The World Is Flat (And Someone Has The Flu)

Barack Obama and Richard Lugar write in the Times about the scary prospects for an avian flu pandemic:

Grounding a Pandemic

By BARACK OBAMA and RICHARD LUGAR

Washington — When we think of the major threats to our national security, the first to come to mind are nuclear proliferation, rogue states and global terrorism. But another kind of threat lurks beyond our shores, one from nature, not humans - an avian flu pandemic. An outbreak could cause millions of deaths, destabilize Southeast Asia (its likely place of origin), and threaten the security of governments around the world.

Earlier this year, Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention, called the possibility of avian flu spreading from Southeast Asia "a very ominous situation for the globe." A killer flu could spread around the world in days, crippling economies in Southeast Asia and elsewhere. From a public health standpoint, Dr. Gerberding said, an avian flu outbreak is "the most important threat that we are facing right now."

...

The precedent that experts fear is the 1918 flu pandemic, which began in the American Midwest and swept the planet in the era before air travel, killing 20 million to 40 million people. As John M. Barry, author of "The Great Influenza," has observed, "Influenza killed more people in a year than the Black Death of the Middle Ages killed in a century; it killed more people in 24 weeks than AIDS has killed in 24 years."

At the moment, effective responses to an avian flu pandemic are limited and will come far too late for many people in Southeast Asia. Indeed, so far more than 60 percent of those diagnosed with the avian flu have died. There is no proven vaccine for the A(H5N1) strain and it could take months to produce a fully effective one. Moreover, while some antiviral treatments may help flu sufferers, they are not widely available and must be administered to patients within 24 hours after the onset of symptoms.

...

So what should we do? Recently, the World Health Organization called for more money and attention to be devoted to effective preventive action, appealing for $100 million.

Congress responded promptly. A bipartisan group of senators obtained $25 million for prevention efforts (a quarter of the request, the traditional contribution of the United States), allowing the C.D.C., the Agency for International Development, the Health and Human Services Department and other agencies to improve their ability to act.

Given the potential for disaster, $25 million seems like chicken feed.

Comments

[richard mcenroe]

Of course, if any American pharmco does rush a vaccine onto the market, they'll be class-action'd to death for any real or imagined side-effects...

[Jamie]

Like a meteor strike, this is the opposite of an unprecedented event, and we stand around twiddling our thumbs. (Not all of us, of course - thank you, tireless researchers who must have the worst nightmares ever.)

It's hard to believe that we just experienced a natural disaster that wiped out two hundred thousand people in hours; it's almost impossible for me to get my mind around a modern-day plague.

[Neo]

I really wish that policy makers, especially when dealing with scientific matters, would refer to the "need for more resources" rather than sounding the cry for "more money".

Everybody needs more money. I could use any spare samples that may be left about at that. Back to the point, I think that the discussion should be about resources.

Meanwhile, we still don't have a real good anthrax vaccine .. or do we ? What about hemorrhagic fever ? I saw that monkeys now have a vaccine of Ebola, what about people ? Any more dangers ? More resources ?

[Birkel]

Is it 1977 already? I thought we had already had the swine flu heebee jeebees and forced the producers of the vaccine and the government to pay for the children who died from the treatment.

What's that? Oh, sorry. You said avian flu. Well that makes it all different.

Too bad Senator Obama went to HLS and not the Kennedy School. He'd'a learned about swine flu if he had.

[ed]

Hmmmm.

Is it ok for me to be worried about Chimeras, human/animal hybrids, *now*?

[POUNCER]

The Department of Agriculture's "Animal and Plant Health Inspection Service" or APHIS has dealt with avian flu outbreaks every few years -- in avians. A few stray fowls get into the US's barnyards and infect. APHIS detects and does heroic epidemiology, buys out all the possibly infected birds from everybody who may have been touched -- and destroys them.

