13 December 2006
Slowing Pandemic with Social Action Could Have Costs, Consequences, December 12, 2006(Institute of Medicine studies community interventions to stop influenza transmission)
By Charlene Porter
USINFO Staff Writer
Washington – A prestigious U.S. nongovernmental scientific organization – the Institute of Medicine-- is urging caution about policies to close schools and workplaces if a serious influenza pandemic strikes a town and raising doubts about how effective so-called community interventions really are in slowing the spread of disease.
International health officials have been watching a highly pathogenic avian influenza strain for two years to see if it might be the virus that could set off a wave of serious human disease that would circle the planet, rivaling pandemics of the past that have killed tens of millions.
Because the H5N1 virus that causes avian influenza has killed hundreds of millions of birds in 50 nations and infected humans in 10 nations, governments are evaluating how they could respond if a highly contagious disease brings illness and death to a large proportion of their populations, raising the prospect of both economic and social instability.
In the 1918 influenza pandemic in the United States, some city and town officials took action to minimize social contacts to prevent further spread of the disease. They closed schools and theaters and prohibited worship services and community meetings, hoping the actions would keep infected people away from well people to limit the spread of the disease.
The Institute of Medicine (IOM) – part of the U.S. National Academy of Sciences – examined the implementation of these actions in the past, theoretical models forecasting the implementation of social interventions, and the available science on the effectiveness of such actions. IOM is a private nongovernmental organization that often conducts studies for federal agencies.
The IOM report, released December 12, is not conclusive, but it recommends further study on the issues and suggests that some possible actions that might seem rooted in common sense could have unforeseen consequences.
Creating stockpiles of anti-viral medications has seemed like a good preparatory step as pandemic preparation has gotten more attention, but the IOM report raises questions about the potential problems of high costs and adequate supplies.
The report also makes a strong warning about the potential for the rights of the individual to be trampled in a community effort to control a pandemic’s spread.
“While imposition of costs on individuals can often be justified, care must be taken to ensure that individual sacrifices are only imposed when necessary to protect the public’s health,” the report says. “Balancing benefits and costs is particularly important in the event of a pandemic, where the stress and fear caused by an immediate threat of widespread morbidity and mortality can lead to ill-considered decisions.”
The committee had particular concerns about the proper balance between benefits and unforeseen costs if schools closed to prevent pandemic spread. The panel speculated about whether children might be exposed to more violence outside of the school environment, or whether parents would be able to provide proper nutrition and care when children are home from school unexpectedly.
The IOM panel also looked at historical analyses of actions taken by various communities across the United States as a deadly flu spread across the nation in 1918-1919.
“[C]ommunity interventions may have lowered the peak death rate and … proactive and early implementation were associated with flatter epidemic curves,” the panel said after reviewing historical records, “although there were examples of cities that implemented the strategies but still had severe epidemics.”
The IOM panel recommends further theoretical modeling of potential community interventions and their effects to include a greater array of possibilities than have been considered so far.
Even as that work unfolds, the Bush administration has been pursuing a national pandemic preparedness plan urging state and local governments and private and business institutions to develop plans to cope with widespread sickness.
The United States is also one of the world’s leading contributors to the international effort to help developing world nations better prepare for pandemic. The U.S. contribution to that effort has topped $430 million. (See related article.)
For ongoing coverage of preparation for a potential pandemic, see Bird Flu (Avian Influenza).
Federal state and local pandemic preparedness plans are available at PandemicFlu.gov.
