So, like Kevin over at No Se Nada, this started out as a comment on his avian flu policymaking post but got rather wordy, so I’m spinning it off over here. For those keeping track, the initial volley was this post, but previous discussion was had over here as well (and this post discussed some of his comments from that one).
So, in response, I think we are talking past each other a bit. I see a lot of difference between “wolf-crying” and simple education. I’ll re-post what I said in the comments here regarding that issue (in response to the question, “How do you inform people that this could be a very deadly outbreak without making it a media storm?”):
That’s the question I’ve asked myself and others over and over, and no one can seem to find a good answer for it. I’ve tried to present what we know currently without “hyping” it; indeed, I’ve pointed out several times why H5N1 probably isn’t as deadly as it’s commonly reported (as a 50% mortality rate). Thing is, we’re kind of in a lose-lose situation. We don’t discuss the virus and it hits us, we look bad for not disseminating information. We do discuss it and it fades away, we look bad for “crying wolf.” Since neither position is a great one to be in, I’d prefer to err on the side of more information, personally.
Additionally, the public has a short attention span, and often doesn’t know the behind-the-scenes work that goes into fighting emerging pathogens. For example, many people think that SARS was just “crying wolf,” but don’t realize the work that public health officials did to contain that virus. It’s the problem with public health–when it’s working correctly, no one notices it.
I think it’s wrong also to say either SARS or West Nile were “hysteria.” SARS was scary as hell because it spread quickly around the globe and no one knew what it was. The response from the scientific community was incredible–had the virus identified and completely sequenced in a matter of weeks, and battened down the hatches in a number of communities to keep it from spreading further than it did. This is a key example of the *success* of the public health system, and yet it’s grouped with “hyped” diseases and hysteria because these measures were successful and the virus didn’t spread further. IMO, that’s pretty much completely backward.
Similar with West Nile. The virus has now spread across the country (you can see maps here) and has become the leading arboviral encephalitis in the U.S. There were almost 3000 reported infections in 2005 alone, and 7% died (~200 deaths). Many others were left permanently disabled due to WN encephalitis. And these are just the *reported* cases–as with any infectious disease, those are just the tip of the iceberg.
Additionally, though I understand where you’re coming from, I don’t see it as being as much about resource allocation (although I agree that’s an issue) as about simple information dissemination and planning (which I realize takes money to do, but even Bush seems to realize it’s not something we can safely skimp on). Prevention, relative to treatment, is cheap. Using WN again as an example, it’s a helluva lot less expensive to have a campaign encouraging people to use bug spray and be cautious about mosquitoes than it does to treat cases of WN encephalitis (which, as I mentioned, can lead to permanent disability and hundreds of thousands of dollars in medical care and lost productivity).
Here’s the thing. If we sunk some real money into new vaccine development strategies, allowing us to quickly manufacture vaccines against whatever Mother Nature throws at us, it would protect us not only against yearly changes in circulating flu strains, but also against other emergent pathogens, such as SARS, WN, Ebola, whatever. Similar with money for surveillance for pathogens, in order to detect them early and get the vaccine facilities crankin’ if it was determined the agent was a real threat. As I mentioned here, this kind of system will also give us early warning of a bioterrorism event–killing several birds with one stone, and making some of the antiterrorism people happy in the process. And as an added bonus, there wouldn’t need to be as much hype about the “disease flavor of the month,” since we’d be much better prepared for just about anything novel.
Here’s the problem: we need a group (government or private) to aggregate all of our risks and prioritize the responses. Only then can we intelligently allocate finite resources for an infinite body of risk. Until then, we have lots of groups clamoring loudly about their problems (and the climate change community must be the loudest and most annoying, I admit), of which Avian Flu is only January’s flavor of the month.
I agree that would be good to have, but again, it’s about more than the resources. Even if you’d have a nice little ordered list or pie chart of funding priorities, we’d still want to have people informed about what’s going on in the microbial world around them (and I think folks in other fields would feel the same way). It would be nice to have the instruments in place, though, to say with confidence that we could take care of it, and minimize any “fear factor” in the story. That’s also one reason I love blogs such as Effect Measure and sites like the Flu wiki, which are run by people who know the topic and can present it without adding reporter sensationalism, or having a “Killer virus coming to your town!” type of headline slapped on it by an editor.
[Edited to add: Revere over at Effect Measure has an excellent post, taking a slightly different trajectory to end up at the same conclusion. And I don’t say it’s excellent just ’cause it’s in agreement with me. Additionally, his point regarding community education is better put and more straightforward than my rambling about education above:
The approach we have advocated (and the one that is behind The Flu Wiki) is to strengthen the public health and social services infrastructure so that our society can be sufficiently resilient to withstand the shock of a pandemic with minimal damage. Any investments made to that end are multi-use and will pay off in many ways. We need to work on tools that allow neighbor to help neighbor. Trying to solve the pandemic problem by throwing money at vaccines and antivirals alone is both fruitless and barren with respect to the other important needs Kevin points to. But the policy makers with their hands on the levers of power aren’t interested. they would rather spend money than mobilize the community.
Very good point.]