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After nearly four years of writing about bird flu, pandemics and emergency preparation, you'd think I'd be tired of the topic. Think again ;-0  There's a great deal of activity under the surface, and though the media isn't covering this regularly, and though other considerations vie for attention (and rightly so - the economy, the price of gas, the Iraq war, health reform, NOLA reconstruction and other issues are all compelling and important), the risk of a pandemic remains... and the efforts of thousands of people on line and off continue to make a difference.

In honor of yesterday's marathon DNC RBC session, here's a couple of comments from two Senators in the news lately who recognize the risk, and have been working to mitigate the consequences. From 2005, Barack Obama:

If we're lucky, we'll have at least a year, or perhaps several years, to prepare for a flu pandemic. But we might not be so lucky. And regardless of whether it is this particular strain of avian flu, H5N1, or another deadly strain, the time to act is long overdue if we want to prevent unprecedented human suffering, death, and economic devastation.

International health experts say that two of the three conditions for an avian flu pandemic in Southeast Asia already exist. First, a new strain of the virus has emerged to which humans have little or no immunity. Second, this strain has shown that it can jump between species.

The last condition--the ability for the virus to travel efficiently from human to human--has not been met, and it is the only thing preventing a full blown pandemic. Once this virus mutates and can be transmitted from human to human, we will not be able to contain this disease. Because of the wonders of modern travel, a person could board a plane in Bangkok, Athens, or Bucharest and land in Chicago less than a day later, unknowingly carrying the virus. Indeed, we learned this lesson from SARS, which moved quickly from Asia to Canada, where it led to many deaths.

As my colleagues know, one of my top priorities since arriving in the Senate has been increasing awareness about the avian flu. In April of this year, I introduced the AVIAN Act, which is a comprehensive bill to increase our preparedness for an avian flu pandemic. This bill was incorporated into a larger bill, the Pandemic Preparedness and Response Act, that Senator Reid and I introduced two weeks ago. We need to move this bill as quickly as possible.

That bill did not pass, but co-sponsor Hillary Clinton was also a cosponsor of the subsequently passed Pandemic and All-Hazards Preparedness Act in 2006,  an important law that established the primacy of HHS in a public health emergency, and established within HHS the office of the the Assistant Secretary for Preparedness and Response (ASPR) to:

(1) serve as the principal advisor to the Secretary on federal public health and medical preparedness and response for public health emergencies; (2) oversee advanced research, development, and procurement of qualified countermeasures and qualified pandemic or epidemic products; (3) maintain the Strategic National Stockpile; and (4) provide logistical support for medical and public health aspects of federal responses to public health emergencies. Transfers to the Assistant Secretary functions of the Assistant Secretary for Public Health Emergency Preparedness.

According to,

This bill passed in the Senate by Unanimous Consent. A record of each representative's position was not kept.

In Oct of 2007, Clinton, on the release of the Trust For America's Health/American Academy of Pediatrics joint report on the impact on children of both a pandemic and pandemic planning (schools will close in a severe pandemic for up to 6 to 8 weeks) said:

I am pleased to see that Trust for America’s Health and the American Academy of Pediatrics have released this report highlighting the needs of pediatric populations during a pandemic influenza epidemic. As our public health system works to prepare for both a potential pandemic and seasonal influenza, we must ensure that our efforts to protect our health extend to children as well.

I can't find much, if anything that John McCain has said or done on the topic (post if you know of something). Many of John McCain's votes on pandemic related issues were actually votes on Iraq troop bills with pandemic (and other issues) added on (those votes broke along party lines). But what we can say is that Clinton and Obama have been following this topic for at least three years whereas McCain's interest is unknown.

That leaves the next President, whoever it is, with an unpredictable attitude towards public health and pandemic preparedness. One can predict that in an attempt to be Not Bush, current policies will change. In my view, that can be a good thing (less bioterror, more natural disaster preparedness would be appropriate). So, with that in mind, this story raised some eyebrows last week:

A strain of bird flu has moved a step closer to developing the traits required to create an epidemic of the disease in humans, scientists warned on Monday.

Researchers who analysed samples of recent avian flu viruses found that a strain of the virus called H7N2 had adapted slightly better to living in mammals.

Tests on ferrets proved the strain could be passed between animals but scientists said the evidence suggested that bird flu could be transmitted between humans.

It followed on the heels of this one from early May:

Pandemic flu threat remains substantial, health experts say

The world still faces a substantial threat of a flu pandemic and countries need to speed up preparations for a global outbreak, health experts said Tuesday.

"We can't delude ourselves. The threat of a pandemic influenza has not diminished," said Keiji Fukuda, coordinator for the World Health Organization's Global Influenza Program.

It was a reminder that we don't know when and from which virus the next pandemic is coming from, but we know with certainty that sooner or later, we'll have to deal with a worldwide pandemic influenza. The last time the world saw one was in 1968.

It's also a reminder that there's much more to be done in pandemic preparedness. Local, state and national drills and exercises, and personal preparations (at least two weeks of food and plans for water, including pets) are quietly happening throughout the country, but more needs to be done in each of those areas. Communities need to become resilient enough so that if and when schools close, alternate plans for the vulnerable, special needs kids and working parents can be made.

Remember, working on pandemic preparedness means that your local public health infrastructure becomes more robust and resilient as well. That helps communities, no matter what comes. The alternative, including rationing scarce resources when we run out of staff, space and stuff to take care of people, is a grim necessity that must be considered in advance so that difficult choices can be made fairly and equitably at a local level (and if you think yesterday's rules committee was messy, try doing one of these exercises.)

A reminder from Barack Obama:

If we're lucky, we'll have at least a year, or perhaps several years, to prepare for a flu pandemic. But we might not be so lucky. And regardless of whether it is this particular strain of avian flu, H5N1, or another deadly strain, the time to act is long overdue if we want to prevent unprecedented human suffering, death, and economic devastation.

That's exactly right. Use the time we have, remember the recent examples in China and Myanmar, and consider this a teachable moment. We have less of them than we know.

Originally posted to Daily Kos on Sun Jun 01, 2008 at 05:57 AM PDT.

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