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March 28, 2006

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The trouble with this flu thingie is that all you can do is wait after you stock up on food, water, fuel and batteries - which we did long before H5N1 was part of our vocabulary because we live in earthquake country. At least in the days of the early Cold War, you could practice "duck and cover." Useless drill, but less boring that drumming your fingers.

Well, at least I can read the newest Flu Wiki stuff. Nice interview with Mr. Kim, DemFromCT.

We can rebuild our public healthj infrastructure, including state and local social services, clinics, etc.

We can push offcials to release hoarded sequence data and cooperate on science.

we can rebuild the concept of neighborhood (see Community projects).

we are activists. We can do a lot.

As Larry Brilliant reminded us, it was the activists who pushed and pounded and raised hell until there was some serious funding for AIDS research. We will need to do likewise.

geez. I should have known you'd go all holistic on me. And, of course, you're right.

Saw a good interview with epidemiologist Michael Osterholm in the Twin Cities' City Pages. Naturally, he talks about the biochemical reasons to be more or less concerned about the H5N1 virus, but what I thought set the interview apart was precisely that it emphasized matters that relate to DemFromCT's second comment and earlier post “Bird Flu Preparation: We Are Not Ready”, to wit:


What's going to happen is, even if we could produce vaccines for our country in a timely manner, this global just-in-time economy we live in today is going to see the rest of the world shut down. Eighty percent of all the drugs we use in this country—all the childhood vaccines, everything—come from offshore. Your cardio drugs, your cancer drugs, your diabetes drugs, 80 percent of the raw ingredients come from offshore. I could go through a whole laundry list of other critical and essential products and services that come from offshore. If the rest of the world experiences a pandemic, we're still screwed.

A doctor of epidemiology speaking, folks. He continues to talk about the reasons that a market-driven drug industry is not interested in producing sufficient public health products like vaccines and the antibiotics that we need when vaccines fail, and about the tight status of infrastructure that would be needed for this type of disease, such as mask, ventilators, respirators, IV hook-ups … maintaining the connection between these bottlenecks and our just-in-time economy.


And the lack of strategic slack in the economy is not just in goods that relate most directly to infectious disease or respiratory care. More Osterholm:


Right after Katrina, when FEMA was trying to rescue itself, they put out a call for anyone who had a refrigerated truck unit to come and sit in one of several parking lots in the Gulf states down there, in case they had 10,000 bodies, etc. A contingent of them went. Not all of them, by any stretch of the imagination. Within 72 hours, major food manufacturers throughout the United States reported that they couldn't ship their goods. They had no trucks. We have a razor-thin capacity in this country right now on virtually everything. They had to get FEMA to release the trucks.

To paraphrase Osterholm (and maybe freelance a bit), the real problem is not that we might have an H5N1 epidemic this or next year, but that we will almost surely have some flu pandemic within what responsible people ought to think of as a reasonable planning horizon. And of course, the same planning—improving public health and social infrastructure and removing economic barriers to the meeting of essential social needs—should be part of preparing for all the other quite predictable dislocations that we are exposed to. That would take real leadership. I guess we have to find ways of providing it from the ground up, ’cause you know what's happening at the top. As the Hart-Rudman commission put it in February 2001,

Strategic planning is absent in the U.S. government and its budget processes are so inflexible that few resources are available for preventive policies or for responding to crises, nor can resources be reallocated efficiently to reflect changes in policy priorities.

(Road Map for National Security: Imperative for Change [Phase III report], page 25) and things are almost uniformly far worse now.

prostratedragon, that's exactly right. Whether H5N1 is 'the' virus is far from the point. Whatever and whenever, we are not ready.

DemFromCT, extremely helpful, detailed, answers to the questions most of us are asking, thanks.

Un-huh. And the buried “moral” of this story, ladies and gents, is when it dawns on you only after pages have been written that someone else, like your host, say, might have already hit your main point, at least go back and add the reference;·›

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