Psyche, Science, and Society

Avian flu and public health’s Maginot Line

November 9th, 2007

I haven’t mentioned avian influenza for a long time. But that doesn’t mean that the threat is gone. As Revere points out at Effect Measure, the threat is the same it always was. As in all things human, it’s a matter of probabilities ad possibilities, never certainties. Revere today points out that the appropriate public health response our government should be taking would be good for all of us:

Public health’s Maginot Line

Influenza A/H5N1 (bird flu) bubbles away this year much as in past years and public health professionals continue to wait with bated breath for the other shoe to drop. It could happen this year, next year or not at all. That’s the way the world is. Betting on “not at all” isn’t considered prudent by most people in public health, despite the fact that it’s possible. So given the uncertainty, what is the best strategy?

It is a bit disconcerting to see that the overwhelming preponderance of resources to pandemic preparedness resources are going into influenza-specific counter-measures, particularly vaccines and antivirals. If a pandemic doesn’t materialize not all of it is wasted. The boost that the threat of a pandemic has given to vaccine technology is real and significant and will pay off in the long run for diseases other than influenza for which vaccination is a reasonable preventive. So that’s good. Antivirals are more narrowly specific to influenza. Both are narrowly conceived, however, and are framed in terms of an uncertain event. But they are not the only reasonable response, nor even the ones where, if we were gaming out the possibilities, the likelihood of biggest pay-off would come. What are we suggesting?

In our view the biggest benefit comes with investment in public services which strengthen the community’s response to health threats of all kinds. Investment in routine public health — vital data and surveillance, substance abuse, elder care, maternal and child health, infectious disease control, human resources, social service support for the ill in the community and all the rest of it — is the place where we would put most of the money. If national planners are reluctant to give up the “magic bullet” approach of vaccines and antivirals then we are talking about additional investment. Given that every dollar invested in infrastructure is almost certain to pay off in multiple dollars of saved expense, we can afford this. And if a pandemic does come, it will pay off handsomely there, too. Vaccines and antivirals still depend upon the public health system. They don’t work at a distance.

We’ve been saying this for three years. It is not a change in attitude occasioned by a new threat assessment. On the contrary, our threat assessment has not changed at all. Only the virus changes. Whether the viral changes we are seeing is bringing us closer to a pandemic, farther away from one or are neutral in that regard we don’t know. So we have to respond in the most rational way.

The strategy of vaccines and antivirals appears to us a public health Maginot Line. Effective if the enemy comes that way. But if it goe

Entry Filed under: Avian flu, Healthcare, Medicine, Public Health