The White House released a fact-sheet/summary of pandemic preparations. More has been accomplished w/r/t vaccines and adjuvants than I realized.
Archive for the 'Avian Flu' Category
…the greatest cause of economic loss will arise from the uncoordinated efforts of the public to avoid infection.
Margaret Chan, Director-General of the World Health Organization gave this speech 13 June. As she said, all the studies and simulations I’ve seen indicate that the next pandemic could cost in the trillion range — effectively an “own goal” self-inflicted damage. But I don’t see anyway to avoid the “own goal” response as everything system we depend upon is going to self-abort as workers quarantine themselves.
The preparations for vaccine production and deployment are encouraging. She didn’t comment on progress towards a rapid-realization capability for a specific vaccine.
For the first time in history, the world has been watching the conditions that might start an influenza pandemic unfold in real-time.
…
The most respected scientific journals have published scenarios of the havoc a pandemic could wreak under the unique conditions of the 21st century.
The World Bank has estimated that a pandemic could cost the world economy between 800 billion dollars and 2 trillion dollars, depending on the virulence of the virus.
But both estimates agree: the greatest cause of economic loss will arise from the uncoordinated efforts of the public to avoid infection.
…
An influenza pandemic is a unique event. I know of no other health emergency that can spread to every corner of the globe within a few months.
Once a fully transmissible pandemic virus emerges, its international spread is considered unstoppable.
The three pandemics of the previous century encircled the globe in six to nine months, even at a time when most travel was by ship.
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We know that manufacturing capacity for influenza vaccines is overwhelmingly concentrated in Europe and North America. We also know that manufacturing capacity is finite.
Current capacity is 1.5 billion doses for a monovalent vaccine. This falls far short of what will be needed for a world of well over 6 billion people, all susceptible to infection.
…
Advance procurement mechanisms for a pandemic vaccine are under development. In April, a strategic advisory group of experts confirmed the scientific feasibility of establishing an H5N1 vaccine stockpile.
The experts saw two immediate needs for such a stockpile: to intervene near the start of a pandemic in an attempt to contain it, and to allow protection of essential personnel, such as health care staff, in the initially affected countries.
WHO has initiated work to establish such a stockpile.
I am in dialogue with development partners and with executives from all the leading influenza vaccine companies. I am greatly encouraged by the firm commitments we have received from several companies.
GlaxoSmithKline is announcing their substantial commitment today to provide 50 million doses of H5N1 vaccine to a global stockpile managed by WHO, for which we are most grateful. I am also pleased to announce that Sanofi Pasteur, Omnivest and Baxter will also contribute to the stockpile. These commitments strengthen our collective security. I hope other companies will join.
…
If you put a burglar in front of a locked door with a sack full of keys and give him enough time, he will get in.
Influenza viruses have a sack full of keys and a bag full of tricks.
They are constantly mutating, constantly delivering surprises. We must not let down our guard….
With the Google Earth data visualization project, Janies says, researchers can look at how the more dangerous variants of H5N1 have emerged so that they can develop biological control strategies. Resources to solve the problem are limited, Janies notes, and some potential solutions–such as stopping all migratory birds–are simply impossible. The virtual map could show researchers the best ways to focus their efforts.
“If a picture is worth a thousand words, then a virtual globe is worth a thousand pictures,” says Robert Guralnick, an assistant professor at the University of Colorado at Boulder, who worked on the virtual-mapping project.
A web of lines superimposed on the Google Earth globe shows the various genotypes of H5N1. Each line is color-coded to correspond to a kind of host, such as waterfowl, shorebirds, mammals, or raptors. The researchers say that by looking at the timing and location of different known mutations, they were able to investigate different hypotheses about which animals are responsible for spreading the virus.
Andrew Hill, chief architect of the visualization project, says that one question he and his colleagues explored was whether the virus was being moved by migratory birds, such as waterfowl, or nonmigratory ones, such as chickens. “We found that’s a really difficult question to answer,” says Hill. “It depends on what [geographic] region you’re talking about and what year.”
A short animation of the H5N1 geomapping.
Bruno Giussani posted an 8 May update on Larry Brilliant’s INSTEDD initiative. Bruno is an excellent source for tracking the progress as Google.org doesn’t give PR much of a priority.
When I first heard of INSTEDD in the light of Brilliant’s Google.org appointment I thought “Google is the best possible backer for this program — the right attitude and the right technologies [language translation, web crawling, databases, …]. This could happen much faster than a typical NGO or government program”.
In other words this is not only a very important but it may actually happen soon. Until I read this latest post from Bruno I didn’t appreciate the pace that INSTEDD may be progressing. Bruno wrote [see original for embedded links]:
I recently met Larry Brilliant in Oxford and asked him why he has abandoned the idea of building INSTEDD on top of the already-existing Canadian system GPHIN, which he pointed out as the model during his original TED2006 speech (see video or read summary). He told me that he had realized he could build something “way more powerful” in a shorter time by relying on the Google resources and on those of many partners, including technology companies and organizations active in disaster prevention and response.
