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General News    H3'ed 7/15/10

Tomgram: John Barry, The Pandemic Next Time

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As early as this week, engineers could seal BP's oil leak, fastening a new cap on the mile-deep well belching crude into the Gulf of Mexico. And if they do, and a relief well follows equally successfully, sooner or later news coverage of BP's catastrophe will begin to wane (indeed it is already), as will the public's interest, all of it receding (like the earthquake in Haiti) into background chatter and periodic anniversary pieces. Except, that is, for residents of the Gulf coast region, who will be living with the spill's aftermath for decades to come. Because even if BP and the government's legion of experts do finally install that cap and then the relief well successfully, shut down their response units, and leave the south behind, the spill's impact, especially from a public health perspective, will remain.

Consider major oil spills of the past like the Exxon Valdez in Alaska in 1989 or the Prestige spill off Spain's northwestern coast in 2002. In the Spanish case, serious respiratory problems plagued cleanup workers for years afterward, and DNA testing revealed that the chemical exposure they suffered could cause hormone alterations or even cancer. Today, Gulf cleanup workers face these same risks. At the moment, the federal government doesn't even require workers to wear respirators, and according to BP's own data, 20% of workers have already been exposed to a chemical known to cause kidney and liver problems. A new report by the Center for American Progress (CAP) details one striking aspect of the Alaskan and Spanish catastrophes: the utter lack of any systematic public health response, despite the fact that workers had been exposed to startling amounts of toxic chemicals and oil.

These previous spills and an abundance of scientific evidence suggest the need for a top-down, coherent public-health response to the BP spill. The CAP report, however, finds -- and you undoubtedly won't be surprised by this -- that the federal government has no such plan in place. Instead, it is relying on a jumble of agencies loosely overseen by the Department of Health and Human Services (HHS) when instead, CAP argues, a top HHS official should take charge of the government's response and roll out a comprehensive public health safety plan.

As prize-winning author of The Great Influenza: The Story of the Deadliest Pandemic in History, John Barry points out, this lack of preparation characterizes another public-health emergency on the horizon: the next influenza outbreak. Written for the summer issue of a quarterly magazine we greatly admire,World Policy Journal, Barry's piece is being posted here thanks to the kindness of that magazine's editors. WPJ's latest themed issue -- "Global Health: Protect and Cure" -- goes on sale July 20. (You can, by the way, subscribe to the magazine by clicking here.) Andy

How Prepared Are We for the Next Great Flu Breakout?
Why We're Losing the War Against Influenza

By John M. Barry

[This report appears in the Summer 2010 issue ofWorld Policy Journaland is posted here with the kind permission of the editors of that magazine.]

It is the nature of the influenza virus to cause pandemics. There have been at least 11 in the last 300 years, and there will certainly be another one, and one after that, and another after that. And it is impossible to predict whether a pandemic will be mild or lethal.

In 1997 in Hong Kong, when the H5N1 virus jumped directly from chickens to 18 people, it killed six of them. Public health officials slaughtered hundreds of thousands of ducks, chickens, and other fowl to prevent further spread, and the virus seemed contained. But it wasn't. In 2004, H5N1 returned with a vengeance. Since then, it has killed hundreds of millions of birds, while several hundred million more have been culled in prevention efforts. And it has infected more than 500 human beings, killing 60 percent. The virus's high mortality rate and memories of the 1918 influenza -- the best estimates of that death toll range from 35 to 100 million people -- got the world's attention. Every developed nation prepared for a pandemic, as did local and regional governments and the private sector. They all based their preparations on a 1918-like scenario, but it did not come. It still could.

In March 2009, another influenza pandemic caused by a different virus did arrive, and it was nothing like the lethal one we expected. This particular H1N1 virus generated a pandemic with the lowest case mortality rate of any known outbreak in history. Nothing in the world accounted for the low death toll; it was simply luck that this pandemic virus had low lethality. The World Health Organization counts fewer than 20,000 dead worldwide, but that's only laboratory-confirmed cases. It is impossible to know whether actual mortality was ten or even one hundred times that number.

But even the highest reasonable estimate of those killed by this latest pandemic so far -- we could still see more waves of infection -- still falls far below the anticipated scenario. The world assumed that preparing for a severe pandemic would allow it to adjust easily to a mild one. It was mistaken. This lesser pandemic threw the world off-balance, and very few nations have, with respect to influenza, regained their footing.

A World Under Pressure

The 2009 pandemic put the world under pressure and revealed flaws in both health systems and, more significantly, in international relations. The lessons we might learn from this past event could be of value in our ongoing war against the flu virus. But we're still getting too many things wrong.

Virologists, epidemiologists, public health officials, even ethicists and logisticians are analyzing data from the pandemic. Based on their results, health organizations will likely adopt modest management changes. The WHO previously defined an influenza pandemic as basically any occurrence in which a new influenza virus enters the human population and passes easily between humans; it may refine that definition by adding a virulence factor, similar to the Saffir-Simpson scale for hurricanes (category 1 to category 5). Vaccine delivery systems will improve. Local hospitals will upgrade their triage practices. More fundamental changes, such as a shift in vaccine production away from chicken eggs, a technology used for more than half a century, to new production technologies were already under way before H1N1 hit and will accelerate.

These are good starting points. But on larger policy and scientific questions, any efforts to draw conclusions could mislead. All other pandemics we know about in any detail -- in 1918, 1957, and 1968 -- sickened 25 percent of the population or more in every country for which data exists. The 2009 data suggests attack rates approached that benchmark figure in children only, while adults were generally attacked at only a quarter to a half that rate, not because of any public health measures taken but most likely because adults had already been exposed to a similar virus, and had some immunity. This distinctly unusual pattern makes it difficult to draw conclusions on the effectiveness of, for example, such non-pharmaceutical interventions as screening airport arrivals or shutting down schools. Yet some epidemiologists are insisting on doing just that. Policy for the next pandemic is being set, and it's based on the analysis of flawed data.

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Tom Engelhardt, who runs the Nation Institute's ("a regular antidote to the mainstream media"), is the co-founder of the American Empire Project and, most recently, the author of Mission Unaccomplished: Tomdispatch (more...)

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