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November 17, 2005


Don't understand the AIDS idea. I thought, when it came to H5, we were all immunocompromised to begin with.

If anything I would have thought those among us with a STRONGER immune system (or who happen to have better immunity to H5 just by chance) would be more likely to remain asymptomatic & act as carriers & virus evolution chambers.

p.s. for example, as I learned from Webster himself, in se asia it's likely the fowl that are naturally or artifically MORE resistant (naturally: some ducks, artificially: chickens vaccinated with cheap vaccines that block symptoms but not spreading of virus) that act as carriers.

AIDS people don't handle secondary infections well. But stronger immune systems in 1918 led to 50% of the patients who died being in the 20-40 year old range, very unusual for flu.

If only I'd read your link:

It was the cytokine storm that overwhelmed so many victims of the 1918 flu pandemic. Aids patients may be spared that fate.

But equally possible, with their immune defences down, they could succumb easily to the disease.

"In that situation," said Laurie Garrett, "vast populations of HIV positive people could be obliterated by the pandemic flu."

It also notes that Webster's conclusions are based on immunocompromised cancer patients with regular flu -- which seems like a big leap.

If anything, I would expect that large AIDS-positive populations would be devastated and (as horrific as it is to say) act as a firebreak against spread of the virus.

That is what they call "equally possible" citing "health expert" Laurie Garrett -- who, post-Googling, is a science writer not a doctor or researcher or even policy person. In a showdown between me & Laurie vs. DemFromCT & Webster, I would not be betting on my side. It's counterintuitive that having AIDS would protect you against being killed by H5N1 but I understand now what you're saying about the immune system's reaction to the virus (cytokine storm) being the real killer rather than the virus itself.

One question that was raised when I heard Webster speak was, why has India been spared so far? It has denser populations than Vietnam or Indonesia, is on the same migratory bird paths, and isn't exactly a world apart hygenically. Webster suggested it was the cultural relationship with poultry -- they are not as big a part of the diet or culture in India -- and also the reduced presence of pig livestock (pig intermediaries are key in transmitting the virus from birds to humans). He indicated the combination of birds and pigs in the markets may be a major part of the menace. If that's right, it may be thankfully slower taking off in Africa... perhaps the lack of that killer combination will help balance out the effects of large HIV+ populations.

Institute prizes for effective vaccines and relax liability laws for vaccine makers. Our government has been discouraging what it should be encouraging.

while i completely agree that it makes sense to create incentives to encourage vaccine development and production.... these proposals seem about the stupidest ones i can think of.

my biggest beef is with relaxing liability laws for vaccine makers. while we're talking about economic incentives, we need to be clear that this is also going to create incentives to cut corners when it comes to safety. isn't the goal to create incentives to increase (and diversify) production - especially surge capacity. relaxing liability laws does NOTHING to create incentives for vaccine production surge capacity.

so please, let's go back to the drawing board and think up some better incentitives. here's a couple proposals off the top of my head:

first: incentives for vaccine development and production capacity.... create an artificial demand for critical vaccines. multiyear purchase orders for vaccines awarded via a joint nih/fda managed review process (yeah, it might not be the best - but do you want politicians & pharma making these decisions?). priority given to product safety, efficacy and production technology designed for surge capacity.

yes, this means more fed spending. but at least it is a shared cost - instead of cost that falls only on those harmed by unsafe vaccinations. and i argue it provides better incentives.

second: while i have no objection to prizes, that doesn't seem like enough of an incentive. wouldn't we be better off redirecting some of the "bioterrorism defense" $ towards vaccine research? it wouldn't cost anything and the same nih institute (niaid) would have the same amount of research $ - but the research priorities would change.

p.s. in the spirit of full disclosure - an nih grant pays my salary and i work in bsl 3 lab - but not on vaccine research.

I think the debate between fed support and purchasing of vaccine vs. relaxing liability is a great one, and should be what we're talking about. I do know the current system does not work. There have been pediatric vaccine shortages, flu vaccine shortages, etc nearly every year for the last five.

The status quo is untenable and in the context of bird flu, ridiculous.

"The status quo is untenable and in the context of bird flu, ridiculous."

agreed - completely and w/o reservation.

what i fear is a bad situation can be made worse (iraq anyone?)...

p.s. my thanks to you and your blogging partners for all your work educating the rest of us (and getting us thinking seriously) about pandemic flu public health issues.

selise, my pleasure. it's getting tougher to have serious discussion about this, not easier. Flu Wiki tries.

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