 According to the Director General of the World Health Organization, the three greatest threats facing humanity are the global food crisis, climate change, and pandemic influenza. The current flu pandemic has killed hundreds and infected hundreds of thousands, but in a world in which millions of people continue to die of diseases like AIDS, malaria, tuberculosis, why is there so much concern about this so-called swine flu? Because apparently the last time a nearly entirely new flu virus jumped species and caused a pandemic, it went on to become the deadliest plague in human history, the influenza pandemic of 1918. Most flu strains tend to spare young, healthy adults, but the 1918 virus killed people in the prime of life. More than a quarter of all Americans fell ill. This is a chart of percent of population die. In 1918, as many as 50 to 100 million people lost their lives. A similar virus today could kill many more. What started for millions around the globe is muscle aches and a fever, and a day, or even hours later, with many victims bleeding. From their eyes, ears, nostrils, and into their lungs, homeless orphans, their parents dead, wandered the empty streets. One agonized official in the stricken east sent an urgent warning west, hunt up your woodworkers and set them to making coffins, then take your street laborers and set them to digging graves. This is a clipping from the New York Times at the time, victims of plague everywhere, great pires of bodies consumed by the flames. Many victims strangled and their own bloody fluids, their corpses, tinged blue from suffocation were said to have been stacked like cordwood outside of moors, as cities ran out of coffins, so they dug mass graves. That 1918 flu virus killed more people in 25 weeks than AIDS has killed in 25 years. No war, no plague, no famine has ever killed so many people in so short a time. Where did it come from? The conventional wisdom is that the 1918 pandemic was triggered when an H1N1 bird flu virus in its entirety, all eight gene segments, jumped into human beings. We then apparently passed it along to pigs, sickening millions of them as well. After the pandemic, once our human immune systems got used to this new virus, it turned into the regular seasonal flu, and in pigs it turned into what we call classic, or classical, swine flu. Before 1918, there aren't reports of pigs ever getting the flu at all. So, throughout the roaring 20s, people got the regular flu every year, and pigs got swine flu. Same with the 30s, and same with the 40s. In 1957, an H2N2 bird virus, combined with the seasonal flu, swamping in three genes, triggering the relatively mild 1957 pandemic, and then turned into seasonal flu. Nothing happened to swine flu, though, which remained completely stable. In 1968, an H3 bird virus, combined with the seasonal flu, swamping in two genes, triggering the mild 1968 pandemic, and then turned into the seasonal flu we've had ever since. Still, nothing happened with swine flu virus, which continued to remain stable. Stable throughout the 1970s in North America, and stable throughout the 1980s. But then, by 1999, everything changed. A never-before-described triple species flu virus arose. The classic swine flu virus, after being stable for 80 years straight, picked up three gene segments from the circulating human flu virus, and then two gene segments from a bird flu virus to create the first triple animal reassortment flu virus ever described. Our first hybrid, a human pig viral mutant, was discovered in an industrial pig production operation in Newton Grove, North Carolina, in August of 1998, owned by a massive pork conglomerate called Hogslath. The virus mutated further and then spread within months throughout the United States. Blood samples were taken from more than 4,000 pigs across 23 states just a few months later in early 1999. More than half of the pigs tested positive for exposure in Iowa, Oklahoma, Texas. 10 out of 10 herds positive in Illinois, 9 out of 10 in Kansas. Soon it spread into Canada, and by 2003 the majority of animals tested in industrial pig operations in Mexico also showed evidence of exposure to our triple hybrid strain. We then exported it to Asia, and now the favor has apparently been returned. After reshuffling with classic swine flu, our made in the USA triple reassortment virus picked up two gene segments from a Eurasian swine flu line to create the flu pandemic of 2009. The primary progenitor, the main ancestor of our current pandemic flu virus, as shown in orange, is the triple hybrid mutant that emerged and spread throughout factory farms in the United States more than a decade ago. Six out of the 18 segments, three-quarters of the pandemic virus straight from our triple hybrid, and this diagram, these data, are taken from the most comprehensive genetic analysis to date. Influenza experts have been warning about this triple hybrid mutant for years, an extremely promiscuous mammalian adapted virus. Flu scientists used to worry only about Southeast Asia, but given the appearance of the triple hybrid mutant, now we need to look in our own backyard for where the next pandemic may appear, and six years later it did. After eight decades of stability, what happened in the 1990s that led to these unprecedented changes in swine flu? And same question with bird flu, no human deaths from