World Not Set To Deal With Flu
Strategy for Pandemic Needed, Experts Say

By David Brown
Washington Post Staff Writer
Sunday, July 31, 2005; A01

Public health officials preparing to battle what they view as an inevitable influenza pandemic say the world lacks the medical weapons to fight the disease effectively, and will not have them anytime soon.

Public health specialists and manufacturers are working frantically to develop vaccines, drugs, strategies for quarantining and treating the ill, and plans for international cooperation, but these efforts will take years. Meanwhile, the most dangerous strain of influenza to appear in decades — the H5N1 “bird flu” in Asia — is showing up in new populations of birds, and occasionally people, almost by the month, global health officials say.

If the virus were to start spreading in the next year, the world would have only a relative handful of doses of an experimental vaccine to defend against a disease that, history shows, could potentially kill millions. If the vaccine proved effective and every flu vaccine factory in the world started making it, the first doses would not be ready for four months. By then, the pathogen would probably be on every continent.

Theoretically, antiviral drugs could slow an outbreak and buy time. The problem is only one licensed drug, oseltamivir, appears to work against bird flu. At the moment, there is not enough stockpiled for widespread use. Nor is there a plan to deploy the small amount that exists in ways that would have the best chance of slowing the disease.

The public, conditioned to believe in the power of modern medicine, has heard little of how poorly prepared the world is to confront a flu pandemic, which is an epidemic that strikes several continents simultaneously and infects a substantial portion of the population.

Since the current wave of avian flu began sweeping through poultry in Southeast Asia more than 18 months ago, international and U.S. health authorities have been warning of the danger and trying to mobilize. Research on vaccines has accelerated, efforts to build up drug supplies are underway, and discussions take place regularly on developing a coordinated global response.

The U.S. Department of Health and Human Services will spend $419 million in pandemic planning this year. The National Institutes of Health’s influenza research budget has quintupled in the past five years.

“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.

“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.”

Other scientists are sounding the alarm as well.

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.

In hopes of slowing a pandemic’s spread, public health specialists have been debating proposals for unprecedented countermeasures. These could include vaccinating only children, who are statistically most likely to spread the contagion; mandatory closing of schools or office buildings; and imposing “snow day” quarantines on infected families — prohibiting them from leaving their homes.

Other measures would go well beyond the conventional boundaries of public health: restricting international travel, shutting down transit systems or nationalizing supplies of critical medical equipment, such as surgical masks.

But Osterholm argues that such measures would fall far short. He 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.

At last, front page Sunday treatment of this story. Of course, if you’ve been reading Just a Bump in the Beltway for a while this is not news to you.

Charles Roten put up a list of resources if you want further information back in June. And, of course, there is The Flu Wiki, which has now become the gathering place in English for all things flu. If you read nothing else, study CanadaSue’s imagined scenario for her hometown, Kingston, Ontario.

The Post article, while lengthy, doesn’t spend any time on 1. why this is important; 2. the potential sequalae of such a pandemic; 3. the miserable failure of the government to do any planning. Mike Osterholm is hardly the only scientist who has been screaming bloody murder about H5N1 for some time. That said, I heard NIAID’s Tony Fauci on Diane Rehm’s NPR show last week, and half of what he said was talking out of his ass (or covering it.) If I know that, and I’m no scientist, what else are we missing? It will show up on The Flu Wiki, for sure.