While keen to learn the particulars of aims and capabilities, I applaud what I speculate is the “Google way” of focusing on the goal. If/when concrete results are in the publications should follow. Still speculating that describes the INSTEDD program, consider how extraordinarily different this is from the typical NGO.
In this information void it is hard to appraise the significance of the pilot project — Bruno echos the TED status mentioning the pilot — implying it’s more important than I realized:
According to a status report posted on the TED website after the last TED conference, the new system is currently undergoing its first pilot project. Working with the Rockefeller Foundation and NTI (Nuclear Threat Initiative), six countries along the Mekong River (Vietnam, Thailand, Cambodia, Laos, Myanmar and the Hunan region of China) will do a tabletop exercise about how they would react to a pandemic flu.
Bruno also linked to his interview with GPHIN’s Dr. Ron St. John:
…I guess it was apparent from these posts that I consider GPHIN a formidable instrument, and a possible model for other global advanced alert systems. So I was happy to get a chance to meet with Dr. Ron St. John, the director-general of the Center for emergency preparedness and response at the Public Health Agency of Canada in Ottawa. GPHIN - run by a team of 12 people with a current budget of about 1.5 million dollars - is part of his Center.
Interesting — I missed this 11 January post which came out as we were immersed in the Hobart Summer Festival.
Technorati Tags: INSTEDD, Public Health, GPHIN
With the Google Earth data visualization project, Janies says, researchers can look at how the more dangerous variants of H5N1 have emerged so that they can develop biological control strategies. Resources to solve the problem are limited, Janies notes, and some potential solutions–such as stopping all migratory birds–are simply impossible. The virtual map could show researchers the best ways to focus their efforts.
“If a picture is worth a thousand words, then a virtual globe is worth a thousand pictures,” says Robert Guralnick, an assistant professor at the University of Colorado at Boulder, who worked on the virtual-mapping project.
A web of lines superimposed on the Google Earth globe shows the various genotypes of H5N1. Each line is color-coded to correspond to a kind of host, such as waterfowl, shorebirds, mammals, or raptors. The researchers say that by looking at the timing and location of different known mutations, they were able to investigate different hypotheses about which animals are responsible for spreading the virus.
Andrew Hill, chief architect of the visualization project, says that one question he and his colleagues explored was whether the virus was being moved by migratory birds, such as waterfowl, or nonmigratory ones, such as chickens. “We found that’s a really difficult question to answer,” says Hill. “It depends on what [geographic] region you’re talking about and what year.”
Declan Butler has constructed a Google Earth mashup of public databases on animal and human confirmed cases of H5N1. To add this network line to your Google Earth, please click on this link. Then open the downloaded file, which will auto-create the new network links.
See Declan’s blog post for the details and basic how-to, and his original post for a bit more info.
NB: you need v4.0 or later to display the time series animation.
NB: I’ve not figured out how to get the map keys to display.
Caveat: This is a pro-bono effort, so I do not know whether we can depend on the data being up to date. Similarly, accuracy is an unknown.
Technorati Tags: Public Health
Bruno Giussani posted an email outline of Larry Brilliant’s INSTEDD proposal [International Networked System for Total Early Disease Detection]:
UPDATE 19 April 06 - Here is something Larry Brilliant wrote a few weeks before TED2006 describing his vision for what he later called INSTEDD, for International Networked System for Total Early Disease Detection (this text was sent a few days ago by TED curator Chris Anderson to a few thousand people in the TED mailing list). I’m reproducing it here because it’s a powerful vision, and because it offers a few more details that are not in the texts above:
I’ve been in conversations with WHO, CDC, Johns Hopkins and the other universities from the Pandefense “consortium” about using the prize - and the TED community - to build a virtual earth, with
multiple webcrawlers
infobots
comparative historical databases
hi-res coordinated satellite photography
IM and text messaging
several other IP based systems
…
for the earliest possible detection of new outbreaks of bird flu, novel diseases like SARS and ebola, as well as new emerging biological threats, whether bio-terror or bio-error - and extending to famine, flood, natural disasters, chemical and industrial spills, forced migration and other catastrophes where time is of the essence in responding.
The world would not today be playing catch up with new pandemics if we had such a system in place 30 years ago; governments would not be able to hide cases of bird flu or genocide, they would not be able to delay reporting cases of polio and the world would have an entirely different view of emerging new communicable diseases if such a system were operative.
