Equally vexing is the divide between China’s central government and local officials. A week after China confirmed its first outbreaks in birds, Vice Premier Hui Liangyu admitted to WHO that the central government wasn’t sure what was transpiring in the provinces. For local officials, career advancement hinges on success in promoting economic development. Better to keep quiet about infectious diseases that could deter investment and scare off tourists. So it’s little surprise that Chinese local officials look unkindly on journalists and whistle blowers who publicize these outbreaks, even arresting and expelling them.
Qiao Songju was a simple farmer in Jiangsu, a coastal province just north of Shanghai, when the young man heard a piece of gossip that changed his life. Qiao’s father told him that more than two hundred geese had died a mysterious death at a friend’s farm in the next province. Afraid that local officials were covering up a bird flu outbreak, Qiao called all the way to Beijing and notified the chief of animal husbandry at the agriculture ministry. That in turn prompted a formal investigation, which soon found that at least 2,100 geese and chickens in the village could have the virus. The suspect birds were all slaughtered. Chinese media dubbed Qiao the “farmer hero.” China’s state-owned television nominated him to receive its award for economic figure of the year.
A month later, Qiao blew the whistle again, this time reporting a suspected outbreak in his own home county of Gaoyou in Jiangsu. The police came for him a day later. They arrived at midnight and asked him to accompany them to the station for a “chat.” They made the arrest formal on the following day. Qiao was charged with blackmail and extortion. The accusation was that he had wrung thousands of dollars out of veterinary institutes by threatening to report them for manufacturing bogus flu vaccines. His lawyer called the charges fabricated. His family and supporters, including scores who recorded their outrage over the Internet, questioned the timing of his detention.
But few sympathizers were found among his fellow farmers. The price of eggs in Gaoyou had fallen by half after he’d raised the alarm. The price of chicken meat had tumbled even more. “Qiao Songju is a sinner to all Gaoyou farmers,” said Chen Linxiang, an official in Gaoyou’s agriculture and forestry bureau.
Five months after he was detained, Qiao went on trial in the Intermediate People’s Court of Gaoyou. His lawyer complained that not one of the agriculture ministry officials who could have testified in his defense had chosen to do so. After another three months, in the summer of 2006, the court handed down its verdict and convicted Qiao on six counts. He was fined nearly four thousand dollars and sentenced to three and a half years in prison.
Deep in the interior of China, more than a thousand miles from Gaoyou, in the midst of the great green grasslands of the Tibetan Plateau, is a vast body of salt water called Qinghai Lake. Many in the region consider the lake, China’s largest, to be sacred, and pilgrims still circumambulate its 220-mile shoreline. Sheep and yaks graze on its banks, distant mountains reflected in its azure waters. In the north west corner is Bird Island. Though this rocky outcropping is technically more of a peninsula than an island, the first part of the name is apt. Each spring, thousands of geese, swans, cormorants, and other wildfowl from 189 species congregate here, migrating over the Hima layas and from Southeast Asia to lay their eggs. By the time the
rapeseed of summer has turned the pastures a brilliant yellow, the birds have continued on their way.
In late April 2005, something stunning occurred at Qinghai Lake. The birds began to stagger around like drunks. They became paralyzed, their necks trembling, contorted. Then they would die. This was not supposed to happen. Sure, birds were dying elsewhere in Asia, but those were chickens and other domestic poultry. These victims were wild birds, mostly bar-headed geese and some gulls. For millennia, migratory waterfowl had been nature’s reservoir for flu viruses, meaning these birds could carry the pathogen without getting sick themselves. But now they were dropping at a rate of hundred or more a day. By the time the full numbers were tallied, at least five thousand had perished from what Chinese authorities confirmed was bird flu. The novel strain had abruptly turned its fury on its own natural hosts. Equally alarming was the fear that the birds at this major migratory hub might now carry the infection on with them, speeding its spread westward through the network of overlapping flyways.
