The emergence of the avian influenza virus in Southeast Asia and parts of Europe has caused widespread concern about its possible arrival in the United States. Last November, President Bush requested $7.1 billion in emergency funding from Congress to support initiatives in a national strategy against the virus. The most prominent of these initiatives includes the development of flu vaccines by the Center for Disease Control as well as the spending of over $250 million to help international partners in preventing and controlling the spread of the virus. The federal government's strategy has met with criticism from some members of the scientific community, who allege that it is not doing enough to counter the threat at its roots. This week, the Daily talks to the director of Tufts' community health program, Professor Edith Balbach, an expert on public policy and health care strategies.
Paul Lemaistre: It is uncertain whether or not the avian flu virus will become a pandemic in the U.S., but there are arguments within the scientific community that there is a strong likelihood sometime in the future. Are these arguments realistic?
Edith Balbach: There will be a flu pandemic sometime in your lifetime in the United States. I'm not going to say that it will be this particular strain of flu, [but] it's just inevitable that there are going to be flu pandemics, because the flu virus is easily caught and transported. Will this particular pandemic get to the U.S. in a bird? It could happen. Most water fowl don't cross the Pacific or Atlantic oceans. They don't go that way. If you look at bird flyways they are north to south. The way that it would get here would probably be through Alaska and through that direction. It's possible that it could get here in an exotic bird, but most exotic birds don't get into close enough contact with other birds to [get infected]. It is easier for the flu to move within human beings than it is within birds ... most types of influenzas don't move across species. You have to be within quite intimate contact with birds or other animals to catch the virus. Robert Blendon of Harvard University [conducted] a survey that showed 46 percent of Americans would stop eating poultry if the bird virus showed up in birds in the United States. There is no way that the chicken you find in the grocery store, wrapped in cellophane, is going to have any flu threat. It is ... far from being a living bird at that point.
PL: Have government efforts to develop vaccines for a possible flu pandemic, whether it is the Avian Influenza (H5N1) or not, been sufficient?
EB: Not really. The technology for making flu vaccines hasn't changed in 50 years. It still involves isolating an active virus. [In February] there will be a big meeting at the Center for Disease Control (CDC) where a group of experts around the United States will get together and try to determine which influenza strains will be around next winter [and will try to develop a vaccine]. In Bush's recent flu budget he actually did include [funding] for improved vaccine production. But that's just the production end. On the supply end, we don't have many vaccine makers in the world anymore, and even less in the United States. Vaccines are not high money makers for pharmaceutical firms... the economic incentives for creating vaccines are not strong compared to those medications that you take every day for the rest of your life. So in terms of policy responses we have to put money into vaccine development, and we have to put in some kind of incentives for companies to make these things which could mean protecting them.
PL: Should the government allocate money solely to vaccine development and distribution, or should it invest in other efforts like customs controls at airports and seaports? Does the federal government have to work overseas and foster more international coordination for these health efforts?
EB: Actually the most efficient thing that you can do is to isolate the infected, whether it is a bird or a human or anything else. Quarantining the rest of us, killing the entire bird flock, those are not really economically efficient things to do. The most efficient thing we can be doing is everything we can to work with bird populations in Asia, because that's where this epidemic is really focused. Another policy area we need to look at [is] international cooperation in terms of finding out where is the epidemic right now and seeing if there is something we can do about it. Waiting for it to affect human forms in the U.S. is a really slow way to react.
PL: What role could humanitarian agencies in the U.S. assume in combating the spread of the virus and distributing vaccines and other healthcare?
EB: What we really lack in the US...is [an effective] medical care system. People don't die of flu per se ... what happens is that your body becomes so weakened so you become vulnerable to other things. What we really need to do is administer really good care of people. We have so many hospitals that have closed. I worry a great deal that we won't have the capacity to provide the medical care to people who will need it under these conditions.
PL: Is there a need for vaccinations for the Tufts student population? Is Tufts properly equipped?
EB: I wouldn't worry about flu vaccines, particularly in the student population at Tufts. For the most part we worry about flu vaccines for the elderly and for the very young and the chronically ill - the people who won't be able to survive the first onslaught and live through it. I've never got a flu vaccine in my life; I always thought the side effects would be greater than any risk I'm going to get from the flu. The number one thing you want to do is keep yourself generally healthy.
