Wednesday, April 18, 2007

April 17th Flu Update

By far, today's lead story is the the FDA has approved its first bird flu vaccine. Sanofi Aventis is already stockpiling the virus, which will not be available commercially. We all remember this--its the two-shot vaccine that has limited coverage. Virus is not approved for anyone under 18. Note the less than inspiring comments (though perhaps they are honest) below.

The Sanofi vaccine is given in two 90-microgram doses given about a month apart. The two shots contain 12 times the 15-microgram dose contained in regular winter flu shots.

"You'd like to respond to a pandemic quicker than that and ideally you'd like a vaccine where you had one dose and would need less antigen. Those types of vaccines are under study and development," Norman Baylor, director of the FDA's vaccine office, told reporters, adding later: "At this point, this is where we are."

Those other studies are looking at the use of immune boosters, called adjuvants, to try to improve the effectiveness of the H5N1 vaccine. Eventually, adjuvants also might shrink the needed dose for a pandemic vaccine closer to what's now used in seasonal shots.

CIDRAP also has the vaccine story. Note this:

HHS has said it is moving forward with the development of a "clade 2" H5N1 vaccine, based on viruses that circulated in birds in China and Indonesia in 2003-04 and spread to the Middle East, Europe, and Africa in 2005 and 2006

This might be the most significant article of the day. The University of Pittsburgh Medical Center recently did a study (cited here on CIDRAP) that says pandemic planning is failing to hit the grassroots. My opinion is that the grassroots is where the only progress will be made, just as it was in the New Orleans flood. In general, official forces were in the way and everyday people saved lives. (also cites a few other flu blogs).

Here is a link to the report from Pitt.

Here's a National Academies report on the same topic.

Pakistan has budgeted funds for the bird flu fight.

From Britain, evidence that says that the flu might cause heart attacks. Think about that during a pandemic. (Did anyone ever go back and look at heart attack rates during the 1968 pandemic?)


Taiwan wants WHO membership--partly to aid in bird flu fight.

Nigeria continues to deny that there are human cases there currently.

An expert tells Fiji that it is not ready for a pandemic.

3 Comments:

At 7:17 PM, Blogger Wulfgang said...

Orange;

Certainly a lot to comment regarding your articles today. I’ll start with your two standouts articles – the FDA bird flu vaccine story, and of course, the Pitt Medical Center Study. This is going to be a tough discussion, I can tell already.

Regarding your leading story about FDA avian vaccine approval, I believe it can be summed up as “keeping things in the proper perspective”. As a makeshift tiny stopgap kind of measure, this is good news only for a limited few. Mainly the members of the military, first responders and the medical community, and of course the political hacks. It is highly doubtful, almost certain, that neither you, me, or people reading this sentence, will ever see one shot of the precious vaccine. There will only be enough vaccine for 20 million people, but this is a measly 6-7% of the US population. The news is of absolutely no value to our children under eighteen years of age. The vaccine is even only effective protection to roughly 45% of those who are inoculated.

As Revere has pointed out in several of his articles – this is not a breakthrough. This is the Dutch boy sticking his finger in the dike. Granted, adjuvants are our best technology leverage, if they can be fully developed in time, since it will take an estimated five years before cell-based DNA H5N1 vaccines can be developed, manufactured and brought on-line.

Now your most controversial article: the Pitt Medical Center academic study which concludes that pandemic planning is failing to involve grassroots communities, individuals, and other involved parties who are stakeholders. Again, things must be kept in perspective – there are two sides to every story. It’s easy to point fingers, place blame, establish committees, deny responsibility and have a life-long sense of entitlement. This kind of culture, is in my opinion, what we in the US have evolved into.

For example, I absolutely agree with your comments about the New Orleans flood and Katrina, however, one must consider how utterly unprepared the federal government (FEMA), the state of Mississippi, the city of New Orleans, and the citizens themselves were. Many had time to loot, but they couldn’t find time to leave, and they paid the price. Look at the news all over the news channels the last two about Virginia Tech and the shooter and how unprepared everyone was. Further, look at how the inept and incompetent governor of Louisiana, the mayor of New Orleans, the FEMA acted during the Katrina event. Further still, look at the back-peddling at Virgina Tech: the president of the university, the police and the entire college administration deny any responsibility. It’s sad.