avian influenza for eight decades, until 1997, when H5N1 started killing people in Hong Kong. Then, in H7N7, bird flu emerged in the Netherlands, which went on to infect a thousand people and ended up transmitting human to human. Just two examples of the new bird flu viruses infecting people. In poultry, the number of outbreaks of highly pathogenic, highly disease-causing avian influenza in the first few years of this century have already exceeded the total number of outbreaks recorded for the entire 20th century. As one leading flu expert told Science, we've gone from a few snowflakes to an avalanche. What has been happening in recent years to trigger this kind of evolution and fast forward for both swine and chicken flu viruses? Let's ask the world's leading expert, Dr. Robert Webster, as did the senior correspondent of NewsHour with Jim Lehrer. Was there something qualitatively different about this last decade that made it possible for this disease to do something and hasn't done before some kind of change in conditions that suddenly led a match to the tender? Webster replied, he says, farming practices have changed. He talks about growing up on a farm, but he says, now we put millions of chickens into a chicken factory, next door to a pig factory. And this virus has the opportunity to get into one of these chicken factories and make billions and billions of these mutations continuously. And so what we've changed is the way we raise animals and our interaction with those animals, and talks about how the virus can escape from these factories. In fact, wild birds, but that's what's changed. What we've changed is the way we raise animals. Five years ago, the world's three leading authorities got together for a joint consultation. The World Health Organization, the Food and Agriculture Organization of the United Nations, and the World Organization for Animal Health, the top veterinary authority on the planet. Their job was to uncover the key underlying causes for these emerging animal to human diseases. Number one on their list was the increasing demand for animal protein the world over. Animals were domesticated 10,000 years ago, but never before like this, especially pigs and poultry. Chickens used to peck around the barnyard, but now chickens raised from meat are typically warehoused and sheds confining tens of thousands of birds. Half of the egg-lang hens in the world are now intensively confined in battery cages, small barren wire enclosures extending down long rows and windowless sheds. There can be a million birds on one farm. About half of the world's pig population is also. Now crowded into industrial confinement operations. Old McDonald's farm got replaced, one might say, by the new McDonald's farm. These intensive systems represent the most profound alteration of the human-animal relationship in 10,000 years. No surprise, perhaps, that they have been shown repeatedly to be breeding grounds for disease. A few snapshots before we get back to influenza. China, 2005, the world's largest producer of pork, suffers an unprecedented outbreak of an emerging pig pathogen called strepsuis, causing meningitis and deafness in people handling infected pork products. Hundreds of people infected with the deadliest strain on record. Why? The World Health Organization blames in part these intensive confinement conditions. The USDA elaborates, all strepsuis appears to start out harmless as natural flora, but the stress-induced immune suppression from overcrowding, poor ventilation, allows the bug to go invasive, causing infections of the brain, blood, lungs, heart, and death. Starts out harmless, turns deadly. That's what these conditions can do. This is not arguably how animals were meant to live. Pig factories in Malaysia birthed the NEPA virus, one of the deadliest of human pathogens, a contagious respiratory disease causing relapsing brain infections, killing 40% of people infected, propelling it onto the official U.S. list of bioterrorism agents. And again, according to one of the leaders of the field, it seems to be the conditions in which animals are now forced to live. July 2009, a strain of Ebola was reported on a factory farm in the Philippines, confining 6,000 pigs. Ebola rest in the same strain featured in the hot zone, airborne Ebola, but doesn't appear to make people sick. With enough time to mutate in pigs, though, who knows? So they drove them into these pits and then burned them alive. What better example of the link between how we treat farm animals and potential public health consequences than our investigation of acts of cruelty against sick and crippled dairy cows, which prompted U.S. authorities to initiate the largest meat recall in human history for violations of food safety rules meant to protect the public from bovine spongiform encephalopathy or mad cow disease, a disease that wouldn't even exist. Had it not been for factory farming practices, we took natural herbivores. Cows and sheep turned them into carnivores and cannibals by feeding them slaughterhouse waste, blood, and manure. And then we took downed animals, too sick to even walk, and fed them to people, and now we have mad cow disease. We feed antibiotics by the truckload to farmed animals. Here's the total amount of antibiotic used for all of human medicine every year. Contrast that with how much is fed to farm