I don’t know if you know that SARS was first discovered by a group in Canada following up on reports from a webcrawler about cases of fever, even though the first cases were in China. The system they used, GPHIN (Global Public Health Intelligence Network) is a courageous Canadian government-owned system which crawls newspapers, websites, and public documents in only half a dozen languages. I would like to use the resources of the TED community to produce a “GPHIN on steroids” that would crawl 150 languages, be fully open source, transparent, and a trusted system, openly available to anyone especially at country and local level in the concerned countries, and at universities…
Latest news, Google, the Omidyar Foundation and VC firm Kleiner Perkins have pledged support, and many individuals around the world have done the same (there is room for more).
Technorati Tags: Bioterror, Public Health
A very useful article from Sharon Begley examines both ethics and efficacy of vaccination strategy. Tough questions.
You have 100 doses of a vaccine against a deadly strain of influenza that is sweeping the country, with no prospect of obtaining more. Standing in line are 100 schoolchildren and 100 elderly people.
The elderly are more likely to die if they catch the flu. But they also have fewer years left to live and don’t get out enough to easily spread or catch the disease. The kids are more likely to act like little Typhoid Marys, sneezing virus over anyone they encounter, and have almost their whole life ahead of them. But they’re also less likely to die if they get sick.
Whom do you vaccinate?
The primary source of infectious disease in the US are schoolchildren. Some of the research shows that disrupting that transmission mechanism is highly effective:
Last year, scientists showed in a model that if you vaccinate about 60% of U.S. schoolchildren, flu deaths among the elderly would fall to 6,600 from the typical 34,000. “It’s not necessarily true that the best way to protect someone is to vaccinate that person,” says Ira Longini of the Fred Hutchinson Cancer Research Center, Seattle. “In the case of the elderly, flu vaccine doesn’t protect them very well, so breaking the chain of transmission provides greater protection.”
In the PLoS study, mathematician Lauren Ancel Meyers of the University of Texas, Austin, and colleagues analyzed patterns of flu transmission under different assumptions about how likely a carrier is to infect other people. Using data on household size, age distribution and other factors, they compared a strategy that targets infants and the elderly with one targeting those most likely to catch flu: school-age kids.
For moderately contagious strains, says Prof. Meyers, the optimal strategy is to vaccinate the kids. “This severs the transmission chain,” she says, thereby indirectly protecting the old. For very contagious strains, it is better to vaccinate those most likely to die if they catch flu, such as the elderly. “Highly contagious strains can find their way around this buffer of immunized schoolkids,” she explains.
A commenter at economist Greg Mankiw’s blog suggested vaccinating Starbucks baristas. I agree, that is the same strategy - suppress the critical nodes.
The Larry Brilliant presentation at TED 2006 is a must see [Download the video Duration: 26:3]
Brilliant is a special man, evidenced by the fact that he was recently named Executive Director of the Google Foundation. And because Dr. Brilliant is the epidemiologist who presided over the last case of Smallpox on the planet, he is a “go to guy” for a strategy to dodge the next pandemic, which could, of course, be the Avian Flu.
Dr. Brilliant repeats over and over that “early detection and early response” is our only chance to avoid the next pandemic. He explains how Ron St. John’s Global Public Health Intelligence Network (GPHIN) found SARS some six months before WHO. Similary GPHIN found Avian Flu in Iran last September.
GPHIN uses human interpretation of red-flags detected by a web crawler that is looking at about 20 sites, mostly periodicals — in only seven languages. The data mining software used is Nstein.
Brilliant proposes a vastly expanded global early detection program — to be based upon GPHIN, but in at least 20 languages. The proposed acronym is INSTEDD [international system for early disease detection], which shows its TED roots. “INSTEDD of a hidden pandemic of bird flu, we find it and immediately contain it”. He says the detect/respond facility will also be able to deal with novel bio-terror viruses, industrial accidents, famine, etc.
Aside from the technology of detection, Brilliant believes it is critical that INSTEDD be private, independent of any government. He gives examples of serious response delays at WHO due to its siting within the UN.
There may be a connection between Brilliant’s new role with the Google Foundation and his INSTEDD proposal. Google is the best-qualified and prepared organization on the planet to implement the technology side. E.g., Google has under development what is probably the most capable machine-translation system - based upon statistical rather than rule-based methods. The rest of required infrastructure is obvious.
Technorati Tags: Medicine, Public Health
These are early research results - but certainly encouraging:
A British company reported Wednesday it had achieved the best results ever seen on an experimental human vaccine for bird flu and said mass production might be possible by 2007.
A global health official called GlaxoSmithKline’s early results “an exciting piece of science.” If future tests are as promising, it would be a major step in the frustrating campaign to protect people from a possible deadly flu pandemic.
The U.S. government’s chief infectious disease scientist also was very optimistic.
“The data are really very impressive,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “It changes the whole complexion of the issue that we have to face of getting enough vaccine for people who might need it in a pandemic.”
There are still risks that the virus could mutate into forms that the vaccine would not contain, but this is certainly a positive development for the scientific community’s effort to combat this potential global threat.
Many thanks to Homeland Security Watch for the bulletin.
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