Envío Digital
Central American University - UCA  
  Number 337 | Agosto 2009



Fear in the Time of the Virus

Although the new human influenza virus, a.k.a. swine flu, didn’t originate in Mexico, the deaths there were what first alerted the world to it. The Mexican government’s inappropriate reaction to the epidemic provides interesting lessons, the main one being how political power can use fear of diseases as a method of social control.

Jorge Alonso

In 2009, the world became aware of a new and worrying strain of influenza first dubbed “swine flu” then changed to human influenza A (H1N1). It was first said to have originated in Mexico, but was later found to have had roots elsewhere years earlier.

Various cases in previous years

The H1N1 swine flu virus was identified in a pregnant woman in the late eighties, although 24 people may have died of the same virus in China in the summer of 2005. A new kind of swine flu called H2N3 was detected among pigs in Missouri at the end of 2007 and in September 2008 it was revealed that a girl had been infected with type A swine flu in 2005. In November 2008, a case of type A (H1N1) swine flu was reported in a human being, then in early March of this year respiratory problems and general malaise among a Mexican population living near the pig farms of an important transnational company made the news. The next day it was confirmed that a boy had been infected in San Diego, California, and by the end of the month a girl in the same state suddenly had a fever of over 103 degrees Fahrenheit.

By April 11 the World Health Organization (WHO) began alerting Mexico to unusual cases of pneumonia in Veracruz, but the authorities rejected the idea of any epidemic. Finally, on April 22, Mexico sent the first 51 samples to Canada, where the propagation of a new strain of this flu was confirmed. It had genetic ingredients of swine, bird and human flu and was easily transmitted from human to human.

These different cases had not really sounded the alarm until it was confirmed that there were cases on a massive scale in Mexico. Authorities said they were very worried because they did not know how deadly the illness was or whether any medicine would prove effective against it. Since the name “swine flu” was seriously hurting pork sales even though contagion did not come directly from pigs or their meat, pig producers protested so strongly that it was changed to human influenza A (H1N1).

Specialists calmed down as soon s it was verified that the virus was curable if treated in time with Tamiflu antiviral medicine (oseltamivir), but the Mexican government preferred to employ the politics of fear.

Mexico behind masks

By the end of April there were cases in half of Mexico, particularly the capital city and San Luis Potosí. The authorities decreed an epidemiological emergency, suspended classes throughout the country, prohibited mass activities and restricted certain economic activities. Citizens were insisting on transparent and complete, information, the government’s response fell way short of that.

As the outbreak intensified, health authorities publicized the symptoms—a sudden high fever, headache, aching muscles, sore throat, runny nose and acute general malaise. Informing people that the illness was spread by saliva when people cough or sneeze and by touching contaminated surfaces or materials, they disseminated urgent preventive measures such as avoiding contact with sick people, not sharing food and drink, using a face mask, moving away from other people and covering one’s nose with one’s forearm when sneezing. The authorities also suggested cleaning surfaces, handles and handrails, avoiding greeting people by shaking hands and especially kissing, and constantly washing one’s hands. And finally, while people were advised to avoid crowds, anti-bacterial hand gel was made available in busy places.

The alert was sounded on the global level and many Mexicans travelling in various parts of the world suffered discrimination and humiliation. Being Mexican was taken as the equivalent of carrying the disease. When the flu was found to be spreading in the United States as well as Mexico, the WHO decreed a level 5 alert, meaning the disease had spread to at least two countries in the same region.

Media terror and growing doubts

It became increasingly evident that an illness of this nature could not be confined locally and would soon become a global problem. Despite the Mexican media’s continued stress that the announced measures were timely and pertinent, by May certain civic organizations were having their doubts. While the measures might avoid propagation of the virus, the government had been far from efficient in handling information it had been receiving.

It was impossible to hide cases in several areas of the country where the population didn’t receive immediate care. Since early 2009 the inhabitants of one town in Veracruz had been complaining to the media about an epidemic of a respiratory disease they attributed to the unsanitary conditions of industrial pig farms. Other negative factors included the cuts in health sector resources dictated by neoliberal policies and the fact Mexico had no laboratory capable of detecting the illness immediately, leaving the country dependent on foreign laboratories.

