crossposted at The Next Hurrah
On the heels of pandemic flu awareness week comes this editorial from the WaPo:
SCIENTISTS AT THE Centers for Disease Control and Prevention in Atlanta announced last week that they had reconstructed the genetic code of the flu virus that killed at least 50 million people in 1918. Meanwhile, administration officials are preparing a plan to bolster U.S. preparedness for another pandemic. These two facts are related: The more that is understood about the 1918 flu virus, the more similar it appears to the avian flu that has recently killed millions of birds, as well as some 60 people, in Asia. So far, the avian flu virus has jumped from birds to humans, but not from person to person. If that changes, this flu could be as deadly as -- or, given the speed of modern travel, more deadly than -- its predecessor. This is a potential disaster that, like the hurricane that devastated New Orleans and the Gulf Coast, has long been anticipated. Also as with Hurricane Katrina, it is one for which the U.S. government is not prepared, as Mike Leavitt, the Health and Human Services secretary, acknowledged last week.
It's a good thing that Mr. Leavitt recognizes the problem. Unfortunately, it isn't clear that everyone in the administration understands it. It was disturbing to hear the president ruminate on the use of military troops for mass quarantines. That comment -- conjuring images of soldiers shooting as sick people try to cross a cordon sanitaire -- could have been a scare tactic. In fact, there is no legal, let alone ethical, means of enforcing mass quarantine in this country, and flu viruses, which don't always produce symptoms in the early stages, wouldn't obey them if there were.
And most importantly:
It is also time to look again at the nation's medical emergency response systems, to examine again how doctors would be sent around the country and to involve hospital administrators in the discussion. Even if the avian flu never produces a pandemic, the country would be better prepared for whatever virus comes next.
That is the point. And, while there's a need to concentrate heavily on vaccines, including future reaearch and production, pandemic preparedness goes beyond what those in DC and at the NIH and CDC are up to. From
Peter Sandman:
I have written elsewhere about
adjustment reactions. When people are first confronting a risk they haven't thought about before, it is normal -- and useful -- to "over-react" for a while. Some people become hyper-vigilant; some take precautions prematurely; some obsess. Then a few people turn into fanatics, while most settle into the New Normal, more attentive than previously to the new risk, but not so obsessed anymore.
Officials are prone to misinterpret the public's adjustment reaction as panic or hysteria. Instead of helping people get through it, they tend to try to tamp it down.
The big achievement of the past two weeks is a quantum increase in the willingness of authorities to say scary things about bird flu. In the U.S., at least, this is in part a side effect of Hurricane Katrina; the U.S. government feels it dare not risk accusations of under-reacting to another potential crisis. I think it's also a result of U.S. government fears that just about everyone else was expressing more concern about bird flu than the U.S. government was:
- Civil society was sounding the alarm -- from the Council on Foreign Relations to the New England Journal of Medicine to Trust for America's Health.
- The private sector was getting interested -- hundreds turned out for a recent New York conference on how the financial industry can prepare for a pandemic.
- Other countries' governments were moving further and further out in front.
- Some state and local officials (most notably King County, Washington) were getting way ahead of Washington D.C. in talking up pandemic preparedness.
- Democrats (and Republicans) in Congress were making noises and introducing bills.
It looks very much like President Bush authorized Health and Human Services (HHS) Secretary Michael Leavitt to sound scary too.
That's a good summation. Some other suggestions:
What does all this information on vaccines and antivirals have to do with risk communication? Five things:
- The focus on the pharmaceutical fix is excessively optimistic. It is keeping people from focusing enough on worst case scenarios.
- The focus on the pharmaceutical fix is excessively medical. It is keeping people from focusing enough on non-medical preparedness.
- The focus on the pharmaceutical fix is excessively governmental. It is keeping people from focusing enough on what civil society, the private sector, and individuals can do
- The focus on the pharmaceutical fix is excessively national. It is keeping people from focusing enough on local preparedness.
- The focus on the pharmaceutical fix is excessively first-world. It is keeping people from focusing enough on ways to help Africa, Asia, Latin America, and the Middle East prepare for a pandemic
.
Non-medical preparedness is the next level of things to do. We know the CDC plan will suggest that state and local officials do a certain amount of planning for themselves. Sites like Flu Wiki are designed to augment that process by encouraging some bottom-up planning along with the top-down expertise. The CDC plan, when released wil be a beginning, not an end. it will empower state and local authorities to begin planning, not end it by giving a one-size-fits-all template.
Knowledge is power. if we know what's coming we'll better be able to deal. There is no pandemic today; it's tomorrow we are brginning to plan for. And if it never comes, the exercise will benefit the health care system in ways beyond pandemic planning. The health care system can use the attention if we want it to be there when we need it.