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September 19, 2005

Wilson Center: Avian Flu: The Next Epidemic

diseased poultry.jpg

Washington: September 19, 2005. The Woodrow Wilson International Center for Scholars presented a webcast panel discussion entitled Avian Flu: The Next Epidemic today at the Center's headquarters in Washington, DC. Featured panelists were Michael Osterholm an epidemiologist based at the University of Minnesota's Center for Infectious Disease Reasearch and Policy, where he serves as director, and Helen Branswell, a medical writer for the Canadian Press Agency who has written an extensive series of stories on the looming Avian Flu pandemic.

Osterholm, who also serves as an associate director of the Department of Homeland Security's National Center for Food Protection and Defense, is most widely known for his article published in the July-August edition of Foreign Affairs Magazine entitled Preparing for the Next Pandemic, which raised a number of eyebrows and hackles in this country and around the world. Foreign Affairs Magazine, published by the Council on Foreign Affairs, is known to be followed closely by government policy-makers at the highest levels.

What distinguishes Osterholm is his complete unwillingness to be less than candid in describing the threat of a pandemic of overwhelming proportions brought on the H5N1 virus that has been circulating mainly in South Asia among the domestic bird population since the late 1990's. In his talk and responses to audience questions today, Osterholm makes it clear that he has little patience for politicians who insist on minimizing the looming problem

As he has done in prior talks, Osterholm began his presentation at the Wilson Center by saying that an Avian Flu pandemic is "inevitable." He believes that the disease will mutate at some point in time --"it could be this year, it could be five years out"-- in some highly significant way and become readily contagious among humans. Today, the H5N1 virus has mainly stricken in the millions the poultry populations of China, Thailand, Vietnam and most recently Indonesia. Though it is nearly impossible to get complete figures, it is known that the disease has been transmitted to somewhere over a hundred and twenty humans and that about half of those who've contracted it have died from it. But the disease has also made the jump to the migrating bird population, to rodents and swine as well as humans. It is still not known whether the disease has jumped from person to person directly, though there is some evidence of that in the latest outbreak in Indonesia. Once the virus does make the mutation, unless there is enough effective vaccine available and on hand-- it will be impossible to stop. "It is going to happen", Osterholm says.

In their back to back presentations, Osterholm and Branswell both pointed to some of the enormous challenges that lie ahead for all of us. The H5N1 pandemic has been compared to the Spanish Flu outbreak that occurred right after World War I that killed (Osterholm's figure) 50 to 150 million people. That outbreak occurred when there were many fewer people on earth and no air travel to speed and disperse transmission. For technical reasons the H5N1 strain of the virus is particularly virulent. It is new to humans and therefore will race through a population with little in the way of natural immune defenses. It will also be particularly devastating to the greater societal infrastructure because, in a perverse twist --the various versions of the common H3N2 virus tend to strike the elderly and least healthy hardest each Winter season-- H5N1 will hit hardest young adults at the peak of their physical strength and natural immunity cycles. The phenomenon, which occurred during the Spanish Flu is described by epidemiologists as a W curve. It is clearly worrisome because it means that the very strongest service providers in society, in police, fire and health, will be decimated. As Ms. Branswell, who in no way appeared to disagree with Dr. Osterholm put it: "when pandemic flu hits, there will be no calvary".

Osterholm, who wears another hat as a food supply specialist for the department of Homeland Security raises a number of extremely important points. He describes a situation in Southeast Asia where there is  now a quick turnover --three generations per year-- of billions of edible fowl, some percentage of which carry the virus, coming into close, daily contact with millions of people. He calls the chance that the virus will mutate into the pandemic form a matter of "genetic roulette" with odds of a mutation, against this dangerous wheel, 100 percent.

Given that we are probably about to face one of the great disasters of our history, the real questions arise as to what can be done. Both Branswell and Osterholm offered little in the way of palliatives. They were both able to point out the great difficulties involved in the adequate production of antiviral drugs like Tamiflu that may or may not offer much of a defense and, particularly, the primitive state of flu vaccine production not to mention the difficulties of getting it right in the face of a virus that has not yet recombined into its humanly viral state and even the simple availability of effective facemasks now exclusively manufactured in Asia and, for all practical purposes, the last line of defense.

Both panelists made it clear that it is extremely difficult to project the disastrous impact of a pandemic on the world's economic, political and social fabric given the great differences between today's world and that of 1918-20, the last model available. Osterholm has taken a hard look at the supply chain phenomenon and points out that in a modern on-demand world economy we lack even what would have been natural stockpiles of foods, and manufactured goods in the days of a slower less efficient world where warehouses abounded. Ironically, he points out that the one area where we haven't progressed technically since World War II, is the production of vaccines. He predicts, as do other economists, that there will be a worldwide economic depression as just one in a a chain of dire results. Both panelists fear the impact that a lack of plans even of disposing of the dead will bring onto national psyches.

It's hard not to take away from one of Branswell's slides the cue of Robert Webster, a professor of infectious disease who is credited with being one of the first persons to recognize the emergence of the H5N1 threat: The Canadian journalist quotes him as saying in an interview her editors toned down: "This is the one that scares us shitless... This is the worst virus I've ever met in my long career."

 

 


Download the Osterholm Presentation Powerpoint

Posted by dymaxion at September 19, 2005 06:25 PM

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