Ed. Note: One of ASA’s favorite professionals in the field of reporting on the most important issues in public health is Laurie Garrett. Her work is exceptionally well respected around the world. Laurie Garrett’s rebuttal, as outlined below by Dr. Barbara Price, is extremely important for all and does follow the points ASA and ASA’s authors have made on numerous occasions in the past on the HPAI. We are nearing a crisis and all should be familiar with Garrett’s arguments - her six points plus other information as elaborated in Dr. Barbara Price’s review that follows.

Preparations for a possible bird flu pandemic

Laurie Garrett, a professional in public health and public health awareness, takes issue with a TV personality.

review and comment by Dr. Barbara Price

          “A recently released book, False Alarm: The Truth About the Epidemic of Fear by Marc Siegel is causing a stir. In an interview by the Council on Foreign Relations, Dr. Siegel, a physician, news columnist and TV expert, talked about the book. When asked about why there is so much fear about something general, such as epidemics, he asserts that part of the fear comes from the repeated news on all media about the possibility and our human tendency to believe we will be next to be sick. However, Dr. Siegel’s point of view on SARS, where he says SARS was “a bug that was not easily transmitted,” and the risk of avian flu as a pandemic must be questioned. While acknowledging that the public health systems should be preparing, he’d like to see “30 million doses of vaccine,” Dr. Siegel appears to object to all the noise in the news about the possibility of bird flu mutating to a virus that could cause a pandemic. But wait, isn’t he a news columnist and TV medical expert?

          Laurie Garrett, author of Betrayal of Trust and The Coming Plague and senior fellow for global health at the Council on Foreign Relations, took issue with Dr. Siegel. She wrote a compelling rebuttal to Marc Siegel’s views on epidemics, which are worth reading independent of Dr. Siegel’s thesis. The complete interviews are available on http://www.cfr.org/

          “[Dr. Siegel] demands absolute certainty before he will accept risk; well, that was Condoleezza Rice's excuse for rejecting Richard Clarke’s memorandum warning of an Al Qaeda attack in August 2001.” Garrett then points out the last White House request for possible bird flu pandemic preparation was only 6 per cent of the over $3 billion spent to prepare the US for a smallpox terrorist attack. While the possibility of an attack with smallpox is considered very small, “the government argued” that although the virus had been eradicated, there were known frozen samples in Russia and the United States. Since the Soviets had violated the bioweapons agreement, and there were also possibilities that terrorists could already have obtained samples from them, the preparation was justified.

          Garrett continues explaining why the preparations for a possible bird flu pandemic are important and comparing them to preparations for smallpox from a terrorist attack.
          “1 The virus is genuinely in circulation in a geographic area that now spans from southern Indonesia to central Siberia, a distance of thousands of miles. This week we have word of discovery of H5N1-infected birds on the European side of the Urals and in the Caspian Sea, making it virtually certain the virus will now spread across Europe.
          2 Unlike smallpox, which infects only one species on Earth (humans), H5N1 has been found in dozens of species ranging from migratory birds to pigs to humans.
          3 The virus is actively mutating, taking on new and unpredictable characteristics.
          4 Smallpox has at worst a 30 percent mortality rate in unvaccinated human beings, but the H5N1 kill rate in humans so far is 55 percent.
          5 Smallpox vaccine is 100 percent effective, and a single stockpile, if properly stored, lasts for decades and would be effective against any smallpox strain. The virus does not readily mutate in nature.
          6 In contrast, we have never in history managed to manufacture more than 250 million doses of flu vaccine in a timely manner. It is extremely difficult to make, requires some six to nine months to manufacture even meager supplies, and most of the world's more than six billion humans have no prayer of accessing it. Further, the virus continuously mutates, so a vaccine effective in one season may be useless in the following one.”

          Other points that Garret makes that are also important include:

          “A recent study published in Nature demonstrates that it is possible to stop a virulent pandemic, but only if it is identified and contained at the level of just thirty human cases.”

          “The lag time from identification of a case to global notification from Vietnam, for example, is averaging eight weeks. If H5N1 makes the necessary mutational change to become a rapid human-to-human transmitter, it is a virtual certainty that it will spread far beyond thirty people in eight weeks.”

          And finally, “Dr. Siegel appears not to realize just how difficult it is to both manufacture appropriate vaccines and to distribute and use antiviral drugs. He also appears not to appreciate the difference between preparing middle class Americans for a threat, versus the citizens of the entire world. Resource scarcities in developing countries are so acute at this time that nothing would stop the movement of pandemic flu through their populations.”