animals, just to promote growth and prevent disease in such a stressful and crowded environment, millions of pounds a year. And now we, as physicians, are faced with multi-drug-resistant bacteria and are running out of good antibiotic options. Why do half of the pigs so far tested in the United States have MRSA, MRSA, the so-called super bug that now kills more people than AIDS in the U.S. every year? As Britain's chief medical officer put it in his 2009 annual report, every inappropriate use of antibiotics in agriculture is potentially a death warrant for a future patient. Such use has its opponents and its advocates. The feeding of clinically important human antibiotics to pigs and chickens, just to fatten them faster, is condemned by the American Medical Association, but approved by the American Meat Institute. The American Academy of Pediatrics opposed versus the National Turkey Federation. The American Public Health Association is against it. The American Sheep Industry Association is for it. The National Academies of Science Institute of Medicine opposed. National Chicken Council in favor. The World Health Organization on one side, the National Pork Producers Council on the other. Now, to be fair, the National Cattlemen's Beef Association is also in favor, along with the United Egg Producers. On the other hand, this practice has been condemned by nearly every medical organization in the United States, yet industrial animal agriculture continues this dangerous practice. What about influenza, though? The increasing numbers of flu viruses jumping from farm animals to people. The acceleration of human influenza problems in recent years. To review, here are all the new influenza viruses infecting humans over the last century or so, up to 2005. There was 1918, 1957, 1968, but then look at just 1995 on. Kind of snowflakes to an avalanche in people, too. But why? According to the world's leading agricultural authority, the Food and Agriculture Organization of the United Nations, this is expected to largely relate to the intensification of poultry production, and possibly pig production, as well. The big shift in the ecology of avian influenza appears to be the industrialization of the global poultry sector. We are changing the way animals live by the billions. Spread wing to wing, the number of chickens we slaughter every day would wrap more than twice around the world's equator. In the early 1980s, nearly all the chickens in China were raised in tiny outdoor backyard flocks. Now there are 63,000 CAFOs, concentrated animal feeding operations, in China, with a few confining more than 10 million birds at a single operation. We cram thousands of animals in a cramped, filthy, football field-sized sheds to lie beak to beak, or snout to snout atop their own waste, arguably a perfect storm environment for the emergence and spread of so-called super strains of influenza. This is how Dr. Webster envisions the emergence of the bird flu H5N1, the deadliest flu virus ever recorded. First, it's evolution in chickens from waterborne transmission to airborne transmission. Let me try to explain how this might work. All bird flu viruses seem to start out harmless to both birds and people. It's very important to understand they start out harmless. In its natural state, the influenza virus has existed for millions of years as an innocuous, intestinal, waterborne infection of aquatic birds like ducks. Then how does a duck's intestinal bug end up in a human cough? Well, in humans, the virus must make us sick in order to spread it, it must make us cough in order to transmit virus from one person to the next. In the virus's natural reservoir, though, the duck doesn't get sick because the virus doesn't necessarily need to make the ducks sick in order to spread. In fact, one might say it's in the virus's best evolutionary interest for the bird not to get sick, so it can spread even farther. After all, dead ducks don't fly very far. So the virus silently multiplies and the duck's intestinal lining is excreted into the pond water and is then swallowed up by another duck and the cycle continues as it has for millions of years and no one gets hurt. But if an infected duck is dragged to a live poultry market, for example, and crammed into cages allowing the splattering of virus-infected droppings on terrestrial birds, land-based birds like chickens, then the virus has a problem. Like a fish out of water when the virus finds itself in the gut of a chicken at one of these kind of viral swap meats, no longer has the luxury of easy water-borne spread. Chickens aren't paddling around in the pond, so the virus must mutate or die. Fortunately for us, mutating is what influenza viruses seem to do best. In aquatic birds, the virus is perfectly adapted, harmless, but when thrown into a new environment, land-based birds like chickens quickly starts mutating to adapt to the new host. In the open air, the virus must resist dehydration, for example, and may have to spread to other organs to find a new way to travel. The intestines aren't going to work anymore for this virus, and it may find the lungs and become an airborne pathogen, which is bad news for terrestrial mammals such as ourselves. It goes into chickens as an aquatic virus, but may come out as the flu. Then, H5N1's transformation from harmless to deadly, presumably in these factory