Tuesday, August 9

Leveraging WHO's demand for better reporting on H5N1: US actions would speak louder than words

Yesterday I received a letter from Dr. Patricia Doyle* that contains sound recommendations:

"With regard to biopreparedness, I suggest using closed military bases and VA hospitals for use in bioattack or during a pandemic. We may need to use these facilities so they should be prepped. Buildings would have to be revamped; e.g., old ventilation changed into isolation type.

If the recent outbreak of highly infectious lethal disease(s) in China goes global we may need to have isolation treatment centers at these bases and the VA hospitals to ensure containment and to preserve our first responders and hospital personnel.

Some of the recent reports out of China indicate [swine 'mystery' disease] spreading in hospitals to personnel and other patients. The ideal is not to treat patients with highly infectious disease in the same hospital as the routine patients.

You can be assured that I am hoping Henry Niman and I are wrong [about the current threat from disease outbreaks in China]. I would much prefer "egg" on my face to an outbreak. Any day.
Patricia in New York"

Pundita heartily concurs with the advice but doubts Patricia will ever find egg on her face. China's latest mystery disease aside, humanity is now in a very dicey situation with regard to the spread of H5N1. During this critical period it is wrong to hope that a vaccine is all that's needed to dodge a superpandemic -- one brought on by a supervirus of mutated H5N1/human flu virus. This point is implicit in the caveat attached to the successful H5N1 vaccine trial:
...the strongest response [from the test subjects] was with two shots of the largest dose of the vaccine, 90 micrograms, higher than many experts had expected. That means that the amount the government has bought from Sanofi-Pasteur...would [only] suffice for 450,000 people...The [US] government is seeking...enough additional vaccine to inoculate another 4.5 million people.(1)
You may trust that if a pandemic is quicker on the draw than manufacturing capacity, there will be a clamor from the citizenry -- here and in other countries -- to cut the high required dosage so that more people can have at least 'some' protection.

If governments cede to the demand you don't want to think about what's in store. Ditto if governments refuse to cede; we'll be seeing watered down knockoffs of the vaccine sold on black markets.

And there could be only the smallest window of opportunity to stop a superpandemic.(2) So it's hard to go overboard with biopreparedness. If the superpandemic doesn't materialize we can chalk up the time and money spent to vital practice at quick coordinated civilian response to any kind of disaster. Sooner or later, practice at such response will be the deciding factor in how well a society survives a disaster, whether it's made by nature or humans.

Pundita was reminded of this while reading a July 27 essay by Joe Katzman at Winds of Change titled Playing Chicken with Avian Flu: Pandemic Rising?(3) The essay is stuffed with practical advice about biopreparedness, right down to the level of individual families. Katzman notes:
...begin building little islands of understanding and capability...Plan less. Experience and communicate more. Become a pack in motion, not a herd in wait.
In addition to the obvious reasons for such advice, American action to get prepared for a biodisaster is the best way to convince developing world governments of the need to expend more effort on dealing with killer viruses.

I observed in yesterday's essay that India and other countries have covered up deaths from H5N1 in their countries. It might be more precise to observe that they've covered up their lousy data collection and analysis relating to deaths from highly infectious diseases.

Given the H5N1 antibodies found in poultry workers and the lethality of the disease, it's a statistical certainty that a number of deaths in India (and other Asian countries) since 2003 have been from H5N1 but were reported only as influenza. Better analysis would have pinpointed spikes and anomalies in reported flu deaths and symptoms during the years 2003-2004. Yet developing-world governments view big spending on such programs as a luxury, in the same manner they view stringent anti-pollution measures as a luxury that only rich nations can afford.

The task is to convince such governments that they can't afford not to throw adequate resources toward warding off an epidemic in their country. They need to be very clear on the fact that if a superpandemic materializes they can't assume the rich nations will be in a position to bail out the poorer ones. This point is hard to impress on many governments, as the World Health Organization and the Centers for Disease Control learned the hard way in 2003.

The governments nod and say "Yes of course we understand."

As soon as there is a lull in a disease outbreak they return "Analysis of disease reports" to the bottom of the budget list. That's understandable; humans are by nature gamblers. However, those who have closely followed the career of H5N1 know that now is the time to sit on the gambling urge.

Americans can help get this point across while helping themselves. We should realize that no matter how much crabbing is done around the world about the USA, we are still looked upon as the leader by virtue of our great success as a nation. So, how Americans act has more weight than all the official speeches combined. You can shout about H5N1 data all you want; it's actions that count to convince that you're seriously concerned about the data.

This point also holds true when poorer nations hear they're supposed to work themselves into a lather about biopreparedness. If they see Americans busy at the task, it will sink in that we're not blowing hot air.

There is another reason Americans might want to get on a biopreparedness kick at this time: it is the best way to convince Beijing that a US demand for transparency about H5N1 cases in China is not a plot to overthrow China's Communist Party. The CCP's concern about US plotting is now well within the paranoid range.(4)

* For information on Patricia Doyle see Saturday's Pundita post.

1) The New York Times

2) FuturePundit: Prompt response might stop avian flu pandemic

3) Winds of Change: Playing Chicken with Avian Flu: Pandemic Rising?

4) Pundita: Strange Days in China...

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