I noticed today that Bush is asking for $7.1 billion in order to prepare the country for a possible bird flu epidemic. This will include several hundred million doses of vaccine for the current strain of flu, anti-viral drugs, additional funding to prepare to research any new strains that come out, etc.
Is this necessary? Seems like an aweful lot of money to me. I know a bird flu epidemic COULD be potentially devastating but so far a human carrier mutation hasn’t emerged in either Asia or Europe. This isn’t to say one can’t or won’t though. So for debate…how necessary is this? Is it enough or is it overkill on Bush’s part? Should we be doing something else entirely? Nothing? If we spend this money what level of protection will be be buying?
Actually Bosda Di’Chi of Tricor, I’m well aware of the 1918 pandemic (and the lesser outbreaks in 1957 and 1968)…and that yes, they were all bird related. Can I assume that your answer is ‘yes, we should spend the money’? Could you elaborate on whether you think its not enough, too much, just right? And on what you think this will buy us?
Understand that when I write an OP I’m trying not to give my opinion but I’m ASKING for others opinions. I haven’t said one way or the other if I think its too much, not enough or just right…or what I think this money will buy. Usually just because I don’t want to corrupt the OP with my own opinions but this time because frankly Im’ not sure…thats why I started the OP.
It’s way too much. What really needs to be done, is that the President and Congress need to guarantee the market for vaccine if it’s made, and give grants to Universities and Hospitals to develop new vaccines and vaccine methods. That’s it. Nothing more. This is the freaking anthrax scare all over.
$7.1 billion works out to $25 to me. I’m at the point where I’m just glad that Bush isn’t costing me more. If it only costs $25 so the President is preoccupied with a pet project that isn’t otherwise sinking the nation, I think that’s worthwhile. I just hope he stays occupied for a while. Honestly, I think the only reason he’s doing this is due to all the recent press about bird flu and to appear as someone who takes action.
It would be wise to study the epidemic that never was – the swine flu of 1976, believed to pose as grave a danger as the 1918 pandemic, but which never materialized.
By the way, the article lI’ve linked to states that the 1918 strain was a swine flu:
Anyone remember swine flu. The Ford administration spent oodles getting vacines for the American population against a disease they were afraid would jump from pigs to humans. Unfortunately the vacine made lots of people sick and a few died (more then from the original disease).
I would like to think that the gov’t today is acting from a reasoned risk cost-benefit analysis. I don’t know enough about the numbers to say they aren’t. But I’m suspicious that this is just chest thumping to show how “disaster ready” the federal gov’t is in the wake of Katrina. My gut feel, for what it’s worth is that the 7 billion would be better spent preparing for a more general disaster/epidemic then a specific one that may or may not happen (and the vaccine may or may not help). 7 billion could buy a lot of vaccine producing infrustructure, quarantine facilities and disaster management classes for first responders.
In short, I think that in the wake of Katrina, if the press was yelling that the sky was falling, Bush woulda thrown that 7 billion into cloud protection shelters.
I vote excellent idea. It is entirely possible that the H5N1 strain will not make become a pandemic strain, but I tend to think it will at some point. Just because it looks like there’s no way they’re going to be able to eradicate this strain from the absolutely gigantic poultry populations in Asia. So it’s a probability game - even if you’re talking about an extremely rare event, all you have to do is increase the iterations until the likelihood approaches one that it will happen. The iterations (number of sick birds) appear to be multiplying exponentially over the last year and it looks like this will go on indefinitely, so I’m banking on it happening.
But what if the virus doesn’t make the jump? What would be the damage from this plan? It looks it would be about $2 billion dollars for Tamiflu and vaccine stockpiling that would end up being tossed. The rest appears to be earmarked to improve preparedness and infrastructure in general - which I think almost everyone agrees is necessary since a pandemic will almost inevitably hit us at some point. They happen on average about once every 30 years, so they’re not rare events.
