The Avian Flu Quandry

I may not have been sufficiently specific in my last posting.

An epidemic of avian flu is sweeping Asia. Billions of dollars of costs already have been incurred to destroy poultry that might be infected. Hundreds of human cases have been reported, and many of those people have died. We know that the 1918 flu, which has been estimated to have killed some 50 million people, made the leap from animals to man relatively quickly. Many of the genetic changes that would be required for the current bird flu to do so also have already been reported. Stocks of antiviral medicines that might be used to prevent or delay a pandemic are low, the drugs are expensive, and it would take time and money to increase the supply given their manufacturing difficulty. A vaccine similar in properties to the one likely to be needed has been developed, a very good sign, but there is real fear that not enough vaccine can be produced in time to prevent an epidemic from turning into a pandemic. Moreover, it seems likely that the few countries with industries able to produce quantities of such a vaccine are likely to commandeer all that becomes available to protect their own populations, rather than prevent a world pandemic.

The last time such a threat was perceived was in 1976. It seems that the U.S. government, under the administration of many of the same people in the current administration, responded poorly. The government acted promptly to the swine flu threat, but failed to modify its actions as it later developed that the strain of flu was not as virulent as had been feared, and the swine flu was not becoming epidemic in the United States nor abroad, In 1976, tens of millions of people were immunized, hundreds of negative reacions to the vaccine developed, and ultimately the process cost the government US$400 milion, in the strong dollars of the late 1970's.

We are walking the tightrope again. How much preparation is enough? How much would be too much?

The key officials in charge in the Department of Health and Human Service's flu effort appear to be a lawyer who became Assistant Secretary as an political associate of the former Secretary of HHS, and an educator whose term in HHS's international office has been very controversial and who is a godson of former president Bush. I would like to see experts in international communicable disease control in their places.

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