Array of factors leaves U.S. poorly prepared for avian flu pandemic, experts warn
BY LISA TREI
Professor Lucy Shapiro offered a grim assessment of the threat posed by the well-publicized strain of avian influenza spreading around the globe.
"Right now, H5N1 is actually a clear and present danger," the developmental biologist said recently about the virus that began circulating in Asia in late 2003 and has since spread to Europe and Africa. Shapiro said it is impossible to know whether H5N1 will mutate into a strain that could kill humans on a scale similar to the deadly 1918 pandemic, which cost more than 40 million lives. "It's a rare event, so it's not going to start popping up all over the world, all the time," she said. "Depending on where it happens will tell us whether it will get out."
As wild birds migrate, Shapiro explained, the potential increases for more poultry groups to be infected with the virus. With that, the chance for animal-to-human and, eventually, human-to-human transmission jumps. "Am I worried?" she said. "Yes."
Shapiro, the Virginia and D. K. Ludwig Professor, joined Lawrence Wein, the Paul E. Holden Professor of Management Science at the Graduate School of Business, and U.S. Rep. Zoe Lofgren, D-San Jose, in an assessment of the economics of disaster preparedness during an afternoon panel at the 2006 Economic Summit of the Stanford Institute for Economic Policy Research.
The daylong event featured presentations and discussions with U.S. Secretary of the Treasury John Snow, Google Chief Executive Officer Eric Schmidt and Harvard University economics Professor Martin Feldstein. Topics discussed included tax reform, energy and natural resources, and economic relations with China. University of Chicago Professor Steven Levitt, author of the best-selling Freakonomics, gave a talk. In addition to discussing disaster preparedness, participants met to talk about nanotechnology, California's greenhouse-gas targets and policy issues for the next chairman of the Federal Reserve.
Shapiro, Wein and Lofgren painted a disturbing picture of a nation largely unprepared to face infectious disease pandemics and manmade bioterror attacks in an increasingly interconnected world.
Wein, an expert in homeland security research on bioterrorism and border issues, said smallpox, anthrax and botulinum toxin attacks pose serious threats but are less likely to occur in the near future than an avian flu pandemic.
In the wake of Hurricane Katrina, Wein said, it has become clear that the government is not likely to act as a first responder following a major disaster. "The government is not going to be there for us," he said. "We need citizens to be the first responders."
Lofgren, who serves on the House Committee on Homeland Security, said the destruction caused by Hurricane Katrina demonstrated that Americans need to be as prepared for natural disasters as terrorist attacks. "Although there is some progress, the state of readiness of the United States is not what it should be," she said. "Three years after the creation of [the Department of Homeland Security] it's still a bureaucratic mess. … We have a long way to go. It's not always just a matter of funding—it's a matter of management and leadership."
According to Shapiro, the avian flu is likely to mutate at some point. For example, she said, if a flock of chickens contracts the virus in a small village in Africa with no surveillance or veterinarians operating to provide a quick, accurate diagnosis, someone with an ordinary human flu could pick up the bird strain—allowing the two viruses to recombine into something transmissible from person to person. "The 1918 pandemic arose from an avian flu by a whole lot of mutations," she said. That virus and the current strain have more than a 50-percent kill rate, she added. "This is terrifying."
If the virus mutates, Shapiro said, the United States is poorly prepared to respond. Forty percent of states lack enough medical supplies to cope with a pandemic flu. "We have just-in-time capacity with no surge capacity" for medical supplies, she said. "If you have a pandemic, you must have surge capacity." The problem is compounded because 80 percent of raw materials for drugs come from overseas, and these would be hampered by quarantines and supply delays during an emergency. In addition, Shapiro said, current antitrust rules prevent collaboration among pharmaceutical companies to speed development of new drugs. And unlike new weapons, the U.S. government does not guarantee the purchase of new drugs. "These are the things that have to be changed," she said.
To stand a fighting chance during a pandemic, Shapiro said, antitrust laws must be relaxed, the manufacturing and stockpiling of vaccines and anti-viral drugs must be scaled up and surveillance and epidemiology must be improved. "This is really critical," she said. "If you get a flare-up of a disease in a small town in Laos, we have to have some way of getting Tamiflu [an anti-viral drug] to damp down that outbreak. It doesn't help to [give] everyone in the United States Tamiflu—you have to stop it from getting out of Laos. It's naïve to think that simply by sprinkling Tamiflu over the population of the United States that this is going to protect us. No way. You have to get into the mindset that we live in a global community. We are not alone."