Readying the Global Flu Shot

Pandemic Preparedness Represents Federal Dollars Well Spent

SOURCE: AP/Dita Alangkara While pandemic flu is off the media radar, public health officials are busy tracking what they call the number one infectious threat in the world—and are preparing for the worst-case scenario.

The media have moved on from the avian influenza scare. Editors got bored when, after bird flu first jumped to humans a few years ago, a feared global pandemic did not swallow humanity. But the risk has not diminished. Indeed, scientists agree that it is inevitable that the avian influenza virus will at some point gain the lucky mutation or two that will allow it to spread not just from chickens to people but also quickly and easily from person to person. Such a strain could quickly kill two million Americans and incapacitate tens of millions more, according to government estimates. The global toll would be orders of magnitude higher, wreaking economic and social havoc and perhaps political instability.

A meeting in Washington last week sponsored by the Infectious Diseases Society of America offered a sobering update of what the disease is up to and the level of preparedness here at home and around the world. The facts are scary. But a lot more is known today than in 1918-1919, when the last massive flu pandemic swept around the globe, sickening one-third of all humanity and killing 50 to 100 million people. And it is inspiring to see how much scientific and logistical work is underway to help humanity survive the next pandemic relatively intact.

To speak of humanity being at risk may sound overly dire considering that the so-called H5N1 avian flu is still almost entirely a disease of birds. But the virulent virus is clearly developing an appetite for people. Since 2003, there have been 404 confirmed human cases of avian flu in 15 countries, most of them in Indonesia, Vietnam, and Egypt but with a recent serious uptick in China, which has reported seven cases and four deaths already this year.

Any single case could become the epicenter of a global epidemic in the event of a lucky mutation. And trust me, you don’t want to get infected with this bug. Two out of three people who fall ill from it die. “The potential to kill so many so quickly makes this the number one infectious threat” worldwide, said Keiji Fukuda, coordinator of the World Health Organization’s Global Influenza Program.

The good news is that the global stockpile of antiviral medicines, which will hopefully be at least somewhat effective against pandemic flu, is growing every year. Also growing is the world’s capacity to produce and stockpile large amounts of vaccine, including the 150 million doses that WHO is committed to distributing to low- and middle-income countries if needed.

But let’s not lose perspective on what this “good news” means. We’re talking here about a goal of being able to vaccinate perhaps two percent of the population of these countries—mostly healthcare workers and essential emergency and government personnel. And that is assuming that global distribution goes well. WHO is still considering which countries should serve as storage and distribution hubs, with one consideration being the likelihood that a given government might just grab what’s there for itself in a pinch. “It’s obviously a very political” issue, said Douglas Holtzman of the Bill and Melinda Gates Foundation, which is bankrolling a lot of the nuts–and-bolts planning for a global pandemic response.

Speaking of every man for himself, how are we doing in this country? Until recently Congress has generally been good about keeping the money flowing for federal pandemic preparedness. The nation is on track to accumulate enough vaccine to inoculate every American within 6 months of the first signs of an outbreak, for example. Shortsightedly, however, Senate negotiators last week agreed to remove a crucial $870 million allocation for further preparations to be coordinated by the Biomedical Advanced Research and Development Authority. (A look at what BARDA is up to says a lot about the government’s entirely appropriate worries in anticipation of flu-based “mass casualties.” In addition to speeding the commercialization of emergency medicines and vaccines, for example, there is an effort to mass-produce ventilators for rapid deployment to the countless Americans who would die from pandemic flu without respiratory assistance.) That money needs to be reinserted in conference with the House.

Equally worrisome, pandemic preparedness funding for states and localities—those crucial first responders—has been cut by 25 percent since 2005. It’s crucial that this funding be restored in the 2010 budget, said Jeffrey Levi, a public health policy specialist at George Washington University and executive director of Trust for America’s Health. Levi also worries about the longstanding expectation that private companies will purchase drug stockpiles for their employees. “In a recession this is the first thing to go,” Levi said.

In general, the U.S. preparedness plan needs a thorough freshening up to reflect current scientific and political realities and to highlight unmet priorities. Among them: Hospitals still have virtually no “surge capacity”—the ability to absorb added patients in the event of a pandemic. And only a few states (notably New York and California) have done the tough work of mapping out pandemic rules for hospitals and healthcare workers. Those rules reflect the cold realities of a pandemic, including orders to take older patients off their life-saving ventilators if younger flu victims show up and are deemed to have better odds of long-term survival with the help of that equipment.

Vaccine and drug makers are cranking hard, and should be applauded for their commitments to help prepare the nation for a pandemic. But check out what is behind them: Big federal grants for research and development, and government commitments to pay for about half the cost of new production facilities, which the companies can use to make other profitable pharmaceuticals during non-emergency years.

In short, no entity other than the federal government is going to make sure we are prepared for a pandemic (or bioterror or dirty bomb attacks, requiring similar preparations). There is no better example of your tax dollars at work. So if the sheer embarrassment of recent nomination withdrawals isn’t incentive enough, think about all that is being done on your behalf as you consider cutting corners on your Form 1040 this year.

Rick Weiss is a Senior Fellow at the Center for American Progress and Science Progress.

Tags: biosecurity, public health

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