farms, from a low pathogenicity virus harmless to a highly pathogenic strain of the flu. Again, let me try to explain. In a new host, the more virulent, the more violent the virus becomes in this adaptation process, the quicker it may be able to overwhelm the immune system of its new host. But if it becomes too deadly, though, it may not spread as far. In an outdoor setting, at least, if the virus kills its host too quickly, the animal may be dead before it has a chance to infect too many others. So in nature, there's a limit on how virulent these viruses can get, or at least there was, until now. Enter industrial poultry production. When the next beak is just inches away, there may be no limit to how nasty the virus can get. Evolutionary biologists believe that this is the key to the emergence of hypervirulent, so-called predator-type viruses, like H5N1, disease transmission from immobilized hosts. See, when you have a situation where the healthy cannot escape the disease, where the virus can knock you flat and still transmit from one to another, just because you're so crowded, then there may be no stopping, rapidly mutating viruses from becoming truly ferocious. This may explain the virus of 1918 or rising out of the trenches in World War I. There were these crowded troop transports. Box cars were labeled eight horses or 40 men. So apparently when this harmless virus found itself in these kind of conditions that turned deadly, millions forced together in close quarters, no escaping a sick comrade, this is thought to be where the virus of 1918 may have gained its virulence. From the virus's point of view, though, the same trench warfare conditions exist today in every industrial chicken shed, every industrial egg operation, intensively confined, crowded, stressed, but by the billions, not just millions. The industry is slowly waking up to the growing realization that viruses previously innocuous to natural host species have an all-probability become more virulent by passage through these large commercial populations. This is from industry trade journal. Starts out harmless, turns deadly. That's what these conditions can do. This is not arguably how animals were meant to live. So how does the poultry industry feel about the possibility of its own factory farms leading to a pandemic that could kill millions of people? Well, the executive editor of Poultry Magazine wrote an editorial on just that topic. The prospect of a virulent flu, to which we have absolutely no resistance, is frightening. However, to me, the threat is much greater to the poultry industry. I'm not as worried about the U.S. human population dying from bird flu as I am that there will be no chicken to eat. Factory farming may be a very efficient method of production, but no matter how cheap the meat, it may not be worth the risk. It is likely no coincidence that our first hybrid swine flu arose in the state with the single densest pig population in the country, North Carolina. In fact, the virus arose in the county with the single highest pig population in the nation, now confining more than 2 million pigs. In the 1920s, there were fewer than 2 million pigs in the entire state, and into the 30s, 40s, 50s, 60s, 70s. Classic swine flu continued to remain unchanged into the 1980s. By 1989, the North Carolina pig population reached about 3 million, but then came the 90s. The year that the first hybrid mutant arose in North Carolina was the year the pig population in the state reached 10 million. At the same time, the number of operations diminished fourfold, resulting in a dramatic intensification of the North Carolina pork industry, leading up to the emergence of the new hybrid flu virus first discovered there. What role might this intensification have played in the emergence and spread of the novel virus? There are at least 10 reasons why industrial pork production can present such a breeding ground for a disease. Let me quickly run through them. The majority of U.S. pig factories now confine more than 5,000 animals, each 5,000 captive viral hosts. It goes without saying that with a group of 5,000 animals, if a novel virus shows up, it will have more opportunity to replicate and potentially spread than in a group of 100 pigs in some small farm. Or, more colorfully, Professor Silbergeld from the Johns Hopkins School of Public Health. Instead of a virus only having one spin of the roulette wheel, it has thousands and thousands of spins for no extra cost. It drives the evolution of new diseases. Here's some data that back up the common sense. An investigation of the relationship between farm size and risk of the Eurasian lineage swine flu infection. Pigs from larger farms with a standing pig population, greater than 5,000, appeared to have a significantly higher risk for classic swine influenza H1N1 infection compared to pigs originating from smaller farms. The odds of H1N1 in pigs from those massive farms were five times more as compared to farms confining less than 1,000 pigs. The same result was found for another strain of swine flu. Pigs from farms with thousands of animals were up to nine times more likely to have H3N2 swine flu infection as compared to pigs from farms with only hundreds of animals. A study of pig farms in North America similarly concluded that increasing the number of finishers fattening pigs by 1,000 quadruples