WHO officials had been clamoring for details about the Qinghai outbreak since they first heard about it. They were appalled to learn that Chinese authorities had sampled only twelve of the sick birds at the lake and checked no healthy-looking ones for signs of infection. Though China finally allowed a team of investigators from WHO and FAO to visit Qinghai, the government continued to refuse them access to samples, test results, and the sites of related outbreaks. “They’re doing all they can to block information from us,” WHO’s Beijing office reported to headquarters.
Yi Guan, the maverick microbiologist in Hong Kong who had been amassing bird flu samples across southern China, was not to be denied. One of his former students headed to Qinghai, surreptitiously collected nearly a hundred specimens, and sent them on to Guan for analysis. Barely two months after the die-off on Bird Island began, Guan’s team had published its findings in
Nature
. By comparing the genetic material in these samples with others taken in live poultry markets of southern China, the scientists were able to establish a similarity between the Qinghai virus and two others previously
isolated in Shantou, a city on the Guangdong coast. “This indicates the virus causing the outbreak at Qinghai Lake was a single introduction, most probably from poultry in southern China,” the team concluded.
The Chinese government was infuriated by the claim that the virus had spread from southern China to Qinghai. This made China the source of the global threat rather than an innocent victim of someone else’s birds. No sooner had the
Nature
article appeared online than China’s official Xinhua news agency fired back, quoting Jia Youling, the ministry’s animal-health director. No bird flu has broken out in southern China since the previous year, Jia claimed.
Government officials had been monitoring Guan’s research for more than a year. His genetic detective work was steadily unraveling their deceit. “They were very unhappy,” he recalled. “This is supposed to be a black box. Nobody is supposed to know what is going on. Now I’m opening the door and I have a strong case.”
The article about Qinghai was too much for the government. Jia went on the attack. He announced that Guan’s team had fabricated the data, saying the researchers had lied about taking samples at Qinghai. Soon after, Jia suggested that the team’s lab was so poorly equipped that the tests could have been contaminated and the results meaningless. He further alleged that the scientists had failed to apply for government approval to conduct their research and that the Joint Influenza Research Center at Shantou University Medical College, which Guan helped set up four years earlier, lacked adequate safeguards for doing the tests.
The government ordered the Shantou research center shuttered immediately. Virus samples were to be destroyed or turned over to the ministry’s official animal-flu lab in Harbin, one of only three institutes in China that would now be allowed to conduct this research. Jia later denied any political motive, saying the Shantou lab was one of four around the country that had been closed because it failed standard inspections. But to be sure Guan understood how severely they viewed his activities, agriculture officials accused him of the cardinal sin of disclosing state secrets.
“It was a lot of pressure,” Guan admitted, baring his still-fresh
wounds. “Doing the science is simple. The big problem is that people try to stop you from writing.” As he recounted the incident, his voice rose an octave and he sputtered, almost spitting out his grievance as he struggled for the right words in English. “They tell me, ‘You’re a human doctor and this is an animal matter. Don’t interfere in my animal issue. It’s none of your business.’ ” He paused and caught his breath. Then, filling his lungs with the smoke of a freshly lit cigarette, he continued, “Working on this, I’m not sure how far I can go, how safely I can go. They kept saying I’m leaking state secrets.”
Yet Guan kept going, and his network kept collecting samples even after Shantou’s front doors were closed. That fall, his team published another piece of disturbing research. It documented a new wave of disease that had appeared in China’s poultry and had already spread elsewhere in the region. After sampling more than 53,000 birds at live poultry markets in six southern Chinese provinces, the scientists discovered that a new H5N1 subtype, which they labeled “Fujian-like” because of its similarity to an earlier isolate from Fujian province, had rapidly squeezed out its predecessors. In just a year, the rate of infection in China’s poultry had nearly tripled. This new wave of transmission had renewed poultry outbreaks in at least three Southeast Asian countries and sickened people not only in China but also in Thailand. The scientists said China’s massive campaign to vaccinate all its poultry was possibly to blame for stimulating the emergence of this resistant subtype.
The government responded by calling a press conference to belittle the findings and impugn Guan’s ethics. “The data cited in the article was unauthentic and the research methodology was not based on science,” Jia said. “In fact, there is no such thing as a new ‘Fujian-like’ virus variant at all. It is utterly groundless to assert that the outbreak of bird flu in Southeast Asian countries was caused by avian influenza in China and there would be a new outbreak wave in the world.”
