This past weekend the secretary of Health and Human Services issued some dire-sounding warnings about bird flu, encouraging Americans to stock up on canned tuna and powered milk. Should you be getting your bird-flu survival rations together or is it a lot of hype? What should we be thinking about bird flu? National Review Online asked some health-care and science experts. Here’s what they had to say.
John E. Calfee
Almost everyone survives the common flu because our immune systems are reasonably well prepared for it even without the latest vaccine. But a virus to which our body is completely naive could make most people very sick and a nasty one could kill 10 or 20 or even 40 percent of those who get it.
Wild birds also get the flu. They travel everywhere and infect birds living with humans–such as chickens in Asia. If an avian bug mutates to infect and easily spread among humans, we get an avian pandemic flu, i.e., a worldwide epidemic against which most of us have little resistance.
The odds of a virulent pandemic flu are very small. Pandemics occur a few times per century on average, but the only really dangerous recent one came in 1918 in the unique conditions of World War I. H5N1, the virus that to great acclaim has been killing thousands of birds and a few dozen humans, has circulated for nearly a decade with no evidence of mutating into a human-communicable virus.
But if we do get hit with pandemic avian flu, the consequences would be both extraordinary and unpredictable. No one knows how fast the flu would spread, how susceptible it would be either to existing drugs (such as Tamiflu, now being stockpiled around the world) or to quarantine, how quickly a vaccine could be put into play, or even what proportion of workers (including doctors and nurses) will show up for work as the bug spreads.
–John E. Calfee is a resident scholar at the American Enterprise Institute.
Senator Bill Frist
As H5N1 avian flu continues its spread around the globe, the United States remains unprepared to face a potential pandemic. The disease has already hit Asia, Europe, and Africa; it may soon arrive on U.S. soil. Today, we’re short on hospital beds, ventilators, protective masks, and health-care personnel. To make things worse, we still don’t have an effective vaccine or antivirals. Humans have no natural immunity to H5N1 and infected people spread the disease before they show symptoms.
Even healthy people will see consequences. An avian-flu pandemic, the Congressional Budget Office estimates, would lead to an 80 percent drop in economic activity for the entertainment, arts, and dining sectors and a severe reduction in travel. The total bill, the CBO found, would come in at $675 billion and a typical household would loose about $2,200.
We can mitigate a pandemic’s consequences, however, if we prepare beforehand. The Department of Health and Human Services has planning checklists at www.pandemicflu.gov; anyone who has responsibility for a school, church, home, business, or family ought to check them out. Every American, indeed, has both a responsibility and a duty to plan for a pandemic.
H5N1, a virulent bird flu, was once endemic to Southeast Asia–but cases are now found as far away as Afghanistan and Turkey. There is plenty to be concerned about. HHS Secretary Michael Leavitt advises us to stockpile tuna and powered milk.
The raw anxiety stems from new research suggesting that America’s deadliest flu came from birds. Eighty-eight years ago, just weeks after Babe Ruth lifted the Boston Red Sox to victory in the World Series, his hometown plunged into the hell of the Spanish flu. That horror would, in the coming days, claim the lives of 600,000 Americans; the worldwide toll exceeded the casualties of World War I.
But let’s pause for a moment. Subsequent influenza pandemics didn’t cause that type of devastation. And to date, there has been no sustained human-to-human transmission of H5N1.
What then to do? Back in the fall, the White House released a national strategy, including investing in vaccine research, coordinating with state and local levels of government, and working with foreign countries to detect viral outbreaks. These ideas were relatively modest but important. Unfortunately, Congress has been slow to act. Rather than having Americans stockpile tuna, congressional action would be more productive.
Henry I. Miller
Vaccination to prevent viral and bacterial diseases is modern medicine’s most cost-effective intervention. Were a vaccine to be available quickly after the onset of the widely predicted pandemic from an H5N1 strain of avian influenza (that is, a variant readily transmissible from person to person), it might save scores of millions of lives worldwide–but that’s not now feasible.
The reason is flawed public policy. The Vaccines for Children Program, for example, was a do-gooder innovation of the Clinton administration that disrupted market forces and dealt a blow to vaccine producers. Established in 1994, it created a single-buyer system for children’s vaccines, making the government by far the largest purchaser of childhood vaccines–at a mandated, extortionate discount of 50 percent.
Arbitrary and excessive regulation is another obstacle. The highly risk-averse FDA has been especially tough on vaccines.
Innovation has suffered and vaccine producers have abandoned the field in droves. We are woefully short of capacity to manufacture a vaccine against the pandemic strain, which cannot actually begin until we have it in hand (and have “reverse engineered” the virus to prevent it from killing the chicken embryos in which it is grown). Moreover, when a pandemic strain of H5N1 avian flu actually appears, virtually all of the world’s flu-vaccine development and production capacity will shift to producing a vaccine against it, which will leave us vulnerable to non-pandemic strains that cause the usual annual, or seasonal, flu. (The flu bug kills, on average, 30,000-40,000 Americans each year–even when we have an effective, widely used vaccine.)