the odds of a herd being positive for swine flu. Four times the odds of infection for every additional 1,000 pigs you cram in, which again just makes a certain amount of sense. And when one crowds together the pig operations themselves in the US Midwest and Southeast, the Dutch pigbell in Europe and China, infection risk is increased because of greater opportunities for windborne and other modes of virus transmission. One can apparently decrease herd infection risk 16-fold simply by not packing them all together so tightly. And now we're co-locating pig factories next to chicken factories, facilitating these cross-species jumps of practice Webster calls unsound. In addition to being the US state with the densest pig population in the country, North Carolina is also one of the nation's largest poultry producers, slaughtering nearly three-quarters of a billion chickens every year and caging enough hens to produce literally billions of eggs. One scenario as to the emergence of the triple hybrid virus in 1998 is that it was circulating for a few years before it mutated or simply obtained a critical density necessary to burst into the US pig population. Swine flu is spread just like human flu through respiratory droplets and nasal secretions. So overcrowding pigs allows for large infectious loads to transfer from one animal to another, increasing the likelihood that extremely rare mutations can get passed on rather than just dead-ending in an individual. And in terms of a novel virus then spreading, not only may an increased number of pigs per geographic region facilitate airborne transmission, but an increase in the number of fattening pigs per pen has been associated with higher risk of swine flu infection, because it simply allows more opportunities for direct nose-to-nose contact or for aerosol spread of the virus between penmates. It's like putting 5,000 people in an elevator and someone sneezes. Of course, the more you crowd them, the faster a respiratory virus is going to spread. If overcrowding pigs so tightly increases the risk of the emergence and spread of new viruses, why does the industry do it? Because overcrowding pigs pay according to the trade publication National Hog Farm. You can maximize profits by dropping the space per pig to 6 square feet. That's a 200-pound pig in like 2 feet by 3 feet. They acknowledge this presents some problems, inadequate ventilation, increased health risks, but sometimes crowding pigs a little tighter will make you more money. It may make sense for the pork industry's bottom line, but we are only beginning to understand the true costs of this approach, the externalized costs to society. Furthermore, a large number of pigs per pen also creates physiological stress, which in turn can alter the immune system and predispose pigs to infection, which brings us to the fourth factor. The operation in Newton Grove, North Carolina, where the ancestor of the current pandemic virus was first detected, was a breeding facility in which thousands of sows were confined in gestation crates, also known as sow stalls. Veal crate like barren metal cages about 2 feet wide. These highly intelligent social animals are basically kept in a box week after week, month after month, for nearly their entire lives. They can develop crippling joint deformities, lameness. If they did this to a dog, they could get thrown in jail. Not only can these pregnant pigs not turn around, they can barely move at all. The rise in stress hormone levels in crated sows is thought to be because of interference with the expression of natural maternal behaviors like nest building, and this frustration of normal maternal behavior may result in impaired immunity. Measures as simple as providing straw bedding may decrease morbidity and mortality compared to these concrete slatted floors, presumably by eliminating the immunosuppressive stress of lying on bare concrete their whole lives, which may also lead to an increased infection risk. This minimal act providing straw has been shown to decrease the risk of swine flu infection. For anyone whose German may be rusty, table two risk factors significantly associated with influenza virus infection. Compared to straw bedding, bare slatted floors two and a half times the infection risk. Yet we often deny them even that modicum of mercy to their detriment, and potentially to ours as well. The National Livestock and Meat Board defends intensive confinement in a pamphlet called Facts from the Meat Board. Confinement rearing has its precedents. Schools are examples of confinement rearing of children, not that different from how they described veal crates as similar to a baby's crib. The fact that the industry feels the need to mislead consumers by conjuring images of classrooms and baby cribs speaks to how far out of step animal agriculture has gone from mainstream values of just basic decency towards animals. And they know it. As a professor emeritus of animal science wrote in one of his college textbooks, one of the best things modern animal agriculture has going for it is that most people haven't a clue how animals are raised. For modern animal agriculture, the less the consumer knows, the better. Ammonia, released from decomposing waste, may burn the pig's respiratory tracks and predispose them to respiratory infection in the first place. Ammonia levels have been significantly associated with both pneumonia and pleuritis, or long-lining inflammation. The dankness and lack of direct sunlight enables the flu virus to survive much longer periods than it otherwise would be able to outside. The UV rays in sunlight are actually quite effective in destroying the influenza virus. 