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Followers of the public health scene (by which I mean what's happenin', who's down with who and what's up with that) may have noticed some controversy among various people about the magnitude of the danger of pandemic flu in general, and more specifically by a virus strain currently circulating in birds called H5N1.  As I'm sure you know, it seldom infects humans, but when it does, it is quite likely to kill them.  Many people are concerned that it may mutate into a form which can be efficiently transmittted among people, leading to a destructive worldwide pandemic.  Others think this is unlikely. Our own DemfromCT has been on top of the story for Daily Kos.

Among the contestants are Revere of Effect Measure (who has occasionally filled in on my own blog while I've been gallivanting about the countryside, and for whom I have filled in while he's been gallivanting* about the planet), and Marc Siegel, with whom I have corresponded and spoken on one occasion at some length.  I have been reluctant to say much about this because it's all gotten a bit personal, and I really, truly, want no part of that. But there are issues here that happen to be important to me, so the bullet I must bite.

Marc has summarized his position in the new issue of The Nation.  He accuses the U.S. Centers for Disease Control and the World Health Organization of fueling a "worldwide overreaction to H5N1 avian influenza."  Revere, in contrast, started raising the alarm about H5N1 influenza at a time when he viewed the CDC and U.S. response, at least, as an underreaction, and the WHO, while not necessarily insufficiently concerned, as having insufficient resources and insufficient cooperation from many national governments.

So this argument is largely a matter of degree.  Siegel does not deny that it is possible that H5N1 will evolve into a human pandemic strain, although he considers it very unlikely. However, Marc says, quite specifically, "the priority being placed on it as a potential threat to humans is obscuring diseases that are already worlwide killers: malaria . . . tuberculosis. . . and HIV."  He points out that these diseases already kill a lot of people, and that worldwide spending for HIV prevention and treatment is well below what WHO believes is needed.  He further notes that the latest administration budget proposes cutting funding for HIV research at NIH, while slightly increasing funding for "avian flu and biodefense" research.  He then goes on to talk about the money being wasted on project Bioshield, which is a boondoggle project for terrorism defense.  

I am certainly sympathetic to Marc's rhetoric about insufficient global spending on important endemic diseases.  I have written about this issue many times, including here and here.  But it seems largely a red herring in this context.  There is no evidence whatsoever that spending on pandemic flu preparations has displaced spending on other global public health priorities.  Indeed, Marc seems to contradict himself by invoking WHO as the authority for saying that spending on HIV is insufficient.  If WHO is calling for billions more to be spent on HIV, then how can he say that avian flu has somehow made WHO ignore other priorities?

The Bush administration's determination to squander billions on preposterous defenses against highly unlikely bioterrorism scenarios goes back to well before they had, apparently, even heard of H5N1 influenza.  What has happened is that, rather than actually directing any new money to pandemic flu preparedness, they have simply added pandemic flu to the mission statement of their existing biodefense programs.  That's actually a step forward, in my view.  I have told this story here:

There isn't much in the way of a pandemic flu program per se; rather, states are expected to make preparations using two main sources of federal money, the U.S. Health Resources and Services Administration's National Bioterrorism Hospital Preparedness Program (HRSA-NBHPP) and the U.S. Centers for Disease Control and Prevention (CDC) Public Health Preparedness and Response for Bioterrorism Cooperative Agreement.

The word "bioterrorism" in the names of these programs comes from the days when the Bush administration assumed that bioterrorism was the only infectious disease threat facing the country. In Federal Fiscal Year 2004, when they first noticed the possibility of a naturally caused epidemic, the definition of the kinds of emergencies states were supposed to prepare for using these funds was broadened. Hence the CDC program is now called Cooperative Agreement for Public Health Emergency Preparedness, and the HRSA program's mission statement is "is to prepare hospitals and supporting healthcare systems, in collaboration with other partners, to deliver coordinated and effective care to victims of terrorism and other public health emergencies." [emphasis added.]

So, what happened when pandemic flu was added to the scope of these programs? The funds were cut, rather drastically. The HRSA program peaked in FY 2004, and funding declined slightly in FY 2005. I only have the figures for Massachusetts -- $10,686,180 in FY 2004, $10,256,868 in FY 2005 -- but you can find out about your own state's funding if you like at the HRSA web site. The CDC program really got wacked -- Massachusetts' funding in CDC budget year 8/31/03-8/31/04 was $21,141,965. Since then, it's been less than $18 million. The states use part of this funding to support preparedness by local health departments, and that's how the federal money trickles down to the local level. Obviously, that pass-through funding also peaked in 2004 and has been much less since then.

