The Coming Influenza Pandemic?

November 15 Flu Update--China confirms its first human case, and says it will vaccinate 14B poultry,

Here is the executive summary:

To combat a possible avian flu pandemic, we should consider the following:

1. The single most important thing we can do for a pandemic—whether avian flu or not—is to have well-prepared local health care systems. We should prepare for pandemics in ways that are politically sustainable and remain useful even if an avian flu pandemic does not occur.

2. Prepare social norms and emergency procedures which would limit or delay the spread of a pandemic. Regular hand washing, and other beneficial public customs, may save more lives than a Tamiflu stockpile.

3. Decentralize our supplies of anti-virals and treat timely distribution as more important than simply creating a stockpile.

4. Institute prizes for effective vaccines and relax liability laws for vaccine makers. Our government has been discouraging what it should be encouraging.

5. Respect intellectual property by buying the relevant drugs and vaccines at fair prices. Confiscating property rights would reduce the incentive for innovation the next time around.

6. Make economic preparations to ensure the continuity of food and power supplies. The relevant “choke points” may include the check clearing system and the use of mass transit to deliver food supply workers to their jobs.

7. Realize that the federal government will be largely powerless in the worst stages of a pandemic and make appropriate local plans.

8. Encourage the formation of prediction markets in an avian flu pandemic. This will give us a better idea of the probability of widespread human-to-human transmission.

9. Provide incentives for Asian countries to improve their surveillance. Tie foreign aid to the receipt of useful information about the progress of avian flu.

10. Reform the World Health Organization and give it greater autonomy from its government funders.

We should not do the following:

1. Tamiflu and vaccine stockpiling have their roles but they should not form the centerpiece of a plan. In addition to the medical limitations of these investments, institutional factors will restrict our ability to allocate these supplies promptly to their proper uses.

2. We should not rely on quarantines and mass isolations. Both tend to be counterproductive and could spread rather than limit a pandemic.

3. We should not expect the Army or Armed Forces to be part of a useful response plan.

4. We should not expect to choke off a pandemic in its country of origin. Once a pandemic has started abroad, we should shut schools and many public places immediately.

5. We should not obsess over avian flu at the expense of other medical issues. The next pandemic or public health crisis could come from any number of sources. By focusing on local preparedness and decentralized responses, this plan is robust to surprise and will also prove useful for responding to terrorism or natural catastrophes.

But there are several reasons why it is impractical for individuals to stock up on flu drugs. First, we don't yet know what an adequate dose is. While 10 pills of Tamiflu -- two pills a day for five days -- is typically enough to battle regular flu, rodent studies suggest we might need more than that to battle H5N1. In August, the Journal of Infectious Diseases reported that the standard five-day dose protected only 50 percent of mice infected with H5N1. Eight days of treatment boosted survival to 80 percent.

In addition, the flu drugs protect you only as long as you are taking them. If you are the only one in your neighborhood taking Tamiflu during an outbreak, it isn't going to do you much good because you will be as vulnerable as everyone else the moment you stop taking the drug.

"You can't keep on using Tamiflu forever," says Suresh Mittal, a virology professor at Purdue University in West Lafayette, Ind. "It's not a vaccine. As soon as someone stops the drug, they are equally capable of getting the infection."

posted by Orange @ 4:38 PM