'Ordinary' Influenza: A Public Health Failure
Stop worrying about avian influenza. Get serious about 'ordinary' influenza.
Why? Last year, 'ordinary' influenza killed roughly 36,000 U.S. residents. That's about equal to breast cancer which kills 40,000 annually. Before the polio vaccine, the polio virus killed 3,000 people annually, and, even if you adjust for population increases, that number would be roughly 9,000 in today's terms. HIV/AIDS kills about 18,000 U.S. residents annually. That means, in the U.S., for every person who died from AIDS, two people died from influenza. With AIDS and breast cancer, people run, walk, jump, skip, and pogo stick for The Cure. Lots of bleeping ribbons. But influenza is a silent killer.
And most of those deaths could be prevented.
I've described elsewhere how a sane vaccination strategy could lower influenza deaths by eighty percent--that's over 28,000 lives. And we don't need to piously invoke Hope for a Cure. We just have to vaccinate more people--and the right ones. It's that simple.
Could you even imagine the kind of pandimensional shitstorm that would ensue if we could reduce AIDS or breast cancer by eighty percent, and we didn't, simply because we couldn't get it together?
For a long time, I was willing to support the concern about avian influenza because I figured that the steps needed to prepare for avian influenza could be 'repurposed' for ordinary influenza. All of the things we'll need to stop a pandemic are the same things we can use every year to treat the annual influenza outbreak: the ability to rapidly produce hundreds of millions of doses of vaccine, a serious distribution system (actually, having a system would be helpful), and educating people about proper public hygiene.
None of that has happened. We don't produce enough vaccine to adequately vaccinate the U.S. population against the annual epidemic (we would need roughly 200 million doses), and that's a reflection of our 'surge' capability, so good luck if an avian pandemic happens.
But what's truly scandalous is our vaccination strategy--or lack thereof. Let's leave aside the fact that people actually have to pay money to receive a vaccine against a disease that kills 36,000 people annually.
Actually, rattle that last sentence around in your noggin. For that not to be utterly insane, you have to have Ayn Rand's Atlas Shrugged shoved so far up your ass that it's sticking out of your mouth.
And the people who are vaccinated are the wrong people. Yes, elderly people should receive the influenza vaccine because it reduces their likelihood of death by about thirty percent. The focus on the elderly, however, ignores a basic, albeit Yogi Berra-esque, rule of viral transmission: the best way to avoid getting influenza is to not come in contact with people who have it. In other words, we have to vaccinate those who spread the disease: medical workers, nursing home patients and staff, and children aged 5-18. Studies indicate that vaccinating seventy percent of children aged 5-18 could reduce influenza deaths by up to eighty percent. In other words, the grandchildren are killing their grandparents.
All that requires is enough vaccine and a system to get it to the people who need to take it (for children, it's called schools). Since we can't even do this right, even though we know that we will have an ordinary influenza 'epidemic' every year, I don't think we stand a chance against a real pandemic.
The reason we haven't implemented these simple steps, I think, is because we've been far too focused on avian influenza. Quite simply, people don't really care about avian influenza. They're too focused on trying to get by, not losing their jobs, and, to use El Jefe Maximo's phrase, "putting food on their family." Worrying about something that might happen isn't even on their radar screens in any serious sense*.
We need to stop focusing on a possible pandemic, and start focusing on the annual epidemic. Because right now, we're not prepared for either.
*Of course, if you ask people, they'll state they're worried, but not enough to do anything about it, which is what matters.