Monday, August 01, 2005

A Bird Flu Commission?

Once there was a time when a major article on bird flu in the US MSM was newsworthy. No longer. They now appear with some regularity and say pretty much the same thing: big problem, we're not ready. But the latest, from WaPo, has something worth emphasizing: if this pandemic, foreseen for a year if not several years, materializes as some of the most knowledgeable public health scientists think it might, there will likely be much after-the-fact finger pointing. As well there might be. Here's Michael Osterholm on the subject:
The most outspoken is Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. In writing and in speeches, Osterholm reminds his audience that after public calamities, the United States usually convenes blue-ribbon commissions to pass judgment. There will be one after a flu pandemic, he believes.

"Right now, the conclusions of that commission would be harsh and sad," he said.
Hey, you're not just whistlin' Dixie, as they used to say (although this seems to be the only tune the Administration knows). So let's do a little before-the-fact finger pointing. The failure to get the US (and many other countries) ready for the bird flu freight train coming down the tracks would be scandalous, if scandalous were a word able to do justice to the magnitude of the negligence. The CDC, our frontline agency against infectious diseases, has been wrecked beyond repair by its Director, Dr. Julie Gerberding. The flu branch has lost some of its best scientists and is in disarray. Senior staff all through the agency are rushing to the exits. And there is silence on the threat from the one agency that could get state and local health departments to sit up and take notice.

Of course if you listen to the Administration, they have been very busy getting ready:
"The secretary or the chief of staff -- we have a discussion about flu almost every day," said Bruce Gellin, head of HHS's National Vaccine Program Office. This week, a committee is scheduled to deliver to HHS Secretary Mike Leavitt an updated plan for confronting a pandemic.

Despite these efforts, the world's lack of readiness to meet the threat is huge, experts say.
Yeah, right. All talk and no action. These guys are really a treat.
"The only reason nobody's concerned the emperor has no clothes is that he hasn't shown up yet," Harvey V. Fineberg, president of the National Academy of Sciences' Institute of Medicine, said recently of the world's efforts to prepare for pandemic flu. "When he appears, people will see he's naked."
Experts understand that if this pandemic is coming and it will come independently of anything we do to stop it. Mandatory school and business closings, quarantines, restriction of international and domestic travel, surgical masks, none of these will work to stop a pandemic once underway. And once underway, the consequences will extend far beyond the hospital, sick room or clinic:
[Osterholm] predicts that a pandemic would cause widespread shutdowns of factories, transportation and other essential industries. To prepare, he says, authorities should identify and stockpile a list of perhaps 100 crucial products and resources that are essential to keep society functioning until the pandemic recedes and the survivors go back to work.
The public thinks that 21st century medicine will find a solution. They think there can be repeat of 1918 in this day and age. But in fact if H5N1 gets loose we don't have a vaccine, and while some are under development there is no guarantee they will work and essentially none that they will be available in time to do anything about the global toll except around the margins.
Tests are underway at three U.S. hospitals on an experimental vaccine against H5N1. But it is not the first H5N1 vaccine.
When a slightly different strain of the virus surfaced in Hong Kong in 1997, killing thousands of chickens and a half-dozen people, researchers used viruses from birds and people to make experimental vaccines. But neither offered much protection in lab tests, and nobody knows why.

Instead of working on the problem, researchers dropped it. First SARS (severe acute respiratory syndrome), and then a different avian flu strain that arose in Europe (H7N7), took their attention.

"The urgency around this issue kind of dissipated," said John Treanor, a physician at the University of Rochester and one of the leaders of the vaccine project. "I think it's an example of how unpredictable things are. We got distracted."
This is a massive failure of leadership. The attention of scientists is focused by the availability of resources and it is the federal government that makes those resources available through the NIH. It is the role of leaders to keep their eye on the prize and they didn't do this and still aren't. Moreover CDC is providing almost no leadership, Administration leaders like Mike Leavitt, Secretary of DHHS, talks but does nothing, the academic establishment (with some exceptions, notably Osterholm) have not shown leadership, and the Institute of Medicine has been inconsistent in its efforts.

So where does that leave us? Here: let's stop worrying about stopping this pandemic and instead get busy immediately in preparing for managing the consequences. Those consequences will extend to all sectors of society and most have not been even imagined, much less planned for, because people haven't turned their attention to it. But they could, and they could do it in advance. Even a small amount of advance thinking in a police or fire department or water treatment plant could save precious time in a crisis.

What kind of questions should be asked? What if if 30% of our workkforce were out? How would we carry on? Are there some people whose jobs are specialized and if they were out there would be a serious problem? If so, who might be called to fill in for them and where would they get the necessary operational informational material to function? Retired employees who know the ropes? Where are they and how do we contact them? dYou get the idea. It's not hard. In fact it's just common sense (which admittedly isn't that common).

This process is starting over at the Flu Wiki and all are invited over to contribute. If you run a gas station, for example, think about what would happen if your supplies were delayed by a week because of absenteeism problems in the supply chain. Similarly for pharmacists. If you are the only pharmacy within 100 miles in a rural area, what happens if your deliveries don't come on time? Once you ask questions like these, you can start to think about reasonable workarounds. But it is much harder in an actual crisis. So let's get started.

When the finger-pointing starts, I don't want the fingers pointing at me.