A month later, Guan shut down his research network in mainland China and told his army of sample takers they would have to find other work. Over the previous eight years, Guan and his “thankless heroes” had sampled more than two hundred thousand birds. Many of the virus samples available to researchers and vaccine developers
around the world had come from work done by Guan and his Hong Kong University colleague Malik Peiris. Time and again, they had alerted the world to crucial turns in the behavior of the virus.
But now he was switching off the radar, pulling the plug on the world’s early-warning system. “Let Dr. Jia Youling come and find a solution,” Guan told me in late 2007. “Let him clarify that I didn’t make a mistake or make up the data so I can recover my honor. Why should I sacrifice my honor?”
“Malik and I did a lot of work for the world,” he continued, his voice rising again. “Who continued on a weekly basis to do sampling for eight years? Anybody else? No. We are second to none in the world. What more can we do?”
PART THREE
CHAPTER NINE
The Secret Call
N
guyen Sy Tuan was conscious but could barely talk. His wasted frame was tucked beneath a white sheet on a metal hospital cot, arms spindly and useless by his sides. Never a husky man, he had lost more than a third of his weight since the virus set upon him nearly two months earlier. Tuan had withered to eighty-four pounds. His head was propped up slightly on a thin pillow. His face seemed frozen in horror, cheeks sunken and lips agape. His bulging eyes were fixed, staring for hours at the ceiling as if the young man was still haunted by a specter that the doctors had predicted would surely claim him. Never before had the specialists in the intensive care unit of Hanoi’s Bach Mai Hospital seen anyone survive such a massive attack.
“We thought there was no way Mr. Tuan could make it,” confided Dr. Nguyen Hong Ha, head of the ICU, as he stood just outside the doorway. “No patient who we’ve put on a mechanical ventilator has ever survived.”
Yet when I visited Tuan, the twenty-one-year-old had already cheated death. He no longer needed the machine to help him breathe. He could even stomach a little rice on his own.
The small, white-tiled hospital room was silent except for Tuan’s occasional dry cough and the muted sound of distant car horns wafting through the second-floor window. To his right was another cot. Not long ago, his teenage sister lay there beside him, burning with a fever of 105, gasping for air just like her brother. Now the cot was
empty. Somehow, she too had eluded death. She had already returned to school in the village, where her classmates, much to her consternation, had nicknamed her Miss H5.
Some doctors on the wards claimed these two cases as a triumph for Vietnamese medicine. But flu specialists nervously monitoring the virus in the spring of 2005 knew better. This unexpected turn of events was no reason to celebrate. The survival of Tuan and that of his sister, ironically, were part of a deeply disturbing trend.
These two siblings, the young seaweed harvester and the mischievous schoolgirl, were at the epicenter of a renewed outbreak in northern Vietnam that signaled to some of the world’s leading virologists and field investigators that the virus had mutated. It wasn’t just the increasing number of cases. It was the pattern. They were coming in larger family clusters, and the overall mortality rate had dropped substantially in a matter of months, suggesting the virus was edging toward pandemic. It may seem counterintuitive, but an astronomically high kill rate can be bad strategy for a prospective epidemic. After all, a virus that swiftly dispatches most everyone it infects gives itself little chance to spread. The 1918 flu virus, by contrast, settled on a far more modest fatality rate, claiming fewer than 5 percent of those infected. Yet it was ultimately able to kill at least 50 million people and perhaps many more.
Over the following months of that spring, new laboratory findings would emerge from northern Vietnam that apparently explained the shifting pattern, confirming that the field observations were no coincidence. Hard science seemed to show that the virus had crossed another threshold. A year earlier, in 2004, this novel strain had demonstrated conclusively that it could pass from one person to another, though widespread transmission had still been elusive. Now, in 2005, that fateful barrier appeared to be falling. Some in the know even concluded that the pandemic had already broken loose. But disease specialists at WHO never publicly disclosed their fears. Instead, they sweated in private, secretly weighing whether to sound a global pandemic alert.