Monday, March 28, 2005

US News on bird flu

We have complained here about the relative lack of attention to the bird flu problem in the American MSM, but there have been some very good articles here and there. The problem is they get lost in the din created by media circuses like the Scott Peterson trial, the Schiavo affair and the Social Security non-crisis. There has been some good reporting but it is lost in the noise. And it will probably stay that way until the Four Horsemen are galloping across the Great Plains.


This week brings some good reporting by US News Senior Correspondent Nancy Shute. It covers the usual material (at least for readers of this site) and also brings to the front issues that need to be grappled with at the local level if a threatened pandemic were to materialize. Things like where will be find the hospital beds? what kinds of things will be closed (what businesse? what schools by whom)? who will deliver food to the supermarket, pump gas, bury the dead (where and in what)?
The doctors are alarmed not because of the number of people that "bird flu" has killed but because the H5N1 virus displays an ominous adaptability and persistence. About 70 percent of those infected so far have died. Since 1997, when the new virus first showed up in chickens and killed six people in Hong Kong, it has spread to birds in eight countries in the region despite repeated efforts to halt it by slaughtering millions of chickens. "The virus has gotten even more widespread," says Klaus Stohr, head of influenza for WHO.
Shute acknowledges that this is not 1918, a time when the cause of the disease that eventually killed an estimated 40 million people worldwide was not even known (it was only identified as a virus in the 1930s). But she correctly points out that despite our ability to make vaccines and antiviral agents, if a pandemic were to strike in the immediate future we would be unprepared. This is not news to readers of this site, but it is good to see an explicit and in-context statement in the MSM:
All this casts harsh light on long-standing weaknesses in the nation's medical defense system, which include an unreliable vaccine supply and insufficient hospital surge capacity. Many hospital emergency rooms are already hard pressed to treat the influx of patients from a normal flu season, let alone a contagion that could send as many as 10 million people to the hospital. And the country's vaccine production capability is woefully inadequate, with only two manufacturers in the market and little financial incentive for other companies to enter. When contamination shut down one company's plant last year, obliterating half the nation's flu vaccine supply, the United States' entire influenza immunization program was thrown into chaos.
This is exactly correct. It puts the lie to the public health establishment's delusion that the influx of biodefense money would somehow "save" public health and rejuvenate its infrastructure. Indeed, as Shute notes, the Bush administration has made things much worse:
Yet the call to arms comes at a time when perpetually lean local health departments have exhausted a few years' worth of federal bioterrorism funding that came their way after 9/11. State budgets are hurting, and the Bush administration proposes cutting funding for the CDC, which is leading much of the nation's antipandemic efforts, by $500 million.
Nor has the endless cycle of needs assessments, draft draft plans, draft plans and no implentation or leadership produced any outcome of use:
The Department of Health and Human Services unveiled a draft national pandemic plan last August; many reviewers said the feds need to be far more explicit, providing state and local governments with priority lists for vaccine distribution and other guidance. HHS is convening panels to revise the plan, with the aim of finishing sometime this summer. "This is one of those rare times when states are saying we really do need some direction and guidance from the feds," says George Hardy, executive director of the Association of State and Territorial Health Officials.
There is much else of interest in Shute's US News report (newstand issue of April 4, 2005). Here is one last sinippet:
Although the 2003 SARS outbreak is estimated to have cost the global economy at least $30 billion, most businesses have yet to consider the cost of a flu pandemic, both in terms of employee absenteeism and disruptions of the global economy. The CDC estimates the economic impact of a pandemic in the United States at between $71 billion and $167 billion, but those numbers don't include disruptions to commerce and society.
Given this scenario, it is amazing that knowledgeable people still don't get the big picture. In a short companion piece antivirals are briefly discussed:
So far, 17 countries are stockpiling Tamiflu, but lagging countries could end up with too little, too late. Hong Kong has only enough to cover 5 percent of its population. The United States has 293 million people--and 2.3 million treatment courses.

Why delay? "Choosing an arbitrary number is probably not the most efficient way to spend public-health dollars," says physician Ben Schwartz, a science adviser in the National Vaccine Program. Among his concerns is Tamiflu's five-year shelf life: "If we stockpile enormous amounts and the pandemic doesn't occur within that time the drug would be worthless."
If a pandemic were to arrive this year or next, relying on antivirals would be futile as the sole manufacturer does not have the capacity to supply the US, much less the global population. But let's examine the thinking here. The Infectious Disease Society of America called for antivirals to supply half the US population, roughly 150 million people, or sixty times the current stockpile for ten days or 240 times the current stockpile for 6 weeks, the recommended time for prophylaxis in the case of an outbreak. At approximately $300/six week course that's quite a lot of money: about $45 billion dollars to keep in reserve for five years. That's an insurance policy of $9 billion/year, or about 2 months costs of the Iraq debacle per year. And the costs of not having it?
"We've never suffered an event of such magnitude that it shuts down the global economy," says infectious-disease specialist [Michael] Osterholm [of CIDRAP]. "In 1918 we were much more self-sufficient."
We'll have to become self-sufficient again because there is no leadership at the national level. Time to roll up our sleeves at the local level, which is where the action will be anyway.

[NB: I have corrected an earlier arithmetic error that was posted briefly earlier this morning]