More to worry about--the Avian Flu

People over a certain age remember the Great Swine Flu scare of 1976. On Februray 5th of that year, an Army recruit at Fort Dix, New Jersey said he felt tired and week. The next day he was dead. The public health officials of the time saw good evidence that the disease that killed the recruit was closely related to the "Spanish" flu that killed up to 100 million people worldwide in 1918-1919.

The disconnect between the public health concerns about a new pandemic and the media's response is alarming.

If the scientific complications of the National Influenza Immunization Program (NIIP) were not enough, the media only helped to make the situation worse. First of all, while the program received broad support at its inception, the press was quick to criticize the program once no new incidents of swine flu appeared in the months after the Fort Dix affair, and emphasized the criticisms of people such as Albert Sabin, known for his polio vaccinations, who originally supported the project, but later pushed for a stockpiling of the vaccination. The press did more than just discourage the immunization plan, for they also helped to push the program forward. In August, when the NIIP appeared likely to never get off the ground, an outbreak of a particularly lethal strain of pneumonia occurred at the Pennsylvania State Convention of the American Legion, killing 29 of 182 cases. While it was later discovered that the disease, called Legionnaire's Disease, was caused by a relatively unknown bacteria, and was in no way connected to swine flu, the press had already played its part. Immediately, despite no evidence to support the claim, the connection was made in the media between the Legionnaires' Disease and swine flu. This was enough public agitation to push necessary legislation through congress, allowing the NIIP to go forward. While the press had helped to save the immunization program, it had done so using extravagant claims, and it might have proved useful if the NIIP had not survived at all. Another example of sensationalism in the media occurred when a few days after the beginning of the immunization program three elderly people died at a vaccination station. Once again, while there was no evidence that the deaths were related to the vaccine, the press quickly exaggerated the story, creating an imagined "body-count" of vaccine victims. The hysteria that followed caused nine states to close down their immunization programs until the CDC announced decisively that the deaths were in no way connected to the vaccination. Judging from these incidents, it is not surprising that the press acted little differently when the actual connection between GBS and the vaccine was discovered. While the press can be slighted for its sensationalist portrayals of the immunization program, the leaders of the program should also be held responsible, for not creating a better relationship with the media, and not using this source as a way to educate the public about the program and influenza.

So why is this important to me now? Because we are looking at another possible influenza pandemic and the authorities seem as clueless as ever:

You think Katrina was bad, imagine a bird flu pandemic which will spread from country to country. The UN and WHO will be in the position of the federal government!

You think the Katrina situation was confused, imagine what an avian flu pandemic would be like: poor countries trying to cover-up cases while the outbreak becomes increasingly widespread while the UN/WHO stands by impotently.

A top H5N1 researcher Yi Guan agrees with me

He urged the World Health Organization and Food and Agriculture Organization to take a more direct role to avert the looming pandemic, which he believes will happen if aggressive action is not taken

"The WHO and FAO must set up a joint expert team. They must get into the (affected) countries and compel them to make changes, take drastic action. The U.N. must say that if you don't follow suit, you will be punished," said the scientist.

A plan that included close surveillance, rapid quarantine, stockpiles of antiviral drugs (and hopefully a vaccine) might be enough to halt spread of the virus andprevent a pandemic, but right now it seems unlikely that will happen. The idea of UN punishment as a stick is, unfortunately, almost laughable.

I'd be a lot happier if Congress and the media would focus on what to do about the next predictable crises, not on what went wrong in Katrina. 1,000 dead seems to be the upper limit on the number who died in Katrina. The number who'd die in an epidemic could be 4 or 5 orders of magnitude large.

So my disaster planning needs to include disruption of services due to quarantines.