We need a variety of incentives to revitalize the portion of the private sector that has been battered by policymakers and regulators–both to push forward good scientific ideas and to pull big drug makers into the field. But that won’t happen overnight, and if the pandemic begins soon–say, within 18-24 months–the death toll could be horrific.
Pandemic flu caused by the current bird virus-of-interest (H5N1) is unlikely to occur.
The virus has remained largely confined to birds for years. Only about 120 people in Asia have been hospitalized due to the virus. Although about 60 deaths have been attributed to the virus, no pandemic is likely to result from a virus that apparently kills such a high percentage of its hosts, since the hosts will have less opportunity to spread the disease.
Given that uncounted numbers of Asian poultry and other birds have harbored the virus, it’s likely that many people have been exposed to H5N1 but haven’t been made ill or at least haven’t required hospitalization. It doesn’t appear that mere exposure to the virus necessarily leads to illness. No one knows why some people are sickened after handling diseased birds but others aren’t.
The virus is not known to be transmitted human-to-human–a requirement for pandemic status. H5N1 would have to acquire significant genetic mutations before that could become a possibility.
None of this is a secret among government and public-health officials. But for petty political and financial reasons, they willfully ignore the facts in favor of fomenting fear. Sure, the public ought to be inoculated–but against the fearmongering politicians and profiteers, not H5N1.
Avian flu is the perfect storm of health scare stories. Over the past few years we have been told of an unstoppable succession of diseases that will kill millions and that we had better prepare for the worst–heterosexual AIDS, human mad-cow disease, the Ebola virus, SARS. This current one shares with mad-cow disease the idea that our food will kill us–something seen in health scares from Alar onwards. And unlike most of those other diseases it relates to an illness we are all familiar with–the flu. Yet, although a truly mutated human version of the disease could be something terrible–just as was plausible in all those other scares–the disease doesn’t even exist yet. The current form has killed only 1 in 31 million of the world’s population.
The reaction of the administration to the threat is forced on them, however. Regulatory bodies such as the EPA and FDA live by the Precautionary Principle, which seeks to spare no expense to reduce risk to zero, even from 1 in 65 million. Add to that the political calculus that, after Katrina, the administration cannot afford to be seen to be ill-prepared in the face of another potential natural disaster, and you have a perfect recipe for a mammoth diversion of resources.
–Iain Murray is a senior fellow at the Competitive Enterprise Institute
The United States is not prepared for the possibility of an avian-flu pandemic. Sadly, the U.S. government, over several decades, has crippled the nation’s once-thriving vaccine industry. In 1957, 26 companies supplied the market for standard children’s vaccines. By the late 1990s only five remained. And in 2004, the entire U.S. flu-vaccine market depended on just two companies.
The only avian flu vaccine likely to be available soon is made by the French company Sanofi-Aventis, one of the two firms we rely on for seasonal flu vaccines. But it’s not clear how soon it could be available.
So why don’t U.S. drug companies, which dominate the global medicine market, make vaccines? For one thing, vaccines are subject to excessively strict screening by the FDA. Second, vaccines are very expensive to produce. Third, out-of-control lawsuits have scared companies away from developing and producing vaccines.
If companies stood a chance of recouping their investments, the high costs of doing business might be manageable. If we remove the red tape and the price controls, we can have a vaccine industry that’s ready for the next pandemic.
Elizabeth M. Whelan
Scary rhetoric about “deadly bird flu” is intensifying. Predictions that infected birds will soon show up in the U.S. are likely correct. But there is a big difference between a virus that infects birds and one that spreads easily among humans. Unless mutations allowing such spreading occur, human deaths from bird flu will remain rare, occurring (as has been the case thus far) only among a tiny handful of people in constant contact with infected birds.
Still, there are reasons to be wary: Among humans infected with H5N1 (fewer than 200), over half died, which is a high mortality rate; also, the devastating flu pandemic of 1918 probably began in birds. Preparation is prudent, but panic is not: no need to hoard food as Secretary Leavitt recently suggested. And no need to worry about eating cooked chicken–even if infected birds appear in the U.S.
Defensive measures are underway: research into new antiviral drugs, faster techniques to make vaccines (though we can’t produce an effective vaccine until we identify the mutated virus), and stockpiling of existing antivirals (Tamiflu and Relenza). And while worst-case scenarios grab headlines, there is a possibility that any mutated virus will be far less lethal in humans than the current virus.
–Elizabeth Whelan is president of the American Council on Science and Health, which has just published the report Avian Influenza, or “Bird Flu”: What You Need to Know.