A kind of media terror was being spread rather than information. It was a good thing for the Felipe Calderón government that the May Day workers’ parade had to be suspended, as it would surely have brought strong criticism of the Mexican Right’s neoliberal economic measures.

Who were the winners?

The lack of honest and timely information and the media manipulation gave rise to various hypotheses. Was this a disease created in the laboratories of the empire to the north that had gotten out of control? While this couldn’t be proved and the WHO declared that the illness had mutated naturally, it and other hypotheses were based on the fact that important, profit-driven capitalist businesses control the production of vaccines and medicines for pandemic emergencies. It didn’t go unnoticed, for example, that Donald Rumsfeld—the Bush government’s defense secretary—was a major stockholder in the pharmaceutical company that holds the patent for the medicine used to treat H1N1 and was therefore among the companies that stood to make a fortune out of the spread of this virus.

Other forgotten “pandemics”

With the prioritization of the morbidity and mortality figures for this epidemic, other health problems were totally pushed aside. Mexico and the world in general seemed to simply accept, without demanding any effective remedies, that a newborn dies from lack of medical care every second, that a child dies of hunger and malnutrition every three seconds, that a child dies from contaminated water every eight seconds, that a child dies of AIDS every minute, that a child dies to lack of medical care every five minutes, that 11 million children die before reaching puberty every year, that 530,000 pregnant women die of malnutrition every year, etc., etc., etc. Dengue, malaria and other transmittable diseases have been relegated as “illnesses of the poor” because tackling them doesn’t offer a gold mine to those in the health business.

The disease marches on

By the first week of May, the United States had the largest number of reported cases of the new influenza, followed by Mexico and Canada. The first scientific article on it appeared on May 11 in Science. The journal forecast that this flu epidemic could become as severe as one in 1957, which caused the deaths of 2 million people around the world, but not as serious as the one in 1918, to which 100 million deaths are attributed.

When President Calderón proclaimed himself a kind of savior of humanity for the measures his government had taken in response to the epidemic, Fidel Castro justified Cuba’s temporary suspension of flights to Mexico by accusing the Calderón government of having concealed the first data so as not to endanger President Obama’s visit to Mexico. Referring to the Science article, Castro pointed out that Mexico already had several thousand cases when it first announced the epidemic and that the infection had emerged at the beginning of the year.

By mid-May, the epidemic had already reached Europe and the WHO warned that the virus could undergo a new mutation and become more aggressive. At that point, the official number of people infected in over 30 countries had topped 5,000. In only a few more days it had risen to over 8,000 and was also showing up in South America, New Zealand, Japan and Israel.

In Mexico, 2.5% of those infected had died. While seasonal flu cases usually affect the two extreme age groups—children and the elderly—this new flu was particularly infecting young women. With panic growing, health speculators started offering fake treatments and selling Tamiflu on the black market.

Why are there more deaths here?

Grassroots groups stressed that fear was the worst enemy of health promotion and that the answer lay in community organization and self-care. The People’s Revolutionary Army (EPR) released a communiqué denouncing the Calderón government for lying about the epidemic’s magnitude and cost. It pointed out that by creating media panic, the government and the communication monopolies had sparked a psychosis among the middle and upper classes, while there was incredulity and collective sarcasm among the working classes that had to face the consequences of an inefficient and corrupt health system every day. “The face mask is just another consumer product, exclusive to those with money. Poor people have to choose between eating a kilo of tortillas or buying a face mask,” they said.

Many people were asking why there were more deaths in Mexico than in other parts of the world, to which the medical world responded that aggravating factors helped turn a curable illness into a deadly one. Along the same lines, the EPR noted that people are defenseless against this kind of disease because of the chronic malnutrition caused by poverty and starvation, and that no hygiene measures are enough for people living in poverty. The EPR also accused Calderón of causing more deaths with his army and police force than the epidemic, and viewed his desire to present himself as the savior of the world as ridiculous. It lamented that most of the deaths were among the poor and stressed that the epidemic had provided a good pretext for containing the protests against an anti-grassroots government.

Everything under control?

While health specialists viewed Mexican society’s behavior as exemplary, they were less flattering toward the government, which had made important decisions that endangered the whole population based on imprecise data. There had also been delays of over a week in providing the information and it had been managed in a perverse way. The government wanted to give the impression that the epidemic had relented in order to reactivate the economy, but the figures didn’t back this up and the number of deaths was actually rising.