Since the birds are usually chickens worth a dollar per or less, this is no great loss even if the rancher is totally "depopulated". (Unlike, say, the cost of depopulating a cattle rancher's herd for brucelloceous or "mad cow disease". )

Just another bunch of unsung heros, usually. "I work for the government and I'm here to help," is NOT a joke or a lie, all the time.

But my point, (and I do have one) is that vaccine research is not the only tool in the drawer. Good old fashioned paperpushing, tracking, checking, phone calls and talking to people are all the nuts and bolts of "epidemiology". Find out where the infections are, where they've been, and where to look next. Then break up the chain.

It's a crime that Reagan did not sic a bunch of APHIS veterinarians on the AIDS epidemic when it first broke. Not that certain San Francisco bath houses needed to be depopulated, but at least to figure out where and when and who were the most active "links" ...

Anyhow, the low-tech tools aren't elegant but they have the advantage of existing, while vaccines, treatments and nano/genetic/magical responses do not. The reality-based-community might well begin by building up an APHIS-like cadre of paper-pushing epidemiologists among state and county public health centers. These could apply themselves to chronic known problems like syph and gono as well as the threat of novel and unknown strains of bird flu. And all it would cost is a few million and getting over some squeamishness about "privacy".

[chris green]

So how come every potential flu epidemic is always framed
in terms of what we need to do to prepare ourselves, produce vaccines, etc for when it inevitably strikes..But no one ever discusses tackling the real problem, which is the farming techniques in SE Asia which create the endless cycle of flu variants? Granted, it wouldn't be cheap to change the lots of these poor farmers, but influenza costs the world billions of dollars.

The lack of an anthrax vaccine is no where near as important as a disease like influenza. Anthrax doesn't
cause epidemics, and the dc sniper killed more people than the unknown anthrax attacker did.

The various hemorragic fevers are scarier because of their contagious nature and resistance to treatment,
but so far the epidemics have always burned themselves out fairly quickly and without spreading very far.

[chris green]

BTW, to the poster about the swine flu scare and vaccination program : if you read up on it, you may come to the conclusion (as I have) that, given the risks and unknowns involved, the decision to attempt mass-vaccination was probably the right one.

There were snafus a-plenty in the vaccination program, but
nothing like this had ever been attempted before. And the dangers of the vaccine were exaggerated (or perhaps more correctly, people hadn't really internalized the fact that any mass vaccination program would kill some people - most vaccines have side effects in some small % of the population).

If you really want to see an ill-advised vaccination campaign, look at the post 9/11 campaign for smallpox vaccinations - here a lot of people were vaccinated, some with no choice in the matter, with a vaccine known to have killed plenty of people, against a disease which
while having a deadly potential, had no outbreaks whatsoever in 25 years.

[Chuck Simmins]

I've written about this subject extensively. The short version: It's all about money. Everybody wants more.

We don't have enough data to make any sort of a prediction about a pandemic. The H5N1 strain might be the next pandemic, or not. It's been known for over a decade, and person to person transmission still remains unproven. The total number of human cases of this variant is still under 200.

It's the people of the Third World who will die in any pandemic, and there's not a damn thing we can do about it. It is not possible to make or distribute enough vaccines or anti-virals to prevent millions of deaths there.

The histories of the last two pandemics in the United States shows that the effects on us will be much less, and might be indistinguishable from a nearly normal flu season which kills about 30,000 Americans anyway. Remember that American medicine deals with a number of epidemics every single day, HIV, West Nile, etc. We're pretty good at it.

This is just another scheme to extort money by using fear. Anyone die from the Alar on their apples lately?

[Birkel]

Hey chris green,

I did read up on it, you frickin' tool. How the heck do you think I know about the case study taught in API 501 at the Kennedy School?

Reading comprehension... It's a skill.

[chris green]

Sheesh I'm sorry I offended you and I implied that you hadn't read up on the swine flu epidemic.

Not flying off the handle and calling people names at the first perception of being slighted... It's a skill.

>I did read up on it, you frickin' tool. How the heck do >you think I know about the case study taught in API 501 >at the Kennedy School?
>Reading comprehension... It's a skill.