Dealing with Plagues

1
Dealing with Plagues

• Administrative agencies
• Prevent
• Respond
• Domestic Policy
• International Cooperation

Protective Bio-Safety Field Uniform
2
Crisis
Indifference
Curious
Govt Acts
3
Influenza

• BIRD FLU H5N1
• H5 animal origin
• 1918 INFLUENZA H1N1
• Swift onset high mortality
• Hong Kong China
• Ducks, Pigs, Humans
• Low selenium
• Watch predict

4
HK BIRD FLU
DUTCH
HK
US ARMED FORCES 1918 VIRUS
CDC
GB
ALASKAN SAMPLES
HK- CHICKENS
MEMPHIS
USDA LAB AMES, IOWA
SWINE
PENN 83 20 M
5
Contrast HK Malaysia

• Malaysia didnt send samples
• Why?
• 2 factors
• Thought it was known disease
• Misdiagnosis
• Pride - didnt like attitude of Western
  scientists

6
WHO promotes
Reagents for labs
Epistemic Community
Epistemology
7
BSL Bio-safety Level

• BSL-1 - Ordinary lab
• BSL 2 - Limit entry hoods
• Pasteur Lab in France
• USAMRIID at Fort Detrick, Md
• BSL 3 - Gloves/box
• Porton Downs in GB is 3
• BSL 4 - Space suit, air-locks
• CDC (Atlanta)

8
WITHIN US

• PUBLIC HEALTH SERVICE
• Centers for Disease Control BSL4
• One maximum containment facility
• US ARMY - Fort Detrick, MD
• BSL 2 LAB PLUS
• 2 MAX. CONTAINMENT UNITS.
• STATE LABS (VARY - QUALITY)

9
Labs funded by governments Reagan cuts by 1983

• Health Services FTE
• 9348 to 3314
• Eliminate STD units
• Infectious Diseases FTE
• 100 to 24
• Continued chronic disease
• Middle class, Elderly

10
Response over time

• NGO EFFORTS WEB TIES
• ProMED (FAS), Univ data banks
• 1990
• 1st computer monitoring of disease outbreaks in
  US
• 1/2 vaccine mfrs quit
• 1991 - DOD cuts Army medical research staff
• Clinton increases staff. By 1998
• INFECTIOUS DISEASE FTE over 900
• EPIDEMIC SERVICES up to 266
• STATS up to 544

11
Politics
Interest groups are on one side Favor
health
Broad citizen support for coping and preventing
plagues
Control Spending
12
Internatl Cooperation?

• Serious Problem
• Focal Point with
• Salient solution
• Leadership
• Veil of Ignorance
• Uncertain about who will be hurt
• Equity - fair solution more important than
  efficiency
• Compliance clear cut

13
Is it easy to get international cooperation for
illness?
Influenza
look at other diseases
Before you give your final answer..