Fragments From Floyd

There is an ember of hope that avian flu might be stopped soon, while it remains only a spark and not a raging conflagration.

Will the nations with the most to lose economically gamble on the altruistic (read: economic self-preservation) move to put out the small fires in Indonesia, Viet Nam and Thailand by sending their supplies of antivirals and vaccines there to possibly contain the spread? A recent Washington Post article points out that...

"... unless antiviral drugs squelch a pandemic at the outset, their ultimate usefulness will be small. ... In theory, even a modest amount of vaccine might be useful. Fighting disease outbreaks is like fighting fires. You do not have to hose down the whole world to put the fire out, but you do have to hose down the perimeter to keep it from spreading. It might be possible to contain an H5N1 outbreak at its source if the surrounding population were immediately vaccinated.

Would the United States, Europe and Japan be willing to donate their precious vaccine supply to mount this long-shot defense? This is perhaps the biggest unanswered question in pandemic flu planning -- and one likely to be answered only at the moment of truth.

Officially, it is a possibility.

If it was done in consultation with the World Health Organization -- and with other governments that would make contributions, as well -- we would be more likely to consider it," said Gellin at HHS. But observers both in and out of the government said, not for quotation, that they doubt the U.S. government would ever send a significant amount of its vaccine stockpile overseas.

Even if this scenario played out and we gave up our stockpiles to put out small fires overseas, there remains the wildcard of spread over vast distance by bird migration (or infected airline passengers) starting too many small fires to handle; and the barrier of secrecy and disinformation across the vast Chinese borders where a significant brush fire may already be spreading.

We (global mankind, science and public health) have not adequately anticipated and prepared for such a scenario, even though we could have seen it coming for a decade or more. If we could turn back time 15 years and know with certainty the pathogens we would face in the future, would there have been any better cooperation between continents? Would we have wasted so much talent, wealth and technology (ostensibly) to protect our people and way of life from acts of terrorism if we'd accepted that it was emerging infectious disease that posed by far the greater threat to our economy and to our very survival?

It seems we may be very near the moment of truth. Is it too late to turn our swords into vaccines?