Philip Alcabes discusses myths of health, disease and risk.

Pandemics, politics, poverty

At Junkfood Science yesterday, Sandy Szwarc exploded some of the myths about the swine flu outbreak.  Although much is made of the fact that the hospitalizations and deaths associated with H1N1 flu infection have predominantly been among children and young adults, Junkfood notes that those numbers are no higher than in past flu seasons.  Her post quotes Dr. Anne Schuchat of CDC, who reminded the media at a May 28th briefing that seasonal flu generally comprises a mixture of H1N1, H3N2, and B influenza strains – and that H1N1 strains tend to cause relatively more illness among the young.

“Declaring a pandemic has more to do with politics than with medicine or helping you to stay safer. In fact, responses to fears about a pandemic are far more frightening and dangerous than the flu itself,” Junkfood Science points out.

At Effect Measure, a post by revere on 6 June voices skepticism over the utility of the W.H.O.’s pandemic threat alert system.  revere writes, “The WHO pandemic alert system, which was instituted in 2003 and had never been seriously tested until this outbreak, immediately met a pandemic it couldn’t handle, not because it was so severe but because it wasn’t severe enough. “  revere finds the threat alert system to be “more of a problem than a help.”

A report out this month on “Pandemic Flu” from the Trust for America’s Health, asserts that “Investments in pandemic planning and stockpiling antiviral medications paid off,” but “even with a mild outbreak, the health care delivery system was overwhelmed.”  Still, this report noted that the “WHO pandemic alert phases caused confusion.”  This is reassuringly un-martial talk for a group whose report is subtitled “Lessons from the Frontlines” and which is partially funded by the Center for Biosecurity.

We agree that the pandemic alert causes confusion – and, we’ll add, consternation – and concur with Junkfood that the alert is about politics.  But W.H.O. gets an overly bum rap.  The agency has been trying to leverage its clunky threat-alert barometer to help health officials in poor countries to plead their case for more funding or better programs, and to get us in the rich countries to notice that it’s the poor who suffer when a disease spreads globally.

The pandemic barometer as constructed is too crude an instrument for that.  As revere points out at Effect Measure, the system could be “scrap[ped]… in favor of an up-to-date information system.”

But the important point will be to shift the focus.  The medical and public health industries have to stop thinking about flu (and other contagions of world importance) as a problem only when Americans’ health is threatened.  The health sector has to start paying much more attention to the conditions under which viruses become epidemic (i.e., human disease) problems:  the many ways that humans and animals interact, especially through markets for wild-animal meat, and the interactions of wild with domesticated animals; economic conditions in poor countries that make it impossible for people to stay out of the way of virus traffic; and the poverty, crowding, and compromised health that make it easy for some viruses to spread once they start adapting to humans.

Instead of worrying about airplane passengers landing at U.S. airports, the focus should be on the real conditions that most of the world – and its viruses – lives in.

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This entry was posted on Sunday, June 7th, 2009 at 9:14 am and is filed under Disease, epidemics, Health Professions, public health. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

2 Responses to “Pandemics, politics, poverty”

Rob says:

Really helpful! Thanks!