Cost/benefit? Well nobody can really estimate what the costs of a pandemic would be. I, however, could easily envision a pandemic that would outstrip $2 billion by a factor of 100 or more. I also think that the odds of a panemic like that happening from this strain are way better than 1 in 100. So I have to go with money well spent. Reasonable people could differ, since the uncertainties here force people to essentially pull numbers out of the air.
By the way, this is *not * the same mistake made in 1976 - since in that case people were actually vaccinated after (I think it was) a single case appeared. Nobody’s planning on vaccinating anybody until there’s evidence of fast and widespread transmission this time around.
For the record, it really doesn’t matter. Swine flu is just a bird flu that’s become easily transmissible to humans via some genetic mixing in a pig. The H5N1 strain has not made that leap to become easily transmissible, so there’s no reason to think that pigs won’t again be the mixing vessel - making this a “swine flu.” In fact one thing that worries epidemiologists is how many pigs are being housed right next to or even among sick birds in Asia. What makes this "bird flu"even more worrisome than usual is that humans are picking up this bird flu directly from birds without a pig intermediary - meaning that humans could also be the mixing vessel in this case. It just multiplies the scenarios that could result in a pandemic strain - it shouldn’t be a comforting piece of information.
I don’t disagree, personally. I think the administration is delighted to have a distraction from their general incompetence adn are using the bird flu to change the subject. But I dont care what their motivation is, I just care that they make the right decisions.
That’s what people thought for a long time. However, using samples of tissues from victims of the 1918 pandemic buried in Alaska, they have recently determined that the 1918 flu was avian. (My wife has just completed a book on the flu.)
You can’t make flu vaccine all that quickly, certainly not in the quantities that would be needed if a pandemic broke out. I don’t know if $7.1 billion is the right amount of money, but it’s insurance. We can just hope that the pandemic doesn’t happen. I can think of lots of worse things to be spending our money on.
If Bush spends too much money and nothing bad happens people will complain he’s wasting money/fear mongering/distracting us from other issues. If something bad happens then people will complain that Bush didn’t spend enough money.
I don’t understand the making of vaccines now, though. Wouldn’t these be potentially useless since the virus has to mutate in order to jump from human to human? Or is it possibly “close enough” for our body’s immune system and we’re praying it doesn’t change too much?
Meh, being president’s tough, and part of it is playing the odds. The point is he needs to put money to avoid likely dangers and not scumb to the temptation to try and fend off every “scare of the day” that the media latches onto.
That’s my understanding as well, and one of the reasons I’m skeptical of this plan. According to the guy on NPR a few weeks ago, the vaccine may be effective on some variants of the flu which may or may not jump to humans. It seems like a lot of maybes to justify 2 billion.
The only time we can be sure that we have an effective one is once we know what the virus actually looks like, which we can only know after it mutates into something really dangerous, at which point it will be too late
We cannot possibly have enough. You have to take them regularly in order for them to be effective, can the US afford 20 doses for each citizen?
The biggest danger (IMO, IANAEpidemiologist, etc) is the shutdown of the economy. When SARS hit Toronto, the only people at risk were certain people in certain hospitals. Only 44 people died. (I know, one is too many, but 44 is really not a lot for an ‘epidemic.’) Still, the economy was thrown for a major loop and people’s lives were massively disrupted.
Even if only a small number of people were actually sick with a scary avian flu virus, the negative effects would be huge. People would panic, and many would refuse to go to work, whether to look after their kids who they would keep out of school, or because they fear public transit, or because they are looking after someone who is sick, or because they’ve taken off with their family to isolate themselves at their cottage, or whatever.
These people would be truck drivers and water safety inspectors and telephone operators and customs officers and people who keep the economy moving.
Critical sectors like transportation and infrastructure (water, energy, etc), not to mention health care, would be disrupted. Supplies of consumer goods would be interrupted, water/electricity/telephone/whatever supplies would be compromised, and so on, because of all the people not going to work.
As far as I’m concerned, THIS is the biggest thing we have to fear from an influenza pandemic, and throwing all the money in the world at antivirals and vaccines will not do a thing to help it.
