Katrina, flu and bioterrorism

Hello from the American Public Health Association conference. “Whats hot?” you ask. I’d say Katrina, flu and bioterrorism. Yesterday I heard talks from a passionate bunch of people disturbed about how the US government is treating public health in the era of bioterrorism. They talked on flu, bioterrorism and hurricane Katrina but some common threads quickly became clear. Funding for basic public health in the USA – things like vaccination, has fallen, as money has been diverted into bioterrorism research and anthrax and smallpox vaccines. There have been deaths as a result. Then there is military involvement in pandemic and disaster management….

Lenny Smith at Albert Einstein in New York asked why flu vaccine was not available to his poor Latino community in 2004. Lack of a variety of suppliers that year resulted in heavy dependence on 2 then one (a British company) failed, so there were shortages. In Smith’s view this was entirely avoidable, but the government had failed to ensure a variety of supply. Politics and private enterprise take too big a role at the expense of the health system, according to Smith. Recent shortages have also occurred as vaccination money was diverted to anthrax and smallpox. Smith asked the question: which disease kills more people? Smith’s conclusion is that vaccines are a political tool and the current health system is not serving the people. This is wrong “Health is a human right”.

Elizabeth Fee aired concerns that the 1918 flu virus has been recreated and made more lethal by mixing with modern strains. It has even been mixed with the current H5N1 bird flu strain. Is this wise? The molecular biologist in me was thinking – well someone has to find out why the 1918 strain was so lethal. But I can also see that the whole thing is a public health nightmare waiting to happen. What if there was a failure of biosafety? And they do happen- see the foot and mouth outbreak in Englans. In the USA there is huge funding for bioterrorism research and naturally everyone wants to get some of that. The problem, Elizabeth said, is that there is a lack of proper safety oversight – it’s being left to local biosafety committees that she says are ineffective. The government does not track who is conducting such work. Outbreak in the making?

The discussion of pandemic preparedness by Howard Ehrman brought in the military. In the event of a pandemic just the same as if there was a natural disaster like Katrina, the military is in charge. "Is this right?" Ehrman asked. Examples from the Katrina hurricane show that bad decisions were made about interventions and the health system just collapsed and still has not been restored. The current plan for a pandemic has some other flaws like the assumption that the disease will start overseas and be well established there first. No accounting for plane travel then, says Ehrman. Action to stop spread of disease is also left very late- when there are local clusters of cases already. Ehrman thinks that the people who know how disease spreads and what is effective to stop it are the public health professionals. They should be in charge.

After all that I was tempted to visit the stand near us, which claimed to have everything you need for surviving pandemics.

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