30 minutes of direct sunlight completely inactivates even H5N1, yet it can last for days in the shade and weeks in moist manure, which brings us to factor 7. Millions of gallons of excrement spewed into open-air cesspits. Swine flu viruses have been shown experimentally to multiply in a pig's digestive tract, be released in feces, and can survive in this slurry of urine and feces for weeks. The spread of this untreated waste on nearby land may then spread the virus out into the environment and to other herds. See, these huge tunnel ventilation fans can suck up aerosolized virus and have been shown to be able to blow large volumes of infectious particles far out into the countryside, which helps illustrate how loosely a term like biosecurity could ever really be applied to industrial animal agriculture. And all that manure attracts flies. Here's a picture taken outside of the home of a neighbor to one of these factory farms. This level of fly infestation has more than just social and property value implications. Research on avian influenza suggests that contaminated flies can move the virus from one confinement operation to another, even miles away. Pig factory employees can dip their boots in antiseptic foot baths all they want. You can't keep flies out of a hog kayfoe. Just as the U.S. pork industry jeopardizes the public through the mass feeding of human antibiotics to pigs to offset the effects of intensive confinement, the industry vaccinate its herds for swine flu. This doesn't prevent the disease, though. It just prevents the drop in carcass weight associated with the disease that's so bad for business. The commercial vaccines that have been tested simply fail to significantly reduce viral shedding, so swine flu viruses continue to circulate and spread. And the immunological pressure placed on these viruses by the vaccines may select for vial mutants with different surface proteins, so it may select for swine flu viruses that grab human or avian genes, possibly increasing the risk of infection for animals and humans by favoring genetic mutation in the generation of viral variants. Unfortunately, one of the surface proteins, our triple hybrid virus, picked up from Eurasia, was the M gene, which codes for an ion channel, which normally we can plug up with the antiviral drug Amantadine, but in Eurasia, swine flu viruses have grown resistant to the drug, like many of the bird flu viruses spreading out of Asia. Why? Factory farms in China were feeding the drug to their chickens, putting it right in their water supply, effectively eliminating half of our anti-flu classes of viral treatment drugs. Finally, long-distance live animal transport. The ancestral virus of the current pandemic virus arose on a North Carolina factory farm in August 1998, but then how did it spread across the entire country in but a few months time? And then the world, Mexico, Canada, even Asia, contaminated trucks and shipping containers have been blamed for this global spread of swine flu. In the United States, pigs are trucked coast to coast. Red meat travels on average 1,000 miles on the hoof before it reaches our plate. Pigs may be bred in North Carolina, but fattened in the Corn Belt of Iowa, and then slaughtered in California. Sometimes it's cheaper to bring the pigs to the corn than the corn to the pigs. Before factory farms, there were fewer animals, less crowding of farms, less crowding of animals who were actually able to move around. They were outside where influenza viruses get dehydrated to death in the breeze and zapped by sunshine. Manure was composted and actually fertilized the earth rather than contaminating it, attracting swarms of flies. We didn't have to feed them drugs, and even if a new virus arose, where would it go? The pigs ended up in a local butcher shop, not halfway around the world. This factor alone confirms the link between industrial pork production and the current pandemic. How else could a North Carolina virus get to Minnesota, Mexico, and Malaysia? How else? The answer is when pigs fly. But since they don't, one of the reasons we now have a virus infecting well over a million people in the United States is industrial, farm animal production. Only a few hundred people have died, though. You can never call anything that's killed scores of children mild, exactly. But the H1N1 virus hasn't been much worse than the regular seasonal flu so far, but this may just be the first wave. The 1918 pandemic may have been relatively mild at first too, although we're still not exactly sure what happened in 1918, compared to what was to come later. What may have been a first wave in the summer of 1918 hardly even registered a blip, but then apparently came back with a vengeance in the fall to kill tens of millions of people. The worst case scenario would be if the swine flu were to combine with the H5N1 bird flu, both of which have been found in pigs. If a single pig in parts of Asia or Africa, where bird flu has become endemic, becomes co-infected with both the new swine flu and bird