What's New in Life Science Research is managed and written entirely by Seed editors and expert guest bloggers. Read more about them Some foreshadowing: Imagine that every year, tens of thousands of people needlessly died from a predictable and predicted bioterrorist attack. This is the context in which all discussions of preventing bioterrorism should take place. But I'm getting ahead of myself...
There's a lot to say about biodefense, but the very abbreviated version is that you can't have a good biodefense system without a good public health and infectious disease control system. But I want to focus on one topic raised by Our Benevolent Seed Overlords, namely viral pandemics such as avian influenza:
With growing concerns of a viral pandemic such as Avian Influenza, how important will the development of vaccinations and the creation of plans to protect the country from naturally-occurring viral outbreaks be? What do you anticipate would happen in the event of an Avian Influenza outbreak?
Let's start with the last question. What do I anticipate would happen in the event of an Avian Influenza outbreak?
Lots and lots of dead people.
(visual aid)
This gets back to the previous point about needing a good public health system. Every year, roughly 36,000 people die from influenza, most of whom would live with a coherent, comprehensive vaccination program (which would also include a Streptococcus pneumoniae vaccine).
We know the annual epidemic will happen and when it will happen. Yet we do nothing. Charging people $25 for a vaccine shot that gets little serious promotion, and is administered to the wrong people is not a policy*, it is an utter absence of policy.
If we can't even handle the annual influenza problem--which kills twice as many as AIDS in the U.S.--then, sweet Baby Intelligent Designer, how are we going to handle a pandemic of avian influenza?
Avian influenza could be more deadly than annual influenza, and the time frame to produce vaccine could be even shorter than usual. This won't help matters.
What is frustrating is that this is largely a matter of logistics: organizing a system to stick a proven vaccine** in enough people's arms. Sure, it would be nice to move away from egg-based vaccine production, but we could still produce enough vaccine to vaccinate most people (not everyone can receive the vaccine).
Like many things in public health, our current failure with annual influenza (and my prediction of failure with a possible avian influenza or other viral pandemic) is largely a structural, not a technological, failure.
The good news is that this failure can be walked back. The bad news is that biology is hard and icky, so policy makers (and the parasitic pundit class) are often out of their depth. Much will depend on who heads the CDC and to what extent Daschle listens to him or her.
*The best bang per shot (if you will) is vaccinating kids between 5-18--the grandkids are killing their grandparents, along with adults who are in high contact situations. Although, the best strategy would be universal vaccination.
**The vaccine doesn't provide immunity to everyone. The goal is to vaccinate enough people so that the virus has a hard time finding a susceptible host.
Medicine & Health
Comments
This reminds me of an article I read the other day (Washington Post, via Overcoming Bias).
We (ie humans) have an innate tendency to weight caused tragedies far more heavily than natural ones.
Posted by: Cecil | December 12, 2008 1:44 PM
The fact that it is 'just the flu' is to me the biggest problem. No matter how many ads we beat people over the head with it seems people still think of it as 'just the flu'.
I am reminded of when there was a very minor bacterial meningitis outbreak in my city and damn near everyone rushed out to get the vaccination despite its relatively high cost.
I am sure if there were a SARS vaccine or a west nile vaccine everyone and their mother would rush to get it as well, while the flu is left neglected.
Posted by: Jon | December 12, 2008 3:33 PM
An individual's choice about being vaccinated is never discussed in public health "debate". I always find it funny that public health "debates" immediately and summarily eliminate individual choice before even starting to discuss a possible solution. But you can't have a centrally planned solution with individual choice, can you?
What other dictatorial tendencies do you have?
Posted by: Marc | December 12, 2008 3:37 PM
I'd say mass vaccination is easily compatible with individual choice. The problem is that it's inconvenient and somewhat costly to get enough people vaccinated and so people don't really have the easy choice in the first place. If employers could be talked into giving everyone a half-day off and $50 to cover costs, participation would be very high without having to coerce anyone. The employers benefit too - I wouldn't be surprised if the program paid for itself in gains made by not having some significant number of workers floored for two weeks by the virus.
Posted by: Matt Springer | December 12, 2008 4:57 PM
The University of Minnesota is the world record holder for mass flu shots in a single day, 11,810.
http://www.bhs.umn.edu/services/worldrecord.htm.
Free, to the vaccinee, flu shots were provided to students, staff and faculty. The University's employee health plan paid for its members; the student health plan paid for its members. This year's event was the culmination of 5 years of the University's committment to this important public health measure.
Multiple locations, fast queues, smiling servers, festive atmosphere, cookies -- it works, people will get their shots.
Kudos to the folks at Boynton Health Service for developing, organizing and delivering not just a great intervention but a textbook model of how to do it.
Here's the bit that did it for me "Do it for the herd"
I had avoided flu shots for years ("it's just the flu", " it's too much hassle). The well marketed slogan and it's catchy logo struck an Epi 101* chord with me.
The logo is the cow's meow!
http://www.bhs.umn.edu/services/fluclinics.htm
*(Epi 101: Profs. Schuman, Terris and Mandel; UMN Epidemiology Summer Session 1981)
Posted by: Gavin Watt | December 12, 2008 6:19 PM
Oops!
http://www.bhs.umn.edu/services/worldrecord.htm
The link works without the trailing "."
Posted by: Gavin Watt | December 12, 2008 6:22 PM
I'm not really sure why you raise this issue, since there's nothing in the post indicating that Mike is advocating forcing vaccines on people.