Siegel makes a case for investing in vaccine research and manufacturing facilities, which is one thing that Revere has also advocated for.  Marc then decries the mass culling of poultry in response to outbreaks.  I tend to agree with him that this is not helpful and takes a huge toll on the welfare of poor people who depend on poultry for food and income. Revere happens to agree.  

Marc then criticizes the ABC movie Fatal Contact: Bird Flu in America, for "capitaliz[ing] on fear." Well sure.  It's a disaster movie for crying out loud, that's what they do.  There was a movie last night about an earthquake ripping North America in half.  There are ridiculous, over the top disaster movies about volcanoes, tornadoes, extraterrestrial invasions, asteroids hitting the earth, giant monsters emerging from the bottom of the ocean, you name it.  So what?

Finally, Marc says: "Sadly, hyperbole is not a method of discourse exclusive to TV drama; a public health blog for bird flu fanatics recently suggested that the United States should pull out of Iraq and use the resources we save for bird flu preparation. On the surface this sounds like a terrific idea.  On further reflection it seems clear that going into Iraq in the first place was based on the same kind of argument -- in which a remote but scary risk is exaggerated so it appears to be looming -- that has characterized the public health reaction to bird flu."

Now, I must say I don't get this at all. I haven't heard of any blogger recommending that we spend the $2 trillion being squandered in Iraq on bird flu preparation, but it is certainly true that if we weren't wasting that money we could make adequate preparations for just about every possible disaster and make huge strides toward solving our more immediate problems as well.  On the other hand, I don't see how anybody can make a credible claim that vast resources are being wasted on bird flu preparation. (And we certainly aren't killing hundreds of thousands of people and destroying a whole society in the process.) On the contrary, we are spending trivial amounts on these preparations, almost all of which Marc Siegel supports -- in fact he wants to spend more on vaccine resarch and development! His complaints about Project Bioshield are completely off topic and irrelevant.

Virologists and epidemiologists disagree about the likelihood that the specific viral strain H5N1, currently panzootic in birds, will evolve into a form which is readily transmissible from human to human.  They disagree about the likely consequences if it does -- what the infection rate will be worldwide, how many people will become seriously ill, and how many will die.  People also disagree on the extent of economic damage and secondary public health consequences -- from such causes as temporary shortages of health care workers, disruptions in the food supply chain, etc. -- that are likely to occur.  But it would be grossly irresponsible to dismiss the possibility of a very destructive event.  Nobody actually knows how likely it is, they merely have opinions.

Furthermore, no-one disputes that it is entirely possible that someday, one or another strain of virus will cause an emergency, be it worldwide or limited to a region or a continent. Influenza -- H5N1 or another strain -- is one possible candidate, but it could be something else.  Nobody can actually assign a probability to an event of any given magnitude, or say when it will happen, but it almost certainly will.  Humanity has endured destructive epidemics innumerable times in the past and we haven't repealed the principles of biology.  It is prudent to make preparations for such an event.  Preparations are not specific to H5N1 influenza.  Whatever plans and infrastructure we put in place will be equally relevant to any other infectious disease outbreak.  It is entirely reasonable for people to advocate for such investments, and equally reasonable to keep a watchful eye on H5N1.

So, the bottom line is, I really can't figure out what this argument is all about.  Can you?    

*Gallivanting seems to exist only in the present participle.  Nobody ever gallivants, or gallivanted, but many are gallivanting.

Originally posted to therealcervantes on Wed May 24, 2006 at 01:39 PM PDT.

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Comment Preferences

  •  NO SURPRISE HERE..... (1+ / 0-)
    Recommended by:

    Rumsfeld Wants to Profit from 'Avian Flu' 'Vaccine'
    By Nelson D. Schwartz

    Monday 31 October 2005

    Defense Secretary, ex-chairman of flu treatment rights holder, sees portfolio value growing.
    New York - The prospect of a bird flu outbreak may be panicking people around the globe, but it's proving to be very good news for Defense Secretary Donald Rumsfeld and other politically connected investors in Gilead Sciences, the California biotech company that owns the rights to Tamiflu, the influenza remedy that's now the most-sought after drug in the world.
    Rumsfeld served as Gilead Research's chairman from 1997 until he joined the Bush administration in 2001, and he still holds a Gilead stake valued at between $5 million and $25 million, according to federal financial disclosures filed by Rumsfeld.

