Of birds and men
A deadly virus is brewing in Asia. Could this be the next killer pandemic?
In an effort to better predict when H5N1 could explode, scientists at the CDC in Atlanta are working in a high-level biohazard lab, mixing H5N1 genes with those of common flu viruses--a risky experiment, since that's exactly what could create a killer bug in nature. "The way to find out if you've really got a threat and Mother Nature just hasn't rolled the dice enough times is, you construct different gene combinations and you test their properties," says Nancy Cox, chief of the CDC's influenza branch. "You can learn a great deal about what might happen." Preliminary results won't be available for at least six months. "Science is often not as quick as we would like it to be," Cox says.
Indeed. The United States has been working on pandemic preparedness in various forms for a decade, but in the past year efforts have accelerated--49 states have drafted pandemic flu response plans, up from 29 a year ago. Although final plans are due to CDC by fall, most of the states are just now grappling with essential questions, such as who would get vaccines first. Healthcare workers and public-safety officers will probably top the list, says Richard Raymond, chief medical officer for Nebraska Health and Human Services. "That's a different mind-set than people are used to, and it's going to be a little bit controversial."
The Department of Health and Human Services unveiled a draft national pandemic plan last August; many reviewers said the feds need to be far more explicit, providing state and local governments with priority lists for vaccine distribution and other guidance. HHS is convening panels to revise the plan, with the aim of finishing sometime this summer. "This is one of those rare times when states are saying we really do need some direction and guidance from the feds," says George Hardy, executive director of the Association of State and Territorial Health Officials.
Public-health officials also have to maintain a delicate balance between sounding the alarm and overreacting. None of them have forgotten the swine flu debacle of 1976, when more than 40 million Americans, including President Gerald Ford, were inoculated against the swine flu virus in a campaign to head off a pandemic that never materialized.
Officials are also grappling with how to handle the economic and social disruption that pandemics cause. Pandemics last much longer than a hurricane or other natural disaster and typically hit in waves, with a first wave of infections followed by a second wave some three to 12 months later. If children fall ill, parents will have to stay home from work to take care of them, and business will suffer. Ditto if schools are closed to reduce the risk of infection. "We're talking about reducing morbidity and mortality, and maintaining social order," says Matt Cartter, epidemiology program coordinator for the Connecticut Department of Health. "There will have to be a balance. What are you going to do? Are you going to vaccinate sanitary workers so you still have garbage pickup?"