Avian influenza vaccines and public policy
May 10, 2006
Dear Rep. Moran:
You doubtless have followed the media reports about avian influenza (“bird flu”), speculations about a mutation to contagious form, a development that was not considered possible with HIV. ABC-Touchstone aired a sensational disaster movie about bird flu on May 9, resulting in much discussion. ABC “Nightline” followed with a broadcast to present the facts more objectively.
The medical likelihood is that a pandemic would develop much more slowly than in these worst-case scenarios and that the overwhelming majority of people would recover without treatment. There is likelihood that a pandemic would more resemble the 1957 or 1968 outbreaks than the 1918 outbreak, which may have been exaggerated by historical circumstances associated with World War I. In such a scenario, however, there could be profound ethical questions about keeping certain kinds of businesses running, and about public gatherings, and about personal autonomy with a disease that is likely not to harm many of the people who are exposed and can pass it on to others (as “typhoid Mary carriers”) without becoming ill themselves. In some scenarios, there can arise ethical questions about who should do caregiving. I am concerned that overzealous government reactions could do long-term economic harm out of proportion to the real risk to life.
But the other question is why we are so far behind in vaccine development. We should be using our heads and technology to prevent a major tragedy. It appears that Congress has not yet sufficiently addressed the contingent liability issue for vaccine manufacturers, and has not explored the possibility that synthetic vaccines based on core and surface proteins and antigens could be developed quickly and given to almost everyone to prevent a catastrophic outbreak. We should have learned a lot about the biochemistry of this technology by now from attempts to make an HIV vaccine, which will still be more difficult in the long run. As documented on my website, I almost became an HIV vaccine volunteer myself in 1988 at NIH.
Go to editorial on avian influenza Go to earlier letter
Reply by Rep. Moran, June 1, 2006
Thank you for contacting my office regarding your views on avian influenza. The H5N1 strain represents a grave threat to all Americans.
While there have been important advancements in medicine, we still face the threat of pandemic outbreaks of new influenza viruses. Devastating pandemics have happened intermittently over the centuries; the last three in 1918, 1957, and 1968 killing 40 million, 2 million, and 1 million respectively. The H5N1 strain of the influenza A virus has killed approximately 200 million birds in Asia and Europe. It has resulted in the deaths of 62 of 121 people who have been infected with the virus. Although the virus has not been known to be transmissible between humans, the likely mutation of the strain is cause for alarm. While it is impossible to determine whether H5N1 will cause a pandemic, history and likely mutations make it an issue of importance and concern. It is in our best interest to prepare for the very real possibility of a pandemic.
The government has taken steps to help prepare in the event of a pandemic. The Department of Homeland Security has developed the National Strategy for Pandemic Influenza Communication, which takes a three-pillar approach to a likely pandemic. The first pillar, Preparedness and Communication, outlines activities that should be taken to organize the various state and local governments as well as multilateral health groups such as the World Health Organization. The second pillar, Surveillance and Detection, ensures early warning of a pandemic by closely watching the spread of the virus. The third pillar, Response and Containment, is triggered in the event of a pandemic to contain the spread of the virus is a calm and efficient manner.
The Department of Health and Human Services (HHS) is also working with the National Institutes of Health to develop a vaccine against a H5N1 pandemic. Recent clinical trials of a test vaccine have shown that large doses of the test vaccine have produced an immunity in healthy adults. The success of this vaccine in test trials is encouraging news.
The best way to protect yourselves and your families is to become knowledgeable and prepared for what may be a possible pandemic. HHS maintains a website devoted to information about the outbreak of a pandemic. A checklist for individual preparedness and response which can be found at the website: http://www.pandemic.gov I encourage you to visit this website as it is a valuable resource in education yourselves and your family in helping to prepare for a pandemic.
Congress has directed funding to government agencies and other organizations to develop plans for emergency preparedness. In fisca; 2005 Congress appropriate $25 million dollars to USAID to help fund overseas initiatives to minimize H5N1's potential transmission to humans. Additionally, in FY2006 Congress appropriated $3.8 billion in emergency supplemental funds to Defense Appropriations of which the State Department estimated $280 million went to global initiatives. Of the $3.8 billion, $3.3 billion was directed to HHS to synchronize and beef up our domestic preparedness through vaccine registries, disease surveillance, clinical trials, and further research. The rest of the FY2006 emergency supplemental funds went to various other agencies to continue preparation initiatives. Besides funding, Congress has worked to help coordinate preparedness in the event of a pandemic.
I have co-sponsored a Pandemic Preparedness and Response Act (H.R. 4062), a bill that would require states to have a preparedness plan and to accelerate research on development of life-saving vaccines. H.R. 4062 directs the Secretary of HHS to procure antiviral, developed vaccines, and essential medications for the Strategic National Stockpile and to develop a national system for tracking and distributing antiviral medications and vaccines. The bill would also create a national director charged with supporting the efforts of governments and organizations, as well as creating a national plan of preparedness. H.R. is pending further action in the Subcommittee on Health. Please be assured that I will continue to support H.R. 4062 and other like-minded measures as they continue to move through the legislative process.
I invite you to visit my website at http://www.moran.house.gov which contains information on other topics that may be of interest to you.
Blogger entry 8/30/2007 here.
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