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Avian influenza: Katrina of Medicine

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Avian influenza: Katrina of Medicine

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    1. Avian influenza: Katrina of Medicine? Marvin J. Bittner MD MSc Center for Health Policy and Ethics Roundtable, 10/25/05

    2. “Avian flu could be the Katrina of medicine.” John Bartlett MD, Chief, Infectious Diseases, Johns Hopkins Quoted in Wall Street Journal, 10/1/05, A3

    3. MJB HMS ‘75

    4. MJB receives MSc HSPH 06/08/00

    5. Avian influenza: Katrina of medicine? What is influenza? What is avian influenza? Parallels: Katrina, avian influenza “Lessons learned”: Cliché or action?

    6. What is influenza? Impact Spread Vaccine Drugs

    7. Influenza: More than a nuisance Healthy individuals: Nuisance, but extensive, costly in aggregate At risk individuals Decompensate chronic illness Surge in hospitalizations 36,000 deaths, US, typical year

    8. WTC

    9. Cough droplet

    10. Influenza: Spread Droplets Up to 3 ft From infected individuals Ill Subclinical Asymptomatic

    11. Influenza: Vaccine benefits Reduce symptoms Reduce complications, deaths Reduce spread: Third party benefit

    12. Influenza: Vaccine challenges Shifting, drifting antigens each year Grow in eggs Acceptance Frugal buyers More regulations Lawsuits

    13. Influenza: Drugs More resistance: Amantadine (Symmetrel), Rimantadine (Rimactane) Inhalation route: Zanamivir (Relenza) Limited data: Oseltamivir (Tamiflu)

    14. Influenza perspective Surges of illness, death Need for updating vaccine; manufacturing challenges Limited drugs, particularly efficacy data

    15. Avian influenza Background Pandemics 1918, 1957, 1968 1918 40 million deaths Avian influenza (H5N1) 1997 Fowl culled, Hong Kong 2003 East Asia, > 100 humans

    16. Avian influenza concerns 50% mortality or bias? Efficient spread human-to-human? Develop vaccine in time? Only test tube oseltamivir data Mortality estimates 2-50 million?

    17. “Global warming, loss of wetlands, sinking of New Orleans: More susceptible to hurricanes” Impact depends on underlying condition of what is attacked Human activity sets the stage for severe consequences of nature

    18. Impact depends on underlying condition of what is attacked Influenza Lung disease Tolerated poorly in heart disease Are we dealing with tobacco, with other cardiac risk factors?

    19. Human activity sets the stage for severe consequences of nature New influenza strains from South China Chickens, ducks, pigs, humans live together Facilitates gene, virus spread Willing to change agricultural practices?

    20. “Knowledge of hurricanes, New Orleans topography: Consequences of Katrina were foreseeable” Study epidemics (SARS), learn from them Need surge capacity—but efficient hospitals operate at 100%

    21. “Strengthened levees (like Netherlands dikes) would have mitigated destruction” Implement known mitigation strategies for influenza Vaccines Drugs

    22. Vaccine issues Budgets, regulations (research, manufacturing, marketing), lawsuits Acceptance of shortages Pneumococcal vaccine reduces secondary infection, is underused Who has the better marketers—CDC or Procter & Gamble?

    23. Drug issues Regulations, lawsuits Patents US oseltamivir stockpile for < 10%

    24. “Lack of coordination between agencies delayed the response” Incident command (or management) advised by disaster experts to coordinate resources Yet . . . epidemic disaster planning is spotty

    25. “Evacuation plans for the poor, infirm were not implemented” Need practical, practiced plans Disappointing vaccine uptake Virginia Mason threatened to fire health care workers who refused Many high-risk unvaccinated Are we complacent about poverty & poor health outcomes?

    26. “Katrina was retribution for:” Abortion Gays & lesbians Witches Iraq war Gaza withdrawal Kyoto rejection Voodoo Corruption Murder rate Mardi Gras drunkenness Mississippi gambling

    27. Parochial response to avian influenza Researchers, public health officials want $$$ Free enterprise advocates want big pharma to get $$$ Public health officials want disaster preparedness $$$

    28. “Limited impact of $50 billion disaster on an economy in the trillions” Keep avian influenza in perspective 50,000 deaths vs. 2 million US/yr Epidemic vs. QALYs of mental illness Ongoing heart disease Worldwide: Diarrhea, malaria

    29. “Lessons learned”: Cliché or action? Influenza: Nearly annual epidemic, suboptimal response Avian influenza: Scattered, limited efforts Katrina of medicine: Depends on us

    30. Response for health based in science Shun crass politicization, “welfare queens in white coats” Epidemiologic data of CDC Cost-effectiveness of public health Investments in science Communication for health

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