Hopefully there'll be more health issues on the front page and in the diaries - a neglected policy discussion, and a potent political issue from stem cells to flu shots.
Pandemic - what's that mean? And what's that got to do with politics? Well, some definitions and references from the CDC:
An influenza pandemic is a global outbreak of influenza and occurs when a new influenza A virus emerges among people, spreads, and causes disease worldwide. Past influenza pandemics have led to high levels of illness, death, social disruption and economic loss.
There were three pandemics in the 20th century. All of them spread worldwide within 1 year of being detected. They are:
- 1918-19, "Spanish flu," [A (H1N1)], caused the highest number of known flu deaths: more than 500,000 people died in the United States, and 20 million to 50 million people may have died worldwide. Many people died within the first few days after infection and others died of complications soon after. Nearly half of those who died were young, healthy adults.
- 1957-58, "Asian flu," [A (H2N2)], caused about 70,000 deaths in the United States. First identified in China in late February 1957, the Asian flu spread to the United States by June 1957.
- 1968-69, "Hong Kong flu," [A (H3N2)], caused approximately 34,000 deaths in the United States. This virus was first detected in Hong Kong in early 1968 and spread to the United States later that year. Type A (H3N2) viruses still circulate today.
Both the 1957-58 and 1968-69 pandemic viruses were a result of the
reassortment of a human virus with an avian influenza virus. The origin of the 1918 pandemic virus is not clear.
Once a new pandemic influenza virus emerges and spreads, it typically becomes established among people and circulates for many years. The U.S. Centers for Disease Control and Prevention and the World Health Organization conduct extensive surveillance programs to monitor the occurrence of influenza activity worldwide, including the emergence of potential pandemic strains of influenza virus.
See also:
Draft HHS Pandemic Influenza Response and Preparedness Plan
The H and N refer to different components of the viral surface. The numbers refer to different antigenic subtypes of influenza A. Influenza B does not have subtypes. Want details? Find it here and here from the CDC. Melanie notes that this year's Asian bird flu may be the precursor of such a pandemic. This nasty bug would need to mutate to a form that humans could catch (often swine are the vehicle for that by harboring a human and non-human virus simultaneously). OTOH, which year a major reshuffling of viral genome will take place is highly unpredictible. All the experts can say is 'we're due'.
But are we prepared? Ah, that's where the politics comes in.
The CDC, as noted in the links, has developed plans for approaching a pandemic; they've been anticipating this for some time. The approach is a sensible
combination of surveillance; communication with health officials, hospitals and MDs; vaccination; anti-viral medications; steps to limit transmission.
The problem, of course, is vaccine availability. The draft document assumes it'll be available.
Vaccine supply during a pandemic
Initially, when a pandemic influenza strain first infects people in the U.S., there will likely be no or very limited amounts of vaccine available. This period could last for up to six months depending on when the pandemic strain is detected and how rapidly it spreads to the U.S. and on how rapidly vaccine development and production proceed. Previous 20th century pandemics began in the U.S. within weeks of the initial disease outbreak and/or virus identification. In the absence of vaccine, primary response strategies include interventions to slow the spread of infection, antiviral therapy and prophylaxis, and quality medical care. After vaccine becomes available, for some period, vaccine availability will be far less than national demand, requiring prioritized usage of vaccine to optimally decrease morbidity and mortality. As vaccine production increases and with some of the population already having been vaccinated in the initial targeted program, supply will become adequate to meet demand. This may lead to changes in strategies for vaccine distribution and administration because there may no longer be a need to limit vaccine only to those in designated priority groups. Tracking vaccine production, delivery, and use will be important to guide appropriate vaccination strategies and use.
In fact, up to 300 million doses will be needed, as some first-time flu vaccine recipients will need two shots (especially vulnerable children).
While the CDC does excellent planning, the vaccine production end (and that's FDA more than CDC) has been, well, less than stellar this year. And what if this year was the big year? And what plans do we have in place to address the vaccine shortage if in a 'good' year we have trouble getting flu shots done at all? This is two years in a row that there's been a shortage of flu shots, and had either of these two years been a pandemic year, we'd be in big trouble.
Throw in that there's been a shortage of ER space, that the indigent and many other Americnas have trouble accessing health care at times, and you have a recipe for a bad outcome, even without becoming alarmist.
The Bush Administration's FDA approach of letting the market sort these things out is not very reassuring. This may be a natural disaster, and the CDC may have done whatever planning it can, but the Bush Administration's record of ignoring warnings about potential disasters isn't especially reassuring either. If the Bush flu hits , responsibility needs to be clearly placed at the level of the FDA if they do not properly respond. And this time, 'it's not my fault' won't be enough.