    The forms don't reveal the exact number of shares Rumsfeld owns, but in the past six months fears of a pandemic and the ensuing scramble for Tamiflu have sent Gilead's stock from $35 to $47. That's made the Pentagon chief, already one of the wealthiest members of the Bush cabinet, at least $1 million richer.

    Rumsfeld isn't the only political heavyweight benefiting from demand for Tamiflu, which is manufactured and marketed by Swiss pharma giant Roche. (Gilead receives a royalty from Roche equaling about 10% of sales.) Former Secretary of State George Shultz, who is on Gilead's board, has sold more than $7 million worth of Gilead since the beginning of 2005.

    Another board member is the wife of former California Gov. Pete Wilson.

    "I don't know of any biotech company that's so politically well-connected," says analyst Andrew McDonald of Think Equity Partners in San Francisco.

    What's more, the federal government is emerging as one of the world's biggest customers for Tamiflu. In July, the Pentagon ordered $58 million worth of the treatment for US troops around the world, and Congress is considering a multi-billion dollar purchase. Roche expects 2005 sales for Tamiflu to be about $1 billion, compared with $258 million in 2004.

    Rumsfeld recused himself from any decisions involving Gilead when he left Gilead and became Secretary of Defense in early 2001. And late last month, notes a senior Pentagon official, Rumsfeld went even further and had the Pentagon's general counsel issue additional instructions outlining what he could and could not be involved in if there were an avian flu pandemic and the Pentagon had to respond.

    As the flu issue heated up early this year, according to the Pentagon official, Rumsfeld considered unloading his entire Gilead stake and sought the advice of the Department of Justice, the SEC and the federal Office of Government Ethics.

    Those agencies didn't offer an opinion so Rumsfeld consulted a private securities lawyer, who advised him that it was safer to hold on to the stock and be quite public about his recusal rather than sell and run the risk of being accused of trading on insider information, something Rumsfeld doesn't believe he possesses. So he's keeping his shares for the time being.

    •  OF course you know . . . (2+ / 0-)
      Recommended by:
      DaveV, juliesie

      Tamiflu is not a vaccine.

      •  Yes, I know it is not a vaccine..... (0+ / 0-)

        From what I've read, you can't create a vaccine until you actually have a virus.  Bird Flu would have to mutate to a human to human virus before a vaccine could be designed to fight it.

        In the mean time people are getting rich peddling what people perceive to be a medication against the flu based on fear and hype.

        Even our annual Flu Season is hyped in favor of the drug companies peddling their products.  

        Until they can prove human to human transmission this is all hypothetical.  But we get updated on it almost daily in the news. The newsmen always seem disappointed that it hasn't jumped species, yet.

        For the people who haven't figured out that Saddam Hussein isn't sleeping with Osama Ben Laden, Tamiflu is answer.

    •  Article title (0+ / 0-)

      The article title doesn't seem to really match up that well with the text of the story.

      Those agencies didn't offer an opinion so Rumsfeld consulted a private securities lawyer, who advised him that it was safer to hold on to the stock and be quite public about his recusal rather than sell and run the risk of being accused of trading on insider information, something Rumsfeld doesn't believe he possesses. So he's keeping his shares for the time being.

      I don't see where they get that "Rumsfeld Wants to Profit from 'Avian Flu' 'Vaccine' "

      No to defend the scumbag Rumsfeld, but bad reporting is bad reporting.

      Lying can never save us from another lie - Vaclav Havel

      by Muwarr90 on Wed May 24, 2006 at 02:00:44 PM PDT

      [ Parent ]

  •  Well written with good information as well as (0+ / 0-)

    conjecture.  But I have to disagree with one point.  As a young college student, I frequently gallivanted with my friends rather than studying.

  •  Do you believe in a free lunch? (1+ / 0-)
    Recommended by:

    There is no evidence whatsoever that spending on pandemic flu preparations has displaced spending on other global public health priorities.

