Tuesday, November 08, 2005

Bird flu's Flying Dutchman policy

When Helen Branswell writes about flu I always read it. And it is almost always newsworthy. Consider her latest piece on the qualms of flu specialists about the sudden media attention being accorded avian influenza (or, as the media refer to it, "killer flu" or "the deadly H5N1 strain"). After literally years of too little attention, the new fear is too much attention. Concerns range from the anxiety that the failure to have a deadly pandemic will lead the public to view all public health pronouncements as ""crying wolf," to predictions it will induce fear fatigue or will take attention away from other important public health problems.
"I think we might be in some trouble already. I'm not sure it (the coverage) is having the impact that I'd like in terms of pressuring people to keep planning. I think it might have gone over the top," says [Dr. Allison] McGeer, one of Canada's leading infectious disease experts and a long-time proponent of pandemic preparedness.

"It is, I think, inducing a split between the communicable disease people and the non-communicable disease people," she adds, referring to medical and public health professionals.
Branswell's piece is beautifully constructed, drawing out both sides and clearly presenting the dilemma of having to prepare far in advance for an event which will happen at an uncertain time with uncertain severity. It puts its finger on the nervousness in the professional community about an attention long desired but now out of control and threatening unintended consequences.

This could have been avoided if there had been real public health leadership. Years ago they should have signaled the state and local authorities that preparing for epidemic infectious disease was a national priority and worked with them to get ready at the community level. If quiet preparations had been done in this way we wouldn't have the panicked reaction we have now, but something more like the anticipation of a worse than usual influenza season. But public health leaders in the US and elsewhere were no different than the general public in waking up late to the pandemic threat because they were being led around by the nose by political leaders who marched them in lockstep to the political "message" of the day (terrorism). There were plenty of dedicated professionals at CDC who understood the situation but had no support at the top levels of the agency, or above the agency in the Bush Administration. The Bushies didn't want to hear anything except what would support their policies. Bird flu wasn't on the agenda. And their disdain for objective scientific advice is now too well known to bother discussing further.

So the reason the bird flu message is now bouncing uncontrolled from pillar to post is lack of coherent leadership. And it's too late for that leadership at the national level now. It will have to emerge at the local level, as each community begins to grapple with getting ready for an event that might or might not happen. Some communities will see that leadership emerge and fare better than others. Many will just drift with the national ship, rudderless and headed no where in particular.