Thursday, October 06, 2005

Avian Flu

I have kept an eye on Avian Flu news and so read with interest an article in today's Wall Street Journal. The online link is for subscribers only so I will excerpt the article I read in the dead tree version. There was some good and some bad news in the article, so good news first:

1. The Administration appears to be serious and realistic about the threat and where current response readiness is at in the states.

In an interview, HHS Secretary Michael Leavitt said an administration plan to be put forth in coming weeks is designed to ensure a far more robust domestic vaccine industry, with expanded US manufacturing capacity.

2. The US now has capacity to manufacture Tamiflu start to finish on US soil.

Roche doubled manufacturing capacity of Tamiflu in 2004 and again in 2005 and said it will further increase manufacturing capacity in 2006. "We're bringing manufacturing capacity to the US for the first time at a number of facilities," said spokesman Terence Hurley. "we'll now have the capacity to produce Tamiflu from start to finish for the on US soil this quarter. That's important if borders are closed; HHS asked us to do this."

3. Planning includes more than just federal response but state response as well. Given what we saw in Hurricane's Katrina and Rita, state planning is essential. It is at the state level that citizens are most protected. Feds can help with money and inter-state coordination but if state governments fall down on the job, the results are poor indeed.
An important part of the goverment's plan, Mr Leavitt said yesterday, is to clearly delineate the roles of federal, state and local officials in the event of a pandemic crisis- a souce of much contention in the response to Hurricane Katrina.

4. Research seems to show that the 1918 flu pandemic was a type of avian flu.
...a group of scientists yesterday said they had shown that the 1918 Spanish flu epidemic blamed for 50 million deaths had started among birds and then mutated and spread to humans.
Researchers said the discovery...could help researchers track and perhaps contain a major outbreak. "We have been able to unmask the 1918 virus and it is revealing to us some secrets that will help us prepare for a pandemic," said Julie Gerberding, director of the Center for Disease Control and Prevention.

Ok bad news.

1. Tamiflu is in high demand and short supply. Plus, there have been concerns about it's efficacy in connection to avian flu.

There has been some controversy around Tamiflu, and Mr Leavitt, a former three term governor of Utah and ex-head of the EPA, said he considered purchasing the drug to be akin to an automotive seat belt.
"It doesn't eliminate wrecks but helps you survive when they occur," Mr Leavitt said. He said he was aware about recent scientific reports suggesting that Tamiflu might be only modestly effective agaist the H5N1 virus.

2. State response while vital is not up to par. The article quotes Trust for America's Health concluding only 6 states are adequately prepared to distribute vaccines in an emergency, 2/3 of states can't electronicly track diseases and 60% of states don't have scientists needed to test for plague or anthrax. A document by the GAO says:
Federal and state influenza pandemic plans are in various stages of completionsand do not completely or consistently address key issues surrounding the purchase, distributionand administration of vaccines and antiviral drugs. HHS is working on a national plan, 10 states either have developed or are developing plans using general guidance from the CDC, and 19 more states have plans under developement
29 states out of 50 is not a good number to me. Here in Washington the plan is to isolate and "ring" geographically any identified cases with antivirals and vaccines, to stop spread as effectively as they can. They have also been working with British Columbia health officals in resolving any border issues that may arise. While I have concern for US citizens I think that if a pandemic occurs it will be much harsher in Canada, if thier SARS experience was any indicator.

Update: More thoughts at TCS. Offered at Basil's.

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