ordered 100 million doses for a total of nearly one billion euros. First of all, it should be noted that accelerated procedures have been established – in the United States as well as in the European Union – in order to authorize as quickly as possible the production of vaccines meeting the criteria of safety and efficiency. Given the demand, estimated at several hundred million doses, manufacturers exceptionally began producing batches of vaccines without waiting for the go-ahead from regulatory authorities. Secondly, it is worth noting the extent to which international trade in the medical sector between companies from the developed countries and those from emerging countries has been reinforced; to such an extent that India has recently become the world’s foremost producer of vaccines. Chinese laboratories, for their part, perfected the first vaccines against the flu. The slightest demands issued by the health authorities were, above all, at the service of a national aim: the Chinese state has to rapidly protect more than a billion people; all the more so as the WHO had warned that there would not be enough vaccines for the entire world population.
Beck Ulrich, La Société du risque. Sur la voie d’une autre modernité, translation, Paris, Aubier, 2001.
Chiffoleau Sylvia, “Santé et inégalités Nord/Sud : la quête d’un bien public équitablement mondial”, in : François Constantin (Éd.), Les Biens publics mondiaux. Un mythe légitimateur pour l’action collective?, Paris, L’Harmattan, 2002, pp. 245-268.
Gabas Jean-Jacques, Hugon Philippe (Éds.), Biens publics à l’échelle mondiale, Paris, Colophon, 2001.
Kaul Inge, Grunberg Isabelle, Stern Marc A. (Eds), Global Public Goods, International Cooperation in the 21st Century, New York, Oxford, Oxford University Press, 1999.
