H5N1 bird flu, vaccine, the MSM, and the perils of cost-benefit analysis

Estimates vary wildly about the deaths from a pandemic of the so-called bird flu, the H5N1 virus strain. A very entertaining and informative HHS powerpoint on the matter put a high estimate for the next pandemic at 7 million deaths worldwide. Some estimates range over 100 million deaths globally, based on the 1918-1919 pandemic.

What you probably don’t know is that there is already a vaccine for H5N1. St. Jude Medical developed one in 2003. Another vaccine is currently undergoing tests, though it has already proved effective almost all the time, according to the University of Minnesota in a report from early August 2005:

The vaccine, made by Sanofi Pasteur, will next be tested in adults over age 65, likely beginning in about a month, according to the Associated Press (AP), and trials in children will follow shortly thereafter. Safety issues will be examined in these groups as well as optimal dosing levels. Normally, older people, children, and people with chronic diseases are most at risk for complications of influenza. The H5N1 strain may not fit this pattern; mortality rates in the 1918 flu pandemic were highest in otherwise healthy young adults.

The high doses needed for protection against H5N1 pose obvious challenges in regard to production capacity. In a Wall Street Journal (WSJ) article today, Fauci said the 2 million US doses already ordered might cover only 450,000 people. Supplying even the amount of vaccine ordered for yearly US influenza vaccination programs is problematic, as evidenced by last flu season’s shortage when the Chiron company was unable to produce the almost–50 million doses it was to supply to the United States. In a flu pandemic, vaccine for the worldwide population would be needed.

The new vaccine, like yearly flu vaccines, is grown in chicken eggs, so the amount that can be produced is dependent on the supply of eggs that producers can supply to vaccine companies. And the growth process takes several months. Experiments on cell-culture vaccines, which would circumvent these limitations, are under way, but their clinical use is far distant. Said Fauci in the Times article, “The critical issue now is, can we make enough vaccine, given the well-known inability of the vaccine industry to make enough vaccine?”

Infectious disease expert Michael Osterholm said the news is hopeful, but he expressed great concern over supply issues. Even though the dosage will likely be refined as study continues, he told CIDRAP News, “We’re starting, from these results, with the amount of antigen needed to immunize a person standing at 12 times what’s needed for a typical flu vaccination.”

And the limiting factors aren’t only the egg supply. “We need to quickly scale up capacity,” said Osterholm, director of CIDRAP, which publishes this Web site. “Since the current annual vaccine-production capacity worldwide is about 1 billion doses of the 15 microgram–antigen vaccine, right now we have the ability to produce less than enough vaccine for 100 million people in the first year of a pandemic. This covers less than 2% of the 6.5-billion world population. The bottom line is that this will do little to stop or even arrest a worldwide pandemic.”

HHS sent out an RFP for 2 million doses of the vaccine on May 14, 2004, and here we are today, with no meaningful production of a vaccine, while health officials worldwide run around like, um, chickens with their heads cut off, shouting about the dangers of an imminent worldwide pandemic. (Can a headless chicken shout?)

Why? Why are we so unprepared? Why, given the hysteria that the MSM generated about Katrina! and Rita!, not to mention the errant snowflake, Abu Ghraib and Club Gitmo, and Natalee Holloway, why is the government apparently so far behind the curve?

The answer is: the numbers don’t pencil out for a mass production and inoculation program for the H5N1 bird flu. The cost benefit analysis says not to mass produce a vaccine for a very good reason: to date, the H5N1 virus has never exhibited the ability to infect human-to-human. It doesn’t make sense, from an economic standpoint and an allocation of medical resources standpoint, to stockpile a billion doses of a vaccine for a bug that people can’t transmit to each other. It is ridiculous to spend billions of dollars on such a wasteful enterprise. A bureaucrat would be fired, or laughed out of the room, for suggesting it……right up until the moment that the virus does begin passing person to person. The moment it does, it will be all-bird-flu-all-the-time on CNN and Fox. There probably will be a Bird Flu Network. Every government and corporate official will be relentlessly hounded and pilloried for their thoughtlessness, ineptitude, and insensitivity.

One way to deal with the hysterical media would be an appeal to adult behavior in management and editorial ranks of the MSM. Okay, next…. Another way to deal with the hysterical media would be censorship: you can’t yell BIRD FLU! in a crowded living room. Okay, next…. Maybe the American people will just have to learn to act like grown-ups, since the media surely won’t.

It is an interesting question as to what the proper preparatory role of government is in a case like this. We are big believers that, next to national security itself, a central role of governments is to prevent panics, to smoothe out what lies below the precipice. The government famously did not do this in financial panics in the 19th and early 20th century, but learned its lesson after the Great Depression — which is a central reason that the Great Crash of 2000 was a blip, not a major event. Likewise, the Bush administration did a mini-bailout of the airline industry just after 9-11: the point was really not the airlines, which have continued to have major problems, but to prevent unnecessary panics and dislocations when the nation was in shock and stressed out.

We think there is a valid argument that in cases like the H5N1 bird flu, that the government should produce some greater stockpiles of vaccine than has been done, but the case is not that strong. How many doses do you want produced? What is your justification for that number? How much should the government spend in advance of a real threat, as opposed to spending on all other priorities? You see how the argument for massive doses and massive spending falls apart. Yet, we know in the wake of Katrina! and Rita! and all the other scare stories, that a political agenda will be in play for the MSM, in addition to their natural, and economically fruitful, hysteria.

Our solution: get the available flu shot, drink OJ and plenty of liquids, stay dry and warm, avoid people with symptoms, and turn off the TV.

2 Responses to “H5N1 bird flu, vaccine, the MSM, and the perils of cost-benefit analysis”

  1. larwyn Says:

    Thank you Jack,
    Sending your post to all my family and friends. But still buying some
    paper masks to have on hand. Think that is valid cost-benefit risk.


  2. wetDirt Says:

    Influenza is most contagious _before_ symptoms show. And there is currently evidence that human-to-human transmission of H5N1 occurred in Turkey in January and Indonesia in March and July, as well as other suspected H2H. Currently, about 60% of people who get this flu, die. What isn’t known is what % of exposed people get it. So the risk of a really, really bad pandemic is out there, and not as far away as you might think. And it will arrive first in the great international airports, in people who appear healthy. The problem is that this is a low-probablity, high-risk issue. Similar issues are the risk of getting into a car accident, or having your house catch on fire. For these problems, we generally pool resources into something called ‘insurance’ to help out the unfortunates. But in an epidemic where half the population is ill, and half of those may die, where will help come from? A vaccine is insurance, and money paid out for insurance is not money down the drain, particularly if you need to file a claim.

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