flu, the concern is that it could theoretically produce a virus with the human transmissibility of swine flu, but also with the human lethality of bird flu. In 1918, the mortality rate of the pandemic was less than 5%. This estimate on the right potentially millions of people dead in the next pandemic is based on the same 2% to 3% mortality rate with the U.S. Centers for Disease Control calls a category 5 pandemic. Around 2% mortality. Around 2 million Americans dead. So that's 2%. H5N1 so far has officially killed over half of its known human victims. Don't even seem to get a coin toss as to whether or not you live through the disease. Robert Webster, the so-called gone father of flu research. We go back to 1918, 2.5% of people died. How many people are dying with bird flu? 50%. We've never seen such an event since the time of the plagues. Up to 60 million Americans get the flu every year, as many as a billion people worldwide, what if it suddenly turned deadly? That's what keeps everyone up at night. The possibility, however slight, that a flu virus like H5N1 could trigger a human pandemic. That would be like combining one of the most contagious known diseases influenza with one of the deadliest. Crossing a disease like Ebola with the common cold. What can we do to prevent this kind of thing in the first place? To lower our risk of generating increasingly dangerous farmed animal flu viruses, the global meat and egg industries must reverse course away from greater intensification. By, for example, here in the annals of the New York Academy of Sciences, replacing large industrial units with smaller farms with lower stocking densities, potentially resulting in less stress, less disease susceptibility, less intense infectious contact, and smaller infectious loads. The United Nations itself has urged that governments, local authorities, and international agencies, need to take a greatly increased role in combating the role of factory farming, which, combined with live animal markets, provides ideal conditions for the flu virus to spread and mutate into a more dangerous form. Factory farms can be thought of as incubators for the original emergence of dangerous strains of the flu. More than five years ago, the American Public Health Association, the largest and oldest association of public health professionals in the world, called for a moratorium on factory farming. In 2007, the Journal of the APHA published an editorial that went beyond just calling for a de-intensification of the pork and poultry industries. The editorial questioned the prudence of raising so many animals for food in the first place. It is curious that changing the way humans treat animals, most basically ceasing to eat them, or at the very least, radically limiting the quantity of them that are eaten, is largely off the radar as a significant preventive measure. Such a change, if sufficiently adopted or imposed, could still reduce the chances of the much feared influenza epidemic. It would be even more likely to prevent unknown future diseases that, in the absence of this change, might result from farming animals intensively and killing them for food. Yet humanity doesn't even consider this option. We don't tend to shore up the levees until after disaster strikes. The editorial concludes those who consume animals not only harm those animals and endanger themselves, but they also threaten the well-being of future generations. It is time for humans to remove their heads from the sand and recognize the risk to themselves that can arise from their maltreatment of other species. How we treat animals can have global public health implications. I am often asked how the industry responds to this kind of sentiment from the scientific community. Well, a few summers ago, the United Nations released yet another report on the global health risks of industrial animal agriculture, along with one of the most prestigious public health institutions in the world. Let me show you the kind of reception it got from US agribusiness. Feedstuffs is America's leading agribusiness publication. An editorial responded this way to the FAO research report. The Food and Agriculture Organization of the United Nations claims to use scientists to generate its reports, but I wonder if those scientists don't resemble a bearded man living in a cave in Pakistan who wants the US on its knees. Cutting down our consumption of chickens and pigs and combating the role of factory farming, as the United Nations has advised, as well as replacing long-distance live animal transport with a carcass-only trade, may help prevent the emergence of future pandemics, but viruses like H5N1 have already been hatched, already spread and mutated into a more dangerous form, and there seems little hope of eradicating either it or swine flu. Dr. Michael Osterholm is the director of the US Center for Infectious Disease Research and Policy and an associate director within the US Department of Homeland Security. He tried to describe what a pandemic with a virus like H5N1 could look like in one of the leading US public policy journals called Foreign Affairs. He suggested that policymakers consider the devastation of the 2004 tsunami in South Asia, duplicate the tsunami in every major urban center and rural community around the planet simultaneously, add in the paralyzing fear and panic of