On May 19, the UN Secretary General called on the world to remain vigilant against the virus as it still was not known how far it would reach, how fast it would spread, how serious it would be and how many people would die. By this point around 10,000 people had been infected in 40 countries. The WHO announced that it feared the new virus would interact with other viruses, stating that an influenza pandemic was evolving before its eyes, making the creation of a specific vaccine harder than initially hoped. On May 22, Science published a new article on the influenza, detailing the original forms of animal-to-human and human-to-human infection.

During the last week of May, just as the government was trying to convince people that the situation was under control, there were over a thousand new cases in Mexico. Some recognized that the information wasn’t reliable, as estimates about the epidemic’s evolution weren’t consistent. Public health experts detected that the real number of suspected and confirmed cases and deaths was being concealed. In fact, the government was worried about releasing the real figures around that time so as not to frighten off investment and tourism.

A late and poor response

Although the United States led the way in the number of people infected, the proportion of infected people—not to mention deaths—among the total population was higher in Mexico. But by then, the interests of businesspeople and merchants weighed more heavily than the health of Mexicans. Health specialist Asa Cristina Laurell wrote that not only had the actions been taken late, but initially paralyzing the country hadn’t helped control the influenza. She argued that an intense search for cases and contacts should have been undertaken, while epidemiological fences should have been applied to isolate and treat the sick, as was being done in other parts of the world. She added that there were also serious recording problems.

While the WHO believed that Mexico had a solid epidemiological emergency system, the reality was quite different. Not only did Mexico not save the world, it actually confused it. During the WHO’s World Assembly it became clear that countries’ recording problems represent a serious weakness in the world emergency network against the pandemic. But even though Mexico’s official under-registration contradicted him, President Calderón continued proclaiming that the country had already surmounted the health contingency. It must be stressed that the government instructed health sector doctors to give out no figures on their own initiative, but while the government controlled the figures, it couldn’t mask the rise in the number of people infected.

Level 6 pandemic: Global alert

The virus spread throughout the world. By the beginning of June there were over 19,000 cases in 66 countries. A few days later the figures had climbed to over 25,000 in 73 countries. Because the virus appears to live better in cold and dry environments than hot and humid ones, the South American winter increased the number of people infected in Southern Cone countries. The WHO warned that the arrival of autumn in the northern hemisphere could reinforce the epidemic. In Mexico new cases kept on emerging and the number of deaths kept on rising, passing the hundred mark.

Mexico announced it would be hosting a summit of health ministers from 40 countries in July to discuss the new flu, swapping experiences on its management in order to give the WHO more information for analyzing how the health crisis was being handled. The WHO’s director general warned that Mexico could experience a second wave of cases. Following an emergency meeting with specialists, she decided to decree the highest level of alert—level 6—as the new virus was so easily transmitted from person to person and country to country. The first pandemic of the 21st century had been established, offering a bleak panorama for countries with deteriorated health systems and limited resources.

The WHO advised preparing for a long battle against the unstoppable new virus, establishing that the emergency would
be long-term and stressing that people between the ages of 30 and 50, pregnant women and people with chronic illnesses (asthma, diabetes and obesity) were at greatest risk. It also announced that its members had to remain alert throughout 2009 and 2010, and possibly for several more years. Although the virus seemed to be showing up in a quite stable form up to that point, it could become more lethal, particularly if it combined with the H5N1 avian flu virus circulating widely among farmyard fowl.

A vaccine? For whom?

Another risk was that the new virus could mix with the more common seasonal flu, which had developed resistance to the antiviral drug Tamiflu. Nonetheless, the WHO advised countries not to close their borders or impose trade restrictions. The phase 6 classification meant the illness had propagated globally, but did not reflect the virus’ virulence or the number of deaths it had caused. Up until that moment, the pandemic was only moderately severe in developed countries.

The main fear was what might happen in poor countries. The WHO announced it would donate another 5 million doses of Tamiflu and recommended that laboratories complete production of the vaccine against seasonal flu, which infects millions every year and causes the deaths of up to half a million people. The WHO praised the fact that the main pharmaceutical companies were already developing a specific vaccine against influenza A (H1N1), but recognized that it would be a few months before it could be put into circulation. The Novartis laboratory declared that over 30 governments had already requested the new vaccine. The United States had already placed an initial million dollar order and other developed countries were ensuring the acquisition of most of the vaccines that would be produced.

