Thursday, November 16, 2006

What we Don't Know About Flu; What that tells us about K4D,

Read "Next Flu Pandemic: What to Do Until the Vaccine Arrives?" by Stephen S. Morse, Richard L. Garwin and Paula J. Olsiewski in Science (Science 10 November 2006: Vol. 314. no. 5801, p. 929). Subscription required.

A flu pandemic is overdue, and almost surely will arrive in the not too distant future. It will take six months (at best) to develop adequate supplies of a useful vaccine once the pandemic strain announces itself. Until the vaccine arrives, other public health approaches will be needed to contain the epidemic. According to this article:
our main defenses will be nonpharmacological interventions, such as hand washing, "respiratory etiquette," face masks, school closure, and social distancing or isolation (6, 7). These are ironically similar to the measures used in 1918 to combat the greatest of all known influenza pandemics (8, 9).

Recent attempts to identify the most effective nonpharmacological interventions have revealed that these measures have a thin science base (6, 7, 10-13). For example, it is uncertain whether influenza transmission from person to person is primarily by large droplets or by fine particles. Although this may seem a specialist issue, it has a direct bearing on how far apart people should position themselves to prevent infection and on whether relatively inexpensive face masks might be useful. Recent results in the guinea pig (14) indicated that transmission of influenza could occur even when cages were kept ~3 feet apart, which contradicts conventional wisdom. The results should be confirmed in other models.
The article concludes:
The Centers for Disease Control and Prevention (CDC) recently awarded grants to study nonpharmacological interventions in community settings. Although a commendable start, the CDC program so far represents $5.2 million in a total proposed pandemic influenza budget of $7.1 billion. The National Institute of Allergy and Infectious Diseases (NIAID) may also include related areas in their funding. We should systematically address knowledge gaps now during upcoming flu seasons, rather than wait to empirically test measures ad hoc when the next pandemic is upon us.
Comment: I simply want to point out that nonpharmacological techniques for public health interventions to limit flu epidemics (which happen every year and kill huge numbers of people) and pandemics (which happen every couple of decades and kill even larger numbers of people) are "public goods". The people who do the research and development of such techniques cannot find a way to appropriate part of the benefits to the public resulting from their work via sales of goods or services. We depend on foundations or governments to fund such research and development, but it is not sexy and does not get the attention it deserves. So billions are spent to develop pharmacological techniques and little for what might be very effective nonpharmacological techniques. The success in finding cost-effective techniques in other public health cases -- oral re-hydration therapy, bed nets against malaria bearing mosquitoes, communications to promote safe sexual behaviors, to name a few -- suggests that such research can be very helpful, not to mention cost effective!

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