Things that will help are more long-term and much “softer,” things that can’t practibaly have piles of money thrown at them:
shortening supply lines, so that we are not dependent on imports from far away in order to survive
having a healthier population, so people’s immune systems are stronger
Just had to answer this one. In the 1918 flu, the death rate for the young and strong was higher than that of the weak. The reason involved how the virus affected the immune system.
In 1918 in Philadelphia they were stacking up the dead like in the plague years.
We certainly know more about this than they did then - it wasn’t until many years later that they found the flu was viral. However, if there is a pandemic, and it spreads like in 1918, I assure you that losing telephone service is not the worst thing that would happen.
If vaccine can be gotten to centers of outbreak to halt the disease before it spreads widely, we might be able to stop it. The 1918 flu spread in large part because of the concentration of men in army bases. (It was only called Spanish flu because wartime censorship stopped news of it from most of the affected countries. Spain, being neutral, reported what was really going on.)
Actually many think it was healthy immune systems that actually killed people in the 1918 pandemic. The highest death rate was among 20-39 yo’s and the theory is that it was a strong cytokine response that overwhelmed the lungs and ended up being fatal.
As far as supply lines, I don’t know about shortening them, but we may be seeing the fatal flaw in having a “just-in-time” economy - nothing’s warehoused. Products just don’t exist until just before they’re manufactured = an economy unforgiving of interruptions.
We cannot possibly have enough. You have to take them regularly in order for them to be effective, can the US afford 20 doses for each citizen?
No, Cowgirl, the “biggest” danger is a highly contagious highly fatal flu bug hitting a world with modern transportation systems and large pockets of immunocompromised individuals (AIDS patients, cancer patients, etc.) rapidly circling the globe and overwhelming the health system’s ability to even try to do anything about it with many millions dead in a matter of months. Big but fairly unlikely precisely because we are preparing. Economic disruptions are much more likely even with a lower number of fatalities. All the more reason to work hard to contain a potential pandemic before it has a chance to emerge.
Vaccines. Current vaccines in development are not guaranteed to be effective against a reassorted avian bug, but are a pretty good stab at it. One shot but with more antigen than is ideal is enough. Work is ongoing to see if adjuvants can be added to stretch a supply out to more people. Stockpiling them is less important or valuable than improving upon the vaccine infrastructure to facilitate rapid production and deployment of a vaccine that does exactly hit the mark in a fairly short time frame. And having the groundwork research done with the likely pathogenic antigens so that the exact mark can be found quickly. The good news is that the kind of revamp needed to accomplish that goal would also help make the various vaccine supply snafus that we’ve lived though more years than not less likely to recurr in the future. And such improvemets would serve us well whether the next pandemic comes from this particular avian source or from some other source. This part is absolutely money very well spent.
Antivirals. The best available modelling demonstrates that 3 million course of Tamiflu at a ground zero would very likely slow down a nascent epidemic enough to allow for vaccine production and deployment. Without much fanfare Roche has donated those 3 million courses to the WHO.
Costs. First off, think levees. Obviously the cost of levee repair seems like a bargain now. The cost of preventing a major pandemic is infintessimal to the costs of not preventing it. This particular avian source may or may not be able to reassort into a pandemic capable strain. But there is very little doubt that there will be another pandemic capable strain emerging sometime, and if history is any guide, likely sooner than later. Preparations that allow us to prevent any such bug from becoming a major pandemic are a must. The cost of not doing so are potentially incalcuable. And the potential benefits to regular yearly vaccine supply issues might even justify the costs in and of itself.
BTW, my reference for the statement that those with the best immune systems suffered the most in the 1918 flu is John Barry, “The Great Influenza,” pp. 249-250 of the Penguin paperback edition.
I think it’s a great idea. The risk is certainly there for this thing to mutate into a form that will spread easily from person to person. If it does, it could be one bad ass strain of flu. We’re better off planning ahead and getting prepared.
There are enough scientists concerned to make me think that this is more than just media hype.