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Preparing for the Next Pandemic

. N Engl J Med, 352 (18): 1839--1842 (2005)

Zusammenfassung

Annual influenza epidemics are like Minnesota winters ? all are challenges, but some are worse than others. No matter how well we prepare, some blizzards take quite a toll. Each year, despite our efforts to increase the rates of influenza vaccination in our most vulnerable populations, unpredictable factors largely determine the burden of influenza disease and related deaths. During a typical year in the United States, 30,000 to 50,000 persons die as a result of influenzavirus infection, and the global death toll is about 20 to 30 times as high as the toll in this country. We usually accept this outcome as part of the cycle of life. Only when a vaccine shortage occurs or young children die suddenly does the public demand that someone step forward to change the course of the epidemic. Unfortunately, the fragile and limited production capacity of our 1950s egg-based technology for producing influenza vaccine and the lack of a national commitment to universal annual influenza vaccination mean that influenza epidemics will continue to present a substantial public health challenge for the foreseeable future.

Links und Ressourcen

BibTeX-Schlüssel
citeulike:845790
Eintragstyp
article
Jahr
2005
Zeitschrift
N Engl J Med
Nummer
18
Seiten
1839--1842
Band
352
citeulike-article-id
845790
priority
0
posted-at
2011-09-30 03:01:41
citeulike-linkout-0
http://www.nejm.org/doi/pdf/10.1056/NEJMp058068
comment
(private-note)4 Preparing for the Next Pandemic By Michael T. Osterholm Summary: If an influenza pandemic struck today, borders would close, the global economy would shut down, international vaccine supplies and health-care systems would be overwhelmed, and panic would reign. To limit the fallout, the industrialized world must create a detailed response strategy involving the public and private sectors. The arrival of a pandemic influenza would trigger a reaction that would change the world overnight. A vaccine would not be available for a number of months after the pandemic started, and there are very limited stockpiles of antiviral drugs. Plus, only a few privileged areas of the world have access to vaccine-production facilities. Foreign trade and travel would be reduced or even ended in an attempt to stop the virus from entering new countries - - even though such efforts would probably fail given the infectiousness of influenza and the volume of illegal crossings that occur at most borders. It is likely that transportation would also be significantly curtailed domestically, as smaller communities sought to keep the disease contained. The world relies on the speedy distribution of products such as food and replacement parts for equipment. Global, regional, and national economies would come to an abrupt halt -- something that has never happened due to HIV, malaria, or TB despite their dramatic impact on the developing world. pandemic influenza. Even with the relatively low number of deaths it caused compared to other infectious diseases, SARS had a powerful negative psychological impact on the populations of many countries. In a recent analysis of the epidemic, the National Academy of Science's Institute of Medicine concluded: "The relatively high case-fatality rate, the identification of super-spreaders, the newness of the disease, the speed of its global spread, and public uncertainty about the ability to control its spread may have contributed to the public's alarm. This alarm, in turn, may have led to the behavior that exacerbated the economic blows to the travel and tourism industries of the countries with the highest number of cases." seems to me that all the discussion is on economic costs. It's in a nation's best interest to play down the threat and the casualties so that people still travel there... unless the fact they're hiding it causes fear severe social or political crisis encountered by China's leadership since the 1989 Tiananmen crackdown. China's problems probably resulted less from SARS' public health impact than from the government's failed effort to allay panic by withholding information about the disease from the Chinese people. The effort backfired. During the crisis, Chinese Premier Wen Jiabao pointed out in a cabinet meeting on the epidemic that "the health and security of Unfortunately, the public is often indifferent to initial warnings about impending infectious-disease crises -- as with HIV, for example. Indifference becomes fear only after the catastrophe hits, when it is already too late to implement preventive or control measures. What would happen today if several cities in Vietnam suffered from major outbreaks of H5N1 infection, with a five percent mortality rate? First, there would be an immediate effort to try to sort out disparate disease-surveillance data from a variety of government and public health sources to determine which countries might have pandemic-related cases. Then, the decision would likely be made to close most international and even some state or provincial borders -- without any predetermined criteria for how or when those borders might be reopened. Border security would be made a priority, especially to protect potential supplies of pandemic-specific vaccines from nearby desperate countries. Military leaders would have to develop strategies to defend the country and also protect against domestic insurgency with armed forces that would likely be compromised by the disease. Even in unaffected countries, fear, panic, and chaos would spread as international media reported the daily advance of the disease around the world. In short order, the global economy would shut down. pumps, and medicines, including vaccines unrelated to the pandemic. Many industries not critical to survival -- electronics, automobile, and clothing, for example -- would suffer or even close. Activities that require close human contact -- school, seeing movies in theaters, or eating at restaurants -- would be avoided, maybe even banned. health stuff shortfalls: Vaccine would have no impact on the course of the virus in the first months and would likely play an extremely limited role worldwide during the following 12 to 18 months of the another six months before mass production of the vaccine. Even if the system functions to the best of its ability, influenza vaccine is produced commercially in just nine countries: Australia, Canada, France, Germany, Italy, Japan, the Netherlands, the United Kingdom, and the United States. These countries contain only 12 percent of the world's population. In the event of an influenza pandemic, they would probably nationalize their domestic production facilities, as occurred in 1976, when the United States, anticipating a pandemic of swine influenza (H1N1), refused to share its vaccine. Even if the medicine were available, most countries could not afford to buy it. Critical antibiotics, for treatment of secondary bacterial infections, would also be in short supply during a pandemic. even now, Australia,s penicillin supplies are only set to last untl Christmas for some reason many countries would not have the ability to meet the surge in the demand for health-care supplies and services duty to treat Health-care workers would probably get sick and die at the same rate as the general public -- perhaps at an even higher rate, particularly if they lack access to protective equipment. If they lack such fundamental supplies, it is unclear how many professionals would continue to place themselves in high-risk situations by caring for the infected. Volunteers who are naturally immune as a result of having survived influenza infection would thus have to be found and employed. That means that the medical community's strong resistance to using lay volunteers, which is grounded in both liability concerns and professional hubris, would need to be addressed. access Who would have priority access to the extremely limited antiviral supplies? The public would consider any ad hoc prioritization unfair, creating further dissent and disruption a year from now Health professionals must learn how to better communicate risk and must be able to both provide the facts and acknowledge the unknowns to a frightened or panicked population. There must also be an international plan for how the vaccine would be allocated. It is far better to struggle with the ethical issues involved in determining such priorities now, in a public forum, rather than to wait until the crisis occurs. The current BioShield law and additional legislation recently submitted to Congress will act to enhance the availability of vaccines in the United States.
URL
/brokenurl#10.1056/NEJMp058068; http://content.nejm.org

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