Monday, August 08, 2005

Bird flu model dilemma

The modeling chickens are coming home to roost and they are landing on the doorsteps of already beleaguered (and anxious sounding) public health "leaders." The ever-reliable Helen Branswell of Canadian Press (one of the few MSM journalists who gets what this is all about and has the contacts to get the scoop) has been listening to the frets of WHO and CDC bird flu experts. She is hearing folks none too happy with the hype around the computer models published last week in Nature and Science (see our take on the papers here).

The models suggest there is a slim window of possibilities that an emerging pandemic in an area like rural Thailand might be slowed significantly or even halted if there were a massive effort to bring antivirals and possibly a (non-existent) priming vaccine to the area quickly and distributed efficiently; and if the stars are aligned just right (the virus is below a certain level of transmissibility, the antivirals work with a stipulated efficiency, etc.). Few people knowledgeable about the facts on the ground believe it is remotely possible, but now the models have put them in a position where they might have to try:
"This is a public health dilemma," Dr. Margaret Chan, the WHO's new chief of pandemic planning, admitted when the modelling work was published last week in the journals Science and Nature.
The former head of the U.S. Centers for Disease Control's Southeast Asian operations calls the issue "an unavoidable challenge" facing the public health community.

"If there's a pandemic, we will and should be held accountable," says Dr. Scott Dowell, who last month finished a four-year stint as director of the CDC's International Emerging Infections Program. The program is headquartered in Thailand.

"These papers are going to be sitting there saying: 'You were told in 2005 that it was theoretically possible to contain it and what did you do to try? Now that it's devastated the world's population with mortality and economic devastation and so forth - what were you all doing?'
But trying might not be the right thing, possibly even harmful if the attempt produced a mutant virus resistant to oseltamivir, the only available antiviral known effective against H5N1. The drug's maker, Swiss-based Roche Pharmaceuticals, is discussing with WHO a significant donation for a rapid-deployment stockpile. Even if available, however, it will likely not work:
[Public Health Canada's] Dr. Arlene King, head of the respiratory diseases section, shares the view that containment of an emerging pandemic would not be possible at this point.

"Simply because the proposed strategy could work in theory doesn't mean it would work in practice," King says, adding significant investment would be needed to bring systems in many Asian countries to a level where containment might be feasible.
And then there's the politicians, grasping at whatever good news they can find so as not to face the fact it was their negligence that left us unprepared. The Center for Infectious Disease Research and Policy's Dr. Michael Osterholm, expresses it this way:
"What I worry about is because of these models, policy-makers or other world leaders will just say: 'Well, this is all we need to do. . . . We've got it covered. We're just going to stop it in its tracks,' " says [Osterholm], who has been one of the most vocal proponents of pandemic preparedness.

"Far too often models take on a precision which they do not deserve. And for policy makers in particular that precision implies some kind of authority or expertise which is not valid," cautions Osterholm . ..
As they say in Minnesota: "You betcha!"