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Preparation for Avian Influenza: what is missing?

Posted by plosmedicine on 31 Mar 2009 at 00:13 GMT

Author: Gregory Pappas MD PhD
Position: Professor, Chairman
Institution: Department of Community Health Sciences, Aga Khan University
Submitted Date: September 10, 2007
Published Date: September 10, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

WHO has begun what may become the largest coordinated public health effort in history in response to the threat to Avian Influenza. (1) The science and tracking of H5N1 influenza has increased international concern that a deadly pandemic of influenza may be imminent. WHO is now rolling out a global program to create international surveillance and a response to what many consider an impending catastrophe.(2)

Recently the author participated in the roll out in Sudan, a country with may become a front line in the fights against a global pandemic. WHO should be congratulated for development of a well organized approach to educating public health professionals and coordinating with public health agencies. While the response program has rapidly evolved, one aspect is missing from our current approach, an understanding of the politics of influenza.

The politics of influenza has hampered influenza response measures for decades. Public health professionals need to be educated about this history and the contemporary dynamics of influenza. In the US the politics around influenza have been an impediment and should provide lessons to the global response.

First is the politics of an imprecise science. Not everyone agrees that the world is on the breach of a catastrophic influenza pandemic. Communication of risk has a political down side. The politics of industrial chicken production is an emerging driver of the epidemic and creates a new political environment in which we must work. The controversy around culling of poultry is just the beginning of a badly needed discussion on political dimension of our response.

The politics of pharmaceuticals while well appreciated are avoided by public health professionals. We must work to understand the politics of the global pharmaceutical industry and related policies if we are to succeed. To work with the industry effectively, and we must work with them, we need to be savvy and clear about our objectives.

Global equity in the response to influenza needs to be addressed. Mike Davis has called this the Titanic paradigm in which the rich of the world are in the life boards with antiviral drugs and the rest of the world is locked in steerage to perish.(3) Our training programs and our response can not ignore this critical dimension. Finally we must acknowledge and work to understand the politics of vigilance. What if it never happens? What if deadly influenza pandemic never emerges? We should not consider vigilance a failure, but the political fall out must be anticipated and addressed in our planning.

An effective response to influenza pandemic will require more than a technically excellent program. It will also require a level of political sophistication that we currently are unprepared for. Mike Davis has written an excellent book, “Monster at the Gate” that provides important insights into the politics of influenza that should be part of the basic education we provide to public health professionals. The study of the politics of influenza should become a core component of the preparation and vigilance for the pandemic that has given us ample warning.


1. J.R. Webby, R.G. Webster, Are We Ready for Pandemic Influenza?
Science 302 (5650), 1519 (2003)

2. D.J. Barnett, R.D. Balicer, D.R. Lucey, G.S. Everly GS, S.B.Omer SB, et al., A Systematic Analytic Approach to Pandemic Influenza Preparedness Planning. PLoS Med 2(12): e359 (2005) doi:10.1371/journal.pmed.0020359

3. M. Davis, The Monster at Our Door: The Global Threat of the Avian Flu. (New York: Owl Books 2006)

No competing interests declared.