| Media coverage over the last year or so on the threat
of a global avian flu pandemic has left little doubt with
most of us that it is probably more a question of when
rather than if our world will
experience a pandemic of proportions one cannot predict.
As reported on Sept. 19, 2006 by the Wall
Street Journal, the World
Health Organization (WHO) Western Pacific regional
director, Richard Nesbit, stated that the risk of Bird
Flu ''continues unabated. After three years now, I'm sure
many journalists and the public are starting to get tired
of the same message'' -- i.e., a global outbreak
could strike any time -- ''but we have an obligation to
keep giving this message.'' Dr. Anders Nordstrom, acting
director general of WHO has acknowledged that the world
is in a ''down period'' of avian flu cases but said
countries should remain vigilant. Concern is that the H5N1 avian flu virus now found in domestic birds in Asia and Eastern Europe could mutate, possibly spreading from person to person. An Implementation Plan issued by the U. S. Administration in early May 2006 (follow-up to the 12-page National Strategy for Pandemic Influenza of November '05) estimates that 200,000 to two million American citizens alone could die. Fortunately today, bird flu remains an animal disease -- with only 328 human cases in 10 countries since 2003 resulting to date in 200 deaths -- and WHO issued on May 30, 2006 a step-by-step plan to limit outbreak of the disease in humans (Reuters). But, a new study by biostatistician Ira Longini reported in the October 1, 2007 issue of Forbes magazine features a computer model to address the probability of a pandemic outbreak without human transmission. His paper, published in the September issue of Emerging Infectious Diseases, addresses an outbreak in May 2006 where seven of an eight member family died following contact with a dead chicken by a 37-year-old woman. The article discusses this ''Indonesian cluster'' and its modest ''R'' factor while contrasting the 5-day incubation period for H5N1 virus with the 2-day period for that of the flu pandemic virus that killed 50 million people in the last century. He predicts that the H5N1 ''cannot be stopped without a vaccine'' if it acquires the same transmissibility. The May '06 issue of Time magazine emphasizes, however, that the White House Plan's focus is on trying ''to contain problems overseas, show the country that the President is in command and keep the people informed so they will be calmer.'' But, local and state governments are then tasked to do their own preparation -- i.e., the same as preparing for a national disaster or a terrorist attack. As the Time article puts it: ''don't rely on the fed's'' when it comes to a cookbook for pandemic preparation. Fortunately, many major cities in the United States have been paying attention and their health authorities are already out front with open hot lines to answer public questions about avian flu. For example in our geographical area, San Antonio's director of the Metropolitan Health District, Dr. Fernando Guerra, has been meeting with political, business, and school leaders. Individual citizens are being asked to make personal preparations should parts of the city have to be placed under quarantine. News conferences called at San Antonio's City Hall are already asking communities ''to take on personal responsibility to have food, water, medications they need'' should citizens be required to stay in their homes for extended periods as reported by Cindy Tumiel of the San Antonio Express. Research suggests that when a pandemic begins, it will develop in waves. Hence, success of local responses could be key to slowing its advance. Local school districts and major employers in population centers should take needed steps to identify and protect key workers who must stay on the job during an outbreak. In the San Antonio region, it is reported that disease surveillance equipment has been increased which will help monitor bird and human populations should the avian flu jump to the North American continent. ''A work in progress'' is the term that most cities and counties will use to describe the state of their local flu pandemic contingency plan. What now is essential is for the major cities, as well rural communities, to organize and send a carefully chosen delegation to Geneva, Switzerland to meet with infectious disease professionals and strategic planners at WHO who have the ultimate expertise in dealing with a pandemic of this nature. It takes the wealth of experience and training of the international doctors and health workers at WHO, including many from our own Centers for Disease Control and Prevention (CDC), to tell you what will really work in attempting to control the spread of an influenza pandemic. Through our contacts in Europe we will also be following closely the outcome of the scientific conference of over 100 nations held at the end of May in Rome to discuss highly pathogenic avian influenza (HPAI) and wild birds, as well as the ecology and virology of HPAI, surveillance, risk analysis and diease management. The 300 scientists attending debated a key controversial issue dealing with the relative role in propagating avian flu played by wild birds, as against domestic poultry, and whether wild birds can in fact serve as long-term reservoirs of a virus like H5N1. The Food and Agriculture Organization (FAO) and the Animal Health OIE organized the conference. There is exciting news from GlaxoSmithKline, a British company, regarding the ''best results to date on an experimental human vaccine for bird flu'' . . . mass production possible by 2007. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (mentioned in The Difference on this web site) believes the data are ''really very impressive'' as reported by Maria Cheng of the Associated Press. It is reported that these preliminary results are based on tests on 400 people in Belgium the majority of which developed strong immunie responses from very low doses of the prototype vaccine. This is in contrast to disappointing results last March with tests of Sanofi Pasteur, developed by Sanofi-Aventis SA. The new prototype vaccine by Glaxo includes an adjuvant -- an immune-system booster -- that allows it to use less of the main active ingredient. An inactivated version of the newer strain of H5N1 used here was isolated last year in Indonesia. It is reported that more than thirty companies are engaged in some 20 or more clinical trials on potential avian flu vaccines. Once a human vaccine for avian flu is approved and mass production begins, there will be periods when quantities will be limited and choices need to be made on what parts of our population you vaccinate first. There are now studies in progress to address the ethical issues and the most effective strategies for reducing illness and death where vaccine rationing is required. Recently, Sharon Begley has written about this in the Science Journal section of the Wall Street Journal. She notes debate raised by the NIH in May '06 about present U.S. policy to first vaccinate the very old, very young and the sick -- putting at the very last individules ages 2 to 64 years of age. She cites a new study in the journal PLoS Medicine that argues ''infants and the elderly don't spread the flu as much as ... a school child or business traveler ... might you decrease both illness and death, including among the old, by vaccinating other age groups first.'' A link to mathematician Dr. Lauren Ancel Myers' PLoS study is available below. And finally, Wall Street Journal reported August 29, 2006 development of an important new diagnostic tool for flu viruses including the H5N1 avian-flu strain. Collaborating with the CDC, scientists from the University of Colorado at Boulder reported in the Journal of Clinical Microbiology having developed a microchip flu test -- which has been named FluChip -- that can identify the H5N1 and 71 other influenza strains in less that 12 hours. Dr Fauci 's institute funded the research and he says ''the ability to quickly and accurately identify strains of influenza would be invaluable to international flu surveillance efforts.'' FDA approved in February a rapid diagnostic test that can identify whether a virus is an N1 type, but only a few laboratories around the world can do the detailed testing afforded by the FluChip, i.e., idenfiy the subtype such as H5. Dr. Nancy Cox, chief of CDC's influenza branch has reported that the new chip can also identify the geographic origin of an emerging virus and other genetic information. However, she expects it will take two years to commecialize the test. Having spent seven years in Geneva working closely every day with the people at WHO on earlier pandemics including SARS and HIV/AIDS, I would like to join as a consultant to help on these local planning efforts. Our geographical location is important I believe. About sixty miles outside San Antonio, we are in the Texas Hill Country at the center of a culture of very active game-bird hunting. This kind of venue quite conceivably could be a candidate for an early ''wave'' of a flu pandemic. We are talking about avid hunters handling wild birds every day. Depending upon the outcome of the debate mentioned above, there may be need to develop protocols for wild game hunting that incorporate reasonable precautions in the handling of game. The author has had extensive private- and public-sector experience in assembling and leading study groups. I have worked with scientists, elected officials, NGOs and other community leaders at all levels. More importantly, I have been intimately involved with a range of consultative studies under the aegis of the National Academies of Science, Engineering, and the Institute of Medicine. As White House Executive Director of the Federal Coordinating Council for Science and Technology, I also became expert in the operation, ''chemistry'' and report-writing of interagency and international study groups -- a key element to the elucidation of a viable pandemic contingency plan. Recently the author has been asked to organize and to chair an ecumenical church working group in the Texas Hill Country on emergency-related issues including avian flu. The group is led by the St. Christopher's parish in Bandera County. Please give me your thoughts on this approach in an e-mail at my HOT E-mail address: bartleytech_@_yahoo.com (Please back out UNDERSCORE on each side of @ placed to avoid spamming.) Many thanks. USA TODAY: Pandemic plan: Don't count on federal rescue | Read the 227-page report (.pdf)
PLoS Study
analysis of patterns of flu transmission: MARQUIS
WHO'S WHO in cooperation with THOMPSON International: |
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THE AUTHOR: William
C. Bartley, with
undergraduate and advanced degrees in electrical
engineering and mathematics, began his career at Texas
Instruments later moving to acedeme at the University of
Texas-Dallas. He organized and directed a space research
laboratory there and designed cosmic-ray research
hardware and software which his team flew on six NASA
deep-space probes and satellites. Recruited by the National
Academy of Sciences-Institute of Medicine in
Washington DC, he directed numerous consultative
studies for the National Research Council.
Appointed to The White House's Office of Science
& Technology Policy (OSTP), he began a period of
public service that included a seven-year tour in Geneva,
Switzerland representing the United States to the World
Health Organiztion working closely with the U.S. Surgeon
General. Upon return to the States, he served as
a special assistant to the Commissioner of FDA
before moving back to The White House as a trade-policy
director in the Office of The U.S. Trade
Representative. He also served at the State
Department where he was senior science advisor in OES..
He moved to a civilian rank of minister-counselor (four-star
equivalent) beginning with his tour in Geneva. With over
50 scientific and technical publications, he is listed in
American Men and Women of Science and Who's
Who in America.