    So, what was displaced?  You can't spend more on one thing without spending less on the other.  Unless you increase the global public health budget -- which means spending less in some other area entirely.  There is an opportunity cost to preparing for a flu pandemic.  

    Are we under-spending or over-spending on flu preparedness?  I don't have a clue.  But to say that spending hasn't been displaced makes no economic sense.

    •  That's an easy one . . . (1+ / 0-)
      Recommended by:

      WHO  has had a budget for global influenza surveillance and infectious disease emergency response all along.  It hasn't been increased, it's just been used for this particular purpose.  It's a separate funding stream from HIV, malaria, etc.

      •  I'm not making my point clearly. (0+ / 0-)

        Are you familiar with the term 'opportunity cost'?  WHO has a global budget for all activites.  If the resources were not spent on pandemic flu preparedness, they would most assuredly be spent somewhere else.  The benefit foregone is called the 'opportunity cost.'     There is no free lunch.

        •  Again, I really don't think that's correct (1+ / 0-)
          Recommended by:

          The debate is about the politics of allocating resources.  As I said before, WHO has had a budget for global influenza surveillance all along.  That's the budget that is being used for flu related activities today.  It has not been changed.  It is also trivially small compared to spending on malaria, HIV, and TB.  Funding for those programs is decided separately.

          Surely you are not proposing that the WHO eliminate its influenza program?  The program already exists. H5N1 exists. So they're tracking it. That's all.

  •  One day there will be another pandemic. (0+ / 0-)

    So what, we survived the first one, in fact the first several.  This is all propaganda to scare us more.  Remember what we learned after Katrina, the US Government cannot save you.  Plus the bird flu "originated" in Asia making it easier to talk about those awful backward Asians spreading disease, so its is easier to hate them too as BuchCo wants us to.

    One American scientist working in China was quoted in the NYT Science section about two weeks ago (in the issues devoted entirely to bird flu risk).  He said that there are about 10 meeting around the world for every victem of the Bird Flu, meaning that it's risk is highly overrated, is the latest fad in public health, and where lots of money stands to be spent and made because of the hysteria.

    I think it is a crok cooked up to further manipulate us.  That's is all our government does any more -- try to scare us and manipulate things in their favor.

  •  Well sure, (1+ / 0-)
    Recommended by:

    We survived previous epidemics -- 1918 influenza, the Black Death, the smallpox that wiped out most of the population of the Americas.  But those experiences weren't very pleasant.  Nowadays, we can better anticipate such events and with a little bit of common sense and a modest investment, we can reduce their impact.  You don't have to believe that an influenza pandemic will destroy civilization to believe that there are prudent measures we can take to get ready.

    •  I'm not seeing many argue for 'prudent measures' (0+ / 0-)

      Instead, I'm seeing advice for living in your boarded-up house or apartment, with no utilities and only stored food and water, and making your own "rehydration drink." Literally.

      The level of fear being mongered is vastly out of proportion to the actual steps people have the power to take.

      You cannot pull out all the stops to prepare for every possible mortal peril; you cannot learn to fight off a shark, survive bird flu, live through a falling elevator, hedge your positions against a dollar meltdown, survive a plane crash, respond to a stroke, and prepare to hunker down in case of a comet hitting the earth all at once, and still hold down a job. There are tradeoffs, and they are unavoidable.

      There is probably a rational program out there that is wise to implement because it is both relatively low in cost yet high in payback, because it addresses a number of risks, including those more likely than bird flu. These might include installing Purell dispensers in every public toilet, cutting down on regular colds and flus; making sure the public health bureaucracy actually knows how to work in an organized fashion, since we're paying for it anyway; and encouraging people to stock up on a reasonable amount of supplies that would come in handy in bad weather and power outages as well as during the Apocalypse.

      I'm not seeing those "prudent measures." I'm seeing people urged to plan to live without income for months, and develop alternate communications network in case the plague wipes out their Brownie Troop.

      I mean, please.

  •  Remember not a single Tylenol death was proven to (0+ / 0-)

    any criminal charges and the Abbott Laboratories Viral-load testing method developed in 1989 has been stifled big time in the Hepititus C national scale plan that would have realized billions.

    No fact has ever came forth that the AIDS virus didn't come from the laboratory!

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