contagion, and we begin to get some sense of the potential of pandemic influenza. Or we could imagine Katrina. Imagine every city, New Orleans, at the same time around the world, people drowning in their own bodily fluids. All perhaps because people insisted on eating cheaper chicken. And pork. Traditionally, pandemics have been thought of as natural disasters, like earthquakes, of which we couldn't possibly have control. But because of the way we now raise animals, future pandemics may be in part considered unnatural disasters of our own making. An influenza pandemic of even moderate impact could result in a single biggest human disaster ever. Far greater than AIDS, 9-11, all the wars of the 20th century, and the tsunami combined. Has the potential to redirect world history as the Black Death redirected European history in the 14th century? Hopefully the direction world history will take is away from raising animals by the billions under intensive confinement, so as to potentially lower the risk of us ever being in the same precarious place in the future. There is, however, hope on the horizon. In 2008, the Pew Commission on Industrial Farm Animal Production released its final report. The prestigious body was chaired by a former Kansas governor, included a former U.S. Secretary of Agriculture, and concluded that industrialized animal agriculture posed unacceptable public health risks and called for gestation crates for pigs to be banned. Noting that practices that restrict natural motion, such as sow gestation crates, induce high levels of stress in the animals and threaten their health, which in turn may threaten our health. I'm happy to report the thanks to the dedication and tremendous work of thousands of volunteers, and despite the industry's best stonewalling, six states so far have already acted to join the European Union in phasing out gestation crates forever. In response to the pandemic, the pork industry, instead of changing its practices, has concentrated on changing the pandemic's name. From a recent editorial in the prestigious journal Nature, unlike their colleagues in public health who focused their energies on protecting the planet's 6.8 billion humans, animal health specialists' primary mission tends to be to promote and protect the national and international livestock and meat trade. This focus on commerce can lead to conflicts of interest, as well as policy positions that border on denial. Considerable energy has been expended trying to keep people from calling the virus swine flu, but of course that's exactly what it is, and in fact pigs on three continents so far have been found with the virus. The meat industry mantra is that they are science-based, but many of their assertions have been scientifically baseless. Their denial may extend deeper than just the name. One of the first confirmed human cases of swine flu appeared near the single largest pig factory in all of Mexico, a subsidiary of Smithfield, the largest pork producer in the world. A single operation that raises nearly a million pigs a year. Smithfield claims that it's just a coincidence that an early swine flu case was discovered near this facility, and it may be, but we will probably never know. What we do know is the meat industry's track record. Consider the poultry industry's cover-up of the Triangle of Doom outbreak a few years ago. The Turlock region in Stanislaw County, California, became known as the Triangle of Doom in 2002. Millions of hens confined in battery cages became infected with an H6N2 virus. Why didn't we ever hear anything about the outbreak? Perhaps more astonishing than the extent and the speed of this outbreak was the fact that no one heard about it. Why? Well, as reported in this publication of the National Academies of Science, the emergence of the Triangle of Doom outbreak was kept quiet. By corporate decision makers in California, who feared that consumer demand might plummet if the public knew they were buying infected meat and eggs. What we are now seeing with swine flu, maybe that same knee-jerk corporate reaction, cover it up, deny any responsibility. What we do know, as published by scientists from the University of Iowa Center for Emerging Infectious Diseases, is that factory farms may indeed themselves act as amplifiers of influenza. They conclude a human influenza epidemic due to a new virus could be locally amplified by the presence of confined animal feeding operations in the community. And again, this was published years ago. The public health community has been shouting from the rooftops for years that factory farms present a public health menace. The science is there, has been there, if we can just muster the political will. Let me end with a quote from the World Health Organization. The bottom line. The bottom line is that humans have to think about how they treat their animal, how they farm them, how they market them. Basically, the whole relationship between the animal kingdom and the human kingdom is coming under stress. In this age of emerging diseases, there are now billions of feathered and curly-tailed test tubes for viruses to incubate and mutate within billions more spins at pandemic roulette. Along with human culpability, though, comes hope. If changes in human behavior can cause new plagues, well then changes in human behavior may prevent them in the future.