- The Washington Times - Saturday, May 23, 2009



Just when concerns about H5N1 avian flu seemed to give way to other worries - especially the flagging economy - a new strain of H1N1 swine flu swept into our consciousness. Its most recent predations, and the responses to them, led virtually every newscast for two weeks.

The electronic media, in particular, were unhelpful. Applying the ethic “If it bleeds, it leads,” they hyped the story endlessly and breathlessly and omitted necessary context. Largely ignored was the realization that yet another manifestation of the flu virus - the garden-variety “seasonal flu” that we try to ward off with vaccine jabs each year - is a consistent, big-time killer, year in and year out.

That fact has important implications for some of the choices we needed to make in real time about how to respond to the H1N1 swine flu - whether to start a crash program to make vaccine from the new virus, for example.

Characteristically, the pronouncements from the World Health Organization, an agency of the highly politicized and self-serving United Nations, have not been reassuring. Most flu and public health experts consider that their decision last month to raise the pandemic flu threat to the penultimate Level 5, “pandemic imminent,” far outpaced the data and was overly alarmist and unwarranted. The “imminence” of a pandemic has pushed governmental authorities and individuals into unwise decisions: unnecessary school, business and event closings and purchases of anti-flu drugs on the Internet - a source of counterfeits as often as not.

Flawed decision-making is typical of the WHO, an organization that is scientifically mediocre, unaccountable and self-serving and whose leadership is based on a kind of international affirmative action instead of merit. The WHO may be well equipped to perform and report worldwide surveillance, but its policy role should be limited.

The decisions are difficult. Should countries close their borders and restrict domestic and international trade? Should they rush to prepare vast amounts of vaccine? What should be the criteria for prophylaxis or treatment with anti-flu drugs?

Closing borders would deny access to many items made abroad that are needed during a pandemic, including masks and gloves, electrical circuits for ventilators and communications gear, and certain pharmaceuticals and their precursors. It also would severely disrupt commerce and the creation of wealth, both of which ultimately impair the health of individuals and societies. The WHO’s Level 5 warning encourages national authorities to take drastic actions.

Far worse is the WHO’s having put vaccine companies on notice that within a few weeks it likely will request that some commercial flu vaccine production be directed to H1N1 swine flu. Even if we did begin to formulate and manufacture vaccine immediately, it likely would arrive far too late to attenuate significantly the first wave of infections, but a crash program to manufacture vaccine could possibly blunt the second wave, if there is one. (Historically, flu pandemics have come in two or three waves, lasting a total of 13 to 23 months. In the case of Spanish flu, the vast majority of deaths occurred during the second wave, which began several months after the first, possibly following a genetic change in the virus during its sojourn in the Southern Hemisphere during the winter months.)

However, the production of a swine flu vaccine could occur at the expense of next winter’s vaccine against seasonal flu - which kills 30,000 to 40,000 a year on average in the United States (and an order of magnitude more worldwide) even when a significant fraction of the population is immunized with an effective vaccine. The absence of adequate supplies of vaccine against next winter’s seasonal flu would invite a public health catastrophe.

The Associated Press reported that U.S. Health and Human Services Secretary Kathleen Sebelius said Tuesday that the United States is working to boost its production capacity for seasonal flu vaccines so those factories could switch to the pandemic swine flu strain if needed. “At this point, we have not placed orders for vaccine,” Ms. Sebelius told reporters in Geneva.

Unless the current situation changes drastically, any suggestion from WHO to shift vaccine production to vaccine against H1N1 swine flu should be rejected categorically.

Although pandemic strains of flu often are both qualitatively and quantitatively much worse than the seasonal flu viruses, the H1N1 virus causing the current outbreak seems to be relatively benign. Except for Mexico (for reasons that remain unclear) illnesses generally have been mild, hospitalizations few and mortality minimal.

Where are we, then, after about two weeks of accumulated knowledge and widespread publicity about the outbreak? For one thing, we’re bedeviled by cost-benefit decisions of all sorts. Only hindsight will pick the winners and losers, but it appears U.S. public health officials - particularly those at the Centers for Disease Control and Prevention and the National Institutes of Health - have acted with appropriate judgment and restraint: They continue to accumulate, analyze and disseminate information and to offer advice to the public and to health professionals.

They are preparing for a worsening of the situation but are not overreacting. They have made testing kits widely available across the country and abroad. Their research laboratories are working around the clock, performing sequencing and other analyses of swine flu isolates, and they are preparing contingency plans in case the situation changes suddenly. Perhaps most important, they are not making dubious, alarmist pronouncements.

The ease and rapidity of international travel raise the stakes for the prospect of emerging diseases. The current outbreak of H1N1 swine flu could serve as a valuable wake-up call. It could make us think critically about who will be entrusted with public health policy decisions in future.

Henry I. Miller, a physician, molecular biologist and former flu researcher, is a fellow at Stanford University’s Hoover Institution. He headed the Food and Drug Administration’s Office of Biotechnology from 1989 to 1993.

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