I think the public health system has done a good job of getting vaccination rates for many diseases to the levels required for herd immunity without actually forcing vaccination. If you consider the current system "dictatorial," with vaccination a requirement for entry into most schools, then that is where I part ways with you on the issue of individual rights vs. community rights.
Posted by: Davis | December 12, 2008 6:28 PM
Marc,
Davis made the point so I don't have to. There's no reason why influenza vaccination can't be made an annual school 'event' (a la the U of M above) with an opt-out clause.
Posted by: Mike the Mad Biologist | December 14, 2008 9:26 AM
Where I work, they offer a free flu vaccine onsite, and you're still on the clock when you go to get it. Jolly decent of them.
Posted by: Jivlain | December 15, 2008 6:34 AM
The Herd immunity argument for influenza is utter B.S. The population with the highest vaccination rate (2008) was 65 and older and there was only 65% coverage. The largest age group (18-45) had the lowest (19%) coverage for influenza. Given that last year�s vaccine was reported to be 40% effective, that means that the effective coverage was only 12% of the entire population. It would take monumental effort to break 50% coverage, but if the vaccine is ineffective that year, what good is it?
Posted by: Chuck | December 16, 2008 5:34 PM
H5N1 is being deliberately downplayed to the public.
Nor are the human-to-human cluster "Containments" that are delaying pandemic start with movement restrictions, Tamiflu "blankets' and animal cull and human monitoring Zones, (supposedly, to give us time to better prepare for pandemic) getting media coverage, probably due to "political and ecnomnic pressures"(the same reason the Pandemic Phase Alert got unplugged: Jan. 2006).
Gerberding should have been fired years ago, and been investigated for Reckless Endangerment and Willful Blindness for lowballing H5N1/Pandemic CFR, "for discussion purposes" because, "it's too hard" to plan for something contagious before symptoms and with "unprecedented" CFR.
(Have you seen the DHS "Best Practices and Model Protocols" pandemic flu doc. from April, 2007 ?)
See a free resource put together by concerned 'netizens' (and hosted by Nez Perce Co.Idaho's Emergency Management as part of their outreach) and see how you can prepare now to cope with long-forseen distruptions:
GetPandemicReady.org
Science still can't make an HIV vaccine, (and that virus doesn't kill chicken eggs) plenty of H5N1 sub-clades and strains multiplying out there already; each person or other mammal is making more (let alone the birds).
Govt has said, at the 2006 state panflu summits with HHS, don't expect any vaccine for panflu firstwave, (nor outside aid). We don't even have vaccine manufacturing capacity for current population - and will the grid stay up while they try to make a safe effective vaccine?
The CFR is staying too high, even in h-h-h clusters (can see that if antiviral isn't started in time). We're too reliant on fragile JIT imports and the electrical grid.
History shows we're on course for, "tragically wrong" outcomes.
We stopped manufacturing "critical needs" here; it has put our nation at risk. If you're not hearing enough about current H5N1 outbreaks, try the PFI Pandemic Flu Forum; one of the places netizens are translating local news stories and keeping track - and even then, no one had heard about a NWFP outbreak, nor "Mr.D." when he flew from NYC to a human cluster Pakistan hadn't reported, and back to NYC, Dec.5th 2007.
Once pandemic does start, preparation time will have just ended.
Panflu year is not a problem just a "better US public health system" is going to fix, so, don't wait for one, nor hope for a vaccine, nor hope govt will warn you to prepare in time; they should have already been doing so.
The seasonal flus have also almost all picked up a Tamiflu-resistent snip; if the CDC doesn't release full sequences there's no way to know if so-called 'Brisbane' strains have also picked up an virulence snip from H5N1. Who can get the CDC back on science and public over political pressure?
Posted by: cr | December 16, 2008 7:19 PM
FLu vaccine is an interesting case in mass psychology. The problem, while public health may still bear responsibility for failure to address, has roots in the long history of how this vaccine was introduced in the USA and the subsequent events over the last 3 decades since that introduction.
Unless a serious evaluation of the public's psychology re influenza and influenza vaccine is addressed, it will be many more decades before flu vaccine use becomes commonplace. We have been telling the public for years that only people with certain medical conditions need this vaccine. That message now must be negated in addition to adding the new information that flu vaccine should be given to the whole population.
Add to that, the common misconceptions that influenza is not a serious disease and the current anti-vaxer conspiracy nutter myths, and you have a perfect storm of ignorance, misconceptions, and ineffective public health resources applied to a $25 preventable cause of death.
By the way, I only charged $20/dose for flu vaccine this year. The vaccine cost went down, not up in the US this year.
Posted by: Skeptigirl | December 17, 2008 1:05 AM
Skeptigirl,
Every disease is serious to some sector of the population. You also spread hyperbole and misinformation concerning this issue if you put the opinion forward that everyone should be immunized for influenza. The $25 spent last year was a complete waste of money, time, and resources last year for a majority of recipients of the influenza vaccine. Was there a statistical difference in the number of ILI deaths last year versus any other year?
Posted by: Chuck | December 17, 2008 10:10 AM
thanks
Posted by: cet | April 27, 2009 7:01 PM
A daily 200 mcg supplement plus an estimated 37 mcg from diet brought me to 150 ng/ml, so I had to cut back. The average American diet provides 106 mcg/day and results in 124 ng/ml, so there's no way you can justify a blanket recommendation of supplementing 200+ mcg per day.
Posted by: seksi | May 15, 2009 9:24 AM