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Based on concern that the pandemic of H1N1 swine flu will intensify in the fall, the White House is moving
with government funded vaccination for H1N1 -- first doses likely available by mid-October
as reported on July 7, 2009 by Betsy McKay with the Wall Street Journal. Nearly 34,000 H1N1 cases have been reported
to CDC resulting in 170 deaths to date. Health and Human Services (HHS) Secretary Kathleen Sebelius stated that her agency
starting with one million initial shots anticipates 'a voluntary fall vaccination program' and the U.S. has set aside about
$1billion for clinical trials plus production of two required bulk ingredients and an additional $7.5 billion will be available.
On June 11, 2009, as reported by Associated Press, Maria Cheng and
Frank Jordans, WHO member nations declared a swine flu pandemic setting the alert level at phase six as later formally
announced by WHO director-general Dr. Margaret Chen. This major step by the World Health Organization followed a statement
regarding a significant entrenchment of this influenza in Australia and Chile. This is the first influenza
pandemic in 41 years." As reported earlier in a Bloomberg article last week, the Former U.S. HHS Secretary
Michael Leavitt was quoted as stating that "formalization of the influenza pandemic does have cascading consequences."
The Swine Flu epidemic
entered a dangerous new phase on April 29, 2009, as the death toll climbed in
Mexico with over 2000 cases reported in that country and WHO raised Alert to phase 5. There were over 80 cases confirmed in other
counties outside the US. That
day saw the number of US cases rise to over 50.
President Obama had stated that the outbreak was cause for concern but was
not yet “a cause for alarm.”
Media coverage over the last two years 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, 2007 by the Wall
Street Journal, the 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, earlier an acting director general of
WHO had acknowledged that the world was in a ‘’down period’’ of avian flu
cases but said countries should remain also vigilant for a future bird-flu pandemic.
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
389 human cases in 15 countries since 2003 resulting in deaths of 63% (Wall
Street Journal 12-10-08) of confirmed cases – and WHO issued on May
30, 2006 a step-by-step plan to limit outbreak of the disease in humans (Reuters).
Now, we have a brand new H1N1 strain of flu
never seen in this country, Swine Flu,
that indeed has led to global pandemic.
A WHO panel was
convened April 27, 2009 to consider whether to raise the WHO pandemic alert
(at that time four, the top being phase six.). Interestingly, the new strain appears to
incorporate a combination of the old swine flu, avian flu and human flu.
A couple of years back, a study by biostatistician Ira
Longini reported in the outbreak of avian flu – a pandemic outbreak without
human transmission. His paper, published in the September 2006 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 Bush White House Plan’s focus was 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 were 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 put it: ‘’don’t rely on the fed’s’’ when it comes to a cookbook for
pandemic preparation. Happily the new
Obama administration appears to be taking a much more enlightened approach to
the Swine Flu pandemic threat! Homeland Security Secretary Napolitano is
taking the lead with the help of CDC at the moment.
Fortunately, many major cities in the United States have been paying
attentionn 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, held meetings with political, business, and
school leaders. Individual citizens have been 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 a scientific conference of over 100 nations held in Rome about a year ago
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 was exciting news in 2007 from GlaxoSmithKline, a British company,
regarding the ‘’best results to date on an experimental human vaccine for
bird flu’’ with. . . mass production possible by late 2007
or 08. 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 the earlier disappointing results 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 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. Sharon Begley has written about this in the Science Journal section
of the Wall Street Journal, 2007. She noted 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
cademeali 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 has approved 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
cademealize 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.
We will now be following closely breaking news on the Swine Flu issue as it develops.
Please watch this page over the next days and weeks as details on this
flu outbreak develop.
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.
The author was 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:
Lauren Ancel Meyers – Univ. of Texas-Austin
MARQUIS WHO’S WHO
in cooperation with THOMPSON International:
Planning for Avian Flu – The Critical Steps Your Business Should Take Now
A 90-minute, interactive audio conference – Register
Now
 THE AUTHOR: William C. Bartley, with undergraduate and advanced degrees in
electrical engineering and mathematics, began his career at Texas Instruments
later moving to academe at the University of Texas-Dallas. He organized and
directed a space-hardware fabrication laboratory for cosmic-ray research instramentation
which his co-investigator team led by Dr. K. G. McCracken 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.
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