If your neighbor’s apartment is on fire, do you hoard all the water until the flames are at your door? That seems to be the U.S. response to the risk of avian influenza. The U.S. strategy (see Owen Barder’s summary U.S. Plans for Avian Flu is mostly "U.S. first." It emphasizes stockpiling existing anti-viral medications and pushing research on vaccines to serve the U.S. Particularly in the face of a global shortage, such massive stockpiling is off-base. It is politically and economically costly; worse, it fails to address the actual public health problem.I made these points at a talk yesterday in Atlanta, at the Fifth International Conference on Emerging Infectious Diseases, where experts from around the world shared sobering news about threats on the horizon and our lack of readiness. You might have seen some of the news reports. The BBC reported: Bird Flu Virus Now in Two Forms while Lawrence Altman reported in the New York Times (log-in required) that “many countries are still not promptly sharing” data about the spread of the virus.In my talk, I noted that Washington’s response to infectious diseases does not reflect an understanding of global interconnectedness – the type of understanding that we routinely see in the case of financial sector "contagion." In the "Asian flu" that macroeconomists and investment bankers talk about – the economic meltdown that started in 1997 and hit Indonesia, Thailand and Korea – President Clinton showed how worried he was about the crisis spreading to Japan, and then to the U.S., by spending five days in the region promising U.S. support and jawboning leaders to take immediate corrective action. The quick-response rescue package included commitments of $35 billion from the IMF, and another $85 billion from other multilateral and bilateral sources.In the case of avian influenza, the global preparedness efforts have mobilized less than $2 billion, including only about $330 million from the U.S., with virtually none of the U.S. resources directed at strengthening surveillance and local response capabilities, or compensating farmers in the developing world who face economic ruin if they sacrifice their poultry. Without such compensation, affected farmers won't take actions required to contain the spread of disease.There are some in Congress who understand what the stakes are and what the strategy should be. Jim Kolbe, Barak Obama and Russ Feingold are among the small handful who seem to get it. But the Administration’s response so far has been weak and alarmingly U.S.-centric.Let's be as serious about global public health as we are about international high finance. Maybe, just for a week or two, this Administration should play musical chairs: the Secretary of the Treasury switches seats with the Secretary of Health and Human Services, and the Fed chief trades with the Director of the CDC. Could be interesting….