The virus is here to stay

Mexico’s health secretary recognized that the appearance of the new virus had taken the authorities unawares but tried to calm people by saying that more and more was already being learned about it. He accepted the likelihood of a new wave of cases during the winter period, and announced that 20 million doses of the seasonal flu vaccine and another 20 million vaccines against the new virus were being acquired. He also said that construction of a new level-three bio-security laboratory would soon be concluded in the capital city and that all state labs would have the capacity to test for the new influenza virus. He accepted that important lessons had been learned in areas such as coordination and perfecting the collection and sending of information, and announced that the epidemiological surveillance platform had been readjusted. He also surmised that Mexico had passed from the epidemic to the endemic phase.

Despite the official optimism, the new influenza virus experienced a new surge in mid-June in four of the country’s states. By early July, the official number of people infected in Mexico was very close to 11,000, with 121 deaths. In absolute numbers, the United States still headed the field with around 34,000 cases, but Mexico was still in second place. Worldwide, there were over 98,000 confirmed cases in 137 countries, with 440 deaths. It was a major cause for concern that Mexico accounted for a quarter of the deaths globally.

Although the Health Secretariat stopped releasing its reports on the epidemic at the end of June, cases kept appearing, and in some states there was a jump in new cases in mid-summer. There were 200 new infections in Yucatán in just a few days in July, placing that state second only to Mexico City. Between June and July the number of cases increased by 80% in the state of Jalisco, forcing local health authorities to accept that the epidemic had come to stay. It’s still not possible to draw up an influenza map using official figures, as they aren’t reliable enough.

The WHO warns against
both panic and complacency

The health authorities from 40 countries who met at Mexico’s Cancún resort on July 1-3 for a summit on influenza A (H1N1) heard the WHO announce that a stronger outbreak was expected and that the virus would inevitably continue to evolve and could not be contained. It stressed that no one knew how the virus would behave. The WHO also changed its initial estimate of the date on which the new vaccine would be available, although it still hoped to have it ready before winter hit the northern hemisphere. It announced its commitment to distribute 250 million doses in developing countries.

The WHO recommended careful monitoring of what happened during South America’s winter and that researchers should prepare for surprises from a virus that was both threatening and changeable as a result of the capacity of flu strains to mix. Since the world was still at the start of the pandemic and did not know how it would evolve, the WHO recommended neither generating panic in society nor fostering complacency. It requested analyses of patients with uncommon symptoms so it could detect possible mutations of the virus. Less than a week after the summit, the WHO reported that some patients were showing signs of resistance to Tamiflu—the medicine most used to treat the new influenza—although fortunately they responded favorably to zanamivir, the other antiviral used against it.

US, Mexican and Canadian health authorities agreed that a second, stronger and more widespread wave of the new virus would hit starting in the autumn and continue through winter. The Mexican health secretary announced that Mexico had 2,400,000 doses of antivirals to respond to the winter increase and that the country was guaranteeing medical care, but warned that some situations might get out of control. Meanwhile, Mexican officials complained of discrimination against Mexicans in various countries.

US$4 billion in economic losses

A Pan American Health Organization committee evaluated the influenza’s economic impact in Mexico, which health authorities calculated to be at least US$4 billion, equal to 0.4% of the GDP. A research study by the Mexican House of Representatives’ Center for Public Finance Studies revealed that 30,000 tons of pork had gone unsold due to the influenza, even though the authorities had promoted pork consumption, insisting the virus couldn’t be transmitted that way.

The virus on top of the crisis

The economic impact of the virus came on top of the world economic crisis, which was already seriously affecting Mexico. Income from tourism fell 14.8% between January and May of this year, while in May alone, with Mexico in the headlines due to the virus scare, international tourism dropped by 49% compared with the same month in 2008.

In April the International Monetary Fund (IMF) had forecast that Mexico’s economy would shrink by 3.7% this year, but in July it revised this figure to 7.2%. This was publicly announced the day after the government said “recovery” was underway. The IMF declared that while the world in general was starting to pick up, the decline in Mexico’s productive apparatus was intensifying and the country was being increasingly affected by the crisis. Calderón had promised to be “the employment President,” but events were making him the President of unemployment. Official figures already admit that thousands of jobs have been lost, outstripping the number of people laid off during the 1995 crisis.