I probably agree with every comment and recommendation in the Pitt report, but people cannot be coerced into planning for a pandemic. The state health officials, mayors and governors can and have reached to most communities – but I would submit that 90% of the population of the entire US and Canada, simply can’t be bothered with it. If anything, they treat a pandemic risk, in the same “just in time” approach and light, they do in their daily lives. Probably like you, many readers and myself, mention a pandemic to your friends, relatives, neighbors and co-workers, and you get a blank stare from folks, as they are wondering what religious cult you may have joined. The vast majority of people are far too busy and important, buying Tahoes with the latest nav’ equipment, getting pizza’s home delivered, planning their 2-3 vacations, to be bothered with an intangible threat such as a pandemic.

So there you have it Orange. You can lead the horse to water, but you can’t make the old nag drink. The report allegedly states, “…official planning incorrectly assumes the public will panic and create a secondary disaster”: maybe in the gated communities the esteemed researchers live in, this is true. But in the inner cities of New York, Detroit, Los Angeles, Washington DC, Houston, Birmingham, Atlanta, Baltimore, Philly, and in most other large cities of the US – you can’t walk down the streets safely at night in most areas of town, without getting popped, car-jacked or mugged. The police cannot protect you when the sun goes down in these cities, only a Smith and Wesson equalizer will. I would not typify these actions and behaviors as responsible. If a pandemic were to emerge next month, the situation would not a secondary disaster in these large cities, but a primary one. The researchers got that wrong by a long shot. All the brilliant academic studies and expectations in the world, will not change people’s demonstrated behaviors.

Taiwan doesn’t have a chance in hades of joining the WHO organization with Margaret Chan there. They would have a better shot at joining the NATO alliance.

As far as the scientific study which documents how influenza trigger’s heart attacks – I guess like most people, I can only worry about so many deadly risks at one time. I’ve already given up drinking, smoking, MacDonalds French fries, Denny’s Grand Slam breakfasts, tanning, saturated fats, my motorcycle, and even Viagra (you know, the four hour problem). I just can’t worry any more, because if I do, that will induce stress and cause a stroke.

Last, what to do with this Nigerian Minister of Information… lets nominate him to the Flat Earth Society. Better still, if he conducted his news conferences, unprotected, inside of commercial poultry houses there, I would believe him.

Maybe, but I’ll bet he’d still probably want me to e-mail my bank account number someplace there.

Wulfgang

 
At 8:46 PM, Anonymous mpb said...

Unfortunately, the lack of grassroots participation isn't new and and it has been especially disappointing with regard to H5N1 and pandemic/disaster preparedness.

I started the Grassroots Science on bird flu over a year ago in part because the federal, state, and tribal agencies failed to provide any information locally. The federal 800 number was incorrectly answered; the person at that end knew nothing of public health or living in the area of concern and was unprepared for what kinds of questions would be asked (nothing like emerging diseases to bring out the conspiricists (sp?)).

We still (2007) have preparedness focussed on birds and not people. The agencies with funding refuse to involve those without ("only members can participate"), etc.

By design funding can only go to agencies. (very few foundations will consider individuals or non-agencies or non-governments).

Even free blogging platforms cost-- the money for dial-up internet, rent, electricity, scientific memberships.

What's ridiculous is that genuine public or community-involvement is not "magic", doesn't cost much,
doesn't take a rocket scientist (the best could use a biocultural scientist, however), and really isn't a threat though many governments or agencies feel any thoughtful process or person is to be avoided. (State of Alaska-- "you're too thoughtful"; "it costs to much money"; "they (rural or native communities) wouldn't understand it"

In fact, public involvement saves money, creates better projects, stabilizes healthier communities, protects us all, keeps from re-inventing square wheels, etc.

There is no way that good science or public policy can be done without the other experts, the community, involved on an equal basis.

Public involvement how-to readings - http://13c4.wordpress.com/2007/02/21/public-involvement-how-to/

Biocultural Dimensions of Environment and Health - http://13c4.wordpress.com/2006/01/11/biocultural-dimensions-of-environment-and-health/

Community-involvement is not public relations and NOT stakeholders, either. The State of Alaska, US FWS, USPHS can join the other agencies such as CDC and Dept of Energy (US-Los Alamos National Laboratory), and local colleges in pursuing their version of "stakeholder involvement" and active antagonism and hostility to genuine collaboration (especially with rural or minority communities).

Community involvement also allows communities to say, "No" to those holding the stake.

Ok, I can see that as a big threat to many.

Just remember a basic precept of science-- Just as people must share seal meat and oil to maintain physical and social well-being, so, too, must they share knowledge--so that their minds will not rot.

 
At 9:09 PM, Blogger Orange said...

Mpb--thanks for posting and reading. Your insights are much appreciated.

 

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