In today’s Friday interview the John Locke Foundation’s Mitch Kokai discusses bird flu and a possible world pandemic with Bennet Waters, clinical assistant professor and deputy director for executive programs in the UNC School of Public Health’s Department of Health Policy and Administration. The interview aired on Carolina Journal Radio (click here to find the station near you).
Kokai: First of all we should point out that you are associate medical officer for the U.S. Department of Homeland Security, but you’re not speaking to us today in that role.
Waters: Correct.
Kokai: Okay. So this is in your role — putting on your hat for UNC-Chapel Hill — in your expert role, not homeland security role.
Waters: I don’t know that I would take it to the level of expert, but certainly my public health [role], yes.
Kokai: Okay. So in 2005 we heard quite a bit about the possibility or probability of another pandemic in the world. How much planning do we need to do for such a pandemic at this point?
Waters: Mitch, I think at this point the issue is to plan as much as we possibly can. There’s been an awful lot written about the avian influenza outbreaks in Asia and the migration of that virus in various parts of the world. One of the things that I think rings true in all of our public-health preparedness is that we do as much as we can, based on what we know at this point. Clearly there have been pandemic influenzas in the past and we have perhaps not been as prepared as we could be as a nation. So the effort now is to use this lead-time to prepare. Whether this turns out to be the virus that causes the next pandemic or not — probably we won’t know for certainty until there is actually an outbreak — but we do know that pandemics recur over the course of history, and we have at least a strong reason to believe that this avian influenza virus shows the potential to produce the next pandemic. And whatever preparations we can start now will probably bode well for the future.
Kokai: Now, based on our past experience, in what we know about pandemics from years past, just how much of a threat could the next one be to us?
Waters: Well, I think it depends on how you define “the next one.” I think that clearly the next one will be a significant threat to us, as have previous viruses been threats to us. Whether the H5N1 turns out to be the next virus, I guess, is a question that remains to be seen. What we know about the virus at this point is that it shows an awful — or shares an awful — lot in common with viruses from, perhaps, 1918 — the Spanish influenza that so much has been written about previously. The virus has shown ability to be sustainable and to be a lethally transmittable disease within the avian population. It has shown the ability to migrate with traditional migratory patterns. It has shown the ability to have limited, and certainly very concentrated at this point, bird-to-human transmissibility. But all of those are things that suggest to us that the virus does have a mutate-able property to it, and clearly paying attention to that is of the utmost importance. Whether H5N1 results in the next pandemic, again, is a question that we will not be able to answer until a sustained human-to-human transmission starts and we identify that particular virus and type it. But again, the similarities between this virus and the 1918 pandemic virus are striking.
Kokai: And for folks who have not read the literature, H5N1 is the particular bird flu virus that we have read so much about.
Waters: That’s correct. That’s what we were referring to as the bird flu.
Kokai: Now, based on the past experience, just how long might a pandemic threat last? This isn’t something that just whips through in a couple of weeks or a couple of months, is it?
Waters: No, typically not. And one of the things that makes a pandemic virus so troublesome is that, by definition, it’s a virus against which we have very little naturally occurring immunities. So this is very different from the seasonal flu for example, for which there is typically a vaccine in the late summer/early fall, based on what we have already identified this year’s flu bug to be. With the particular virus that we’re dealing with now, there is little to no human resistance to this, because it has not been a naturally occurring human virus to date. What we look at — and I would say that I’m certainly not an infectious disease specialist and I would caution anyone against my advice in this regard — but typically we can look at 12-to-18 month cycles for new viruses that occur naturally, and that the body then develops immunities to. But I think even by the best estimates, we’re looking at a year or more of fairly sustained outbreak.
Kokai: Before we ask the next question, there are a couple of Web sites that you mentioned to me before we started this interview that have a lot of basic, detailed information that could help folks. So mention those if you would.
Waters: Now, I’m glad you asked that question, but you know, one of the most frequent questions that I get is, “What can we do to prepare? If I buy into the fact that I should prepare, then what do I do?” And in an effort to be proactive, the government has established two separate Web sites. One is www.ready.gov and the other is www.pandemicflu.gov. Both of those sites contain a great deal of information that has been put together in partnership with the Departments of Health and Human Services, the Department of Homeland Security, and other federal agencies to help individuals — be they at the local, state, or federal level — figure out exactly what they can do to be prepared.
Kokai: Now, as folks are looking, Dr. Waters, at this issue, should they be worried?
Waters: I think it depends on how you define “worried.” I don’t think we need to ring the bells and create a sense of public panic at this point. But I do think that people should be paying attention — and we know from past lessons that preparedness is the best force multiplier in responding to these sorts of things — and to the degree that people are aware of this, are taking some responsibility at the personal level and then taking steps to prepare. I think that’s probably what I would offer as the best recommendation at this point.
Kokai: Now, of course Carolina Journal Radio is tied to the John Locke Foundation, a group that is very interested in personal and in civil liberty, and some of the articles that we’ve read about a pandemic talk about the issue of potential large-scale quarantines or government regulation of where and when you can go to certain places. Is it likely in the next pandemic we will have to deal with some restrictions of that sort?
Waters: Well, at the risk of evading your question, I’m going to say it depends. And I say that it depends because I think that we should endeavor to find regulations that are grounded in good science and to allow good science and good medicine to drive our policy decisions. I think to make broad-based blanket statements about quarantine or sheltering in place, or restrictions on individuals at this point is probably premature. Some of the science that I’ve seen suggests that in Asia in particular, where there have been isolated cases of human avian influenza infection, separating those folks from frequent close contact with either their family or neighbors has had some effect in minimizing the spread, and you know, we can argue whether that has affected the human-to-human transmissibility or not. But once we have a global outbreak and a true pandemic situation, the science that I’ve seen to date has not really reached a definitive conclusion about the efficacy of sheltering in place or quarantine. We know with all influenzas that they’re spread by close, personal contact and so forth. And so to the degree that we can limit the exposure that we have to infected individuals, that’s another step in the planning and preparedness process, but to say that quarantine will be the solution I think, at this point, is not well grounded in science. So at a certain level, all laws are intrusions on individual liberties, and we certainly have a number of laws that protect the public’s health, and these date back to the 1700s and 1800s with tuberculosis and so forth. But again, those are based in sound science, and unless and until we’re sure that sound science demonstrates the efficacy of quarantine or restrictions on individual liberties, I would say that those are probably not primary control strategies over us.