President Calderón has used the rhetoric of placing Mexicans’ health over and above the economy, but when the government perceived that the political control measures employed to respond to the epidemic had overstepped the mark and were affecting the economy, it dropped that tactic to encourage tourism. Members of the governing National Action Party (PAN) wanted to exploit the July 5 legislative elections to provide backing for Calderón’s measures, but the PAN suffered a crushing electoral defeat. Calderón’s government is staggering from failure to failure, and the millions of poor are paying the price.

A bankrupt health system

There has never been an official explanation for why Mexico has had the greatest number of deaths from the virus. But at a minimum the epidemic has revealed how neoliberal policies have dismantled the health system.

Groups attempting to create another way of doing politics from below point out that Mexico is 64th in the WHO health ranking, that its public health budget is much lower than that of other member countries of the Organization for Economic Cooperation and Development, to which Mexico also belongs, and that this measly budget isn’t enough to cover the population’s needs. A full 40 million Mexican workers are underemployed in precarious jobs with miserable wages and sidelined from the social security systems. Transnational laboratories hog 90% of the national medicine market and thus control the health of millions of human beings. These monopolies impose their businesses as if they were public health policies and speculate with the prices of medicines.

The deteriorated health services and miserable conditions affecting the population left vulnerable by the neoliberal economic system offer the influenza better conditions to spread among the poorest and those living far from the health centers. Authorities stressed that the antiviral medicines are effective if applied within 48 hours of the symptoms appearing, but many people in impoverished conditions can only reach health care facilities several days later.

Was Cofre de Perote the locus?

The influenza helped create an important social movement among over 30 communities neighboring the pig farms on the border between the states of Puebla and Veracruz.

In 1994, with support from the state governments, a transnational company pushing Carroll’s pig farms set up shop in the valleys of the extinct Cofre de Perote volcano. Local inhabitants were told the farms would provide a lot of jobs, but work turned out to be scarce and the farms caused major ecological damage. When the communities started defending their lands, water and air, the government responded with repression. The above-mentioned outbreak of pneumonia among roughly a thousand people in March 2009 together with data from Science suggesting that a mutation of swine flu could have occurred in this area encouraged the inhabitants to reactivate their movement in defense of ecology and life.

They stressed that the contamination that might have provided the right conditions for the virus was still present and the situation could become even more dangerous. In addition, they demanded the closure of the pig farms due to their high environmental cost and called for independent national and international organizations to conduct medical and environmental research on the influenza cases in the area and the damage done to land and aquifers by the oxidation lakes installed by the companies. They also called for an examination of the pig carcasses in the farms’ warehouses to check their cause of death and detect whether they had been affected by viruses. The movement’s demands included a total clean-up of the area and an investigation of the actions of the relevant authorities in order to attribute responsibilities.

The movement demonstrated that those affected would not be fobbed off with the idea that this was some kind of “divine punishment,” but rather that identifiable people linked to economic capital and/or in state institutions were directly responsible.

“No” to fear, “yes” to organization

The epidemic exposed the inconsistencies of the Mexican government, which applied media terrorism in an attempt to politically control the social unrest. The government later backed off in response to pressure from big businesspeople when it saw the economic impact this tactic was having. The bioterrorism worked at first and could prove useful again should the epidemic take a turn for the worse or if the political conditions deteriorate.

The government applied a kind of state of exception, suspending or restricting basic rights and disseminating only limited information, another tactic it could use again. Grassroots collectives, however, have proposed alternatives to the strategy of fear-fueled conjecture and demobilization that confined most people to their homes and workplaces. In other countries, the epidemic is being effectively managed without resorting to such methods. An adequate response can be provided if people are responsibly organized and informed. These collectives propose increasing the surveillance, timely detection and control of the disease based on grassroots potential. Commissions need to be created in barrios and towns, while community epidemiological diagnoses have to be conducted in response to the disinformation and state manipulation.

We have to say “no” to fear and “yes” to mobilization, organization, trust and life. And the best medicine of all would be an active epidemiology built up from below.

Jorge Alonso is a researcher with CIESAS Western and envío correspondent in Mexico.

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