H5N1, a subtype of avian flu, has been a major issue for American farmers since 2020. But it’s increasingly becoming a problem for people, too. Initially confined to poultry, the virus has spread to several species over the years, including foxes, minks, and alpacas, and earlier this year, cows. This year, a large-scale infection in cows led to a spate of human cases. Most alarmingly, three recent infections in people — including one that left a teenager in British Columbia in critical condition — can’t be traced to contact with any animals, indicating the possibility of human-to-human transmission. There is still no evidence such transmission is taking place, and authorities say risk to the public is low. But this problem clearly isn’t going away, and the U.S.response to it has been sluggish and opaque. David O’Connor, a well-known professor of pathology and laboratory medicine at the University of Wisconsin, has been a notable critic of the government’s approach. I spoke with him and his colleague Tom Friedrich, a virology professor at Wisconsin, about how COVID fatigue, fragmented health care oversight, and mistrust of the medical establishment has combined to create a high-risk situation.

You had a memorable quote in a recent New York Times op-ed by Tulio de Oliveira: “It seems that the United States is addicted to gambling with H5N1, but if you gamble long enough, the virus may hit a jackpot.” Can you explain exactly how we’re gambling here? What are we doing that’s so risky with regards to this virus?
David O’Connor: It’s been eight months since we first recognized that there were infections in dairy cattle. And while there has been a government response and a lot of conversations about it, the response has been what I would call too little and too late. It simply isn’t matching the scope of the potential risk, and we are gambling by not trying to take that more seriously. If you think about the dairy cattle outbreak in particular, you have a bit of a gap. The USDA, CDC, and FDA can all credibly claim that they should be leading the response, but it doesn’t seem like any one organization has particularly taken up the mantle as the one in charge. USDA regulates agriculture; CDC is concerned about the spillover risk to human health; The FDA regulates milk. And they’ve all been involved, but I think you’d be hard-pressed to find one organization that would say they are running lead on this — that they are the H5 influenza czar overseeing and coordinating all aspects of the response.

When everyone’s in charge, no one’s in charge.
David O’Connor: So what you have are these policies by half measure. Back in May, the USDA asked farms to voluntarily provide milk for bulk testing, but there was no particular incentive for them to do that, so very little bulk testing of raw milk was done. It took until November for the USDA to announce a rollout of bulk-tank testing, and that still appears to be a slow process. A couple of states took it upon themselves to do bulk tank testing. And guess what? They found a bunch of previously unknown dairy herds that were affected. Colorado, Connecticut, and Massachusetts are the three I know.

So some states have done it, but that’s three out of 50. Where has the leadership been in terms of getting the bulk tank testing so that we would simply know how widespread this virus is in dairy herds? The FDA, with some scientists, found that H5 genetic fragments could be found in pasteurized milk. So if you buy milk at the grocery store, you’d find that some of it has H5 genetic fragments. Milk is totally safe to drink — the virus is inactivated. But here we have the ability to understand how much H5 is in our dairy supply. And critically, we could use genetic epidemiology tools to understand the sequence of the virus. So how much H5 is out there? Where is it? What does it look like, how is it changing?

When the FDA has done surveys of these products, they tout the fact that they tested 167 products. Is that a lot of products to test, given the scale of the dairy industry around the United States? I would argue that they should be testing 10 times, 50 times that number if we really want to understand how this virus is potentially moving through time and space. And for the CDC’s part, they recently released a study that found that among 115 dairy workers, seven percent had antibodies to H5N1. That’s almost 10 percent — admittedly of a small number of people they reported on — who have apparently been exposed to this virus occupationally in the last year. So we have to be asking: Why have they only looked at 115 people? Why did it take a peer-reviewed scientific article for that information to come out? Why was it not broadcast more quickly and with greater urgency? This is the sort of thing that we are seeing from the response, and it’s just sclerotic and seemingly very, very conservative.

There was a lot of talk during COVID about our fragmented healthcare system then, and how that was a real impediment. But this is more about the limits of our fragmented government surveillance system. Is there any workaround to that? Is that just the way the system is set up?
Tom Friedrich: As you guys both alluded to, there’s no one agency in charge. That’s not only true at the federal level,........

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