Planning for Pandemics (repost from 2005)

by John Quiggin on February 28, 2020

The news of deaths from bird flu in Indonesia is pretty scary. Although, as I’ve mentioned recently Indonesia has made a lot of progress in many respects, the handling of this threat so far seems to show the worst of both worlds: all the ill ffects of authoritian habits combined with the timidity of weak politicians. There have been a lot of coverups, and an unwillingness to tackle the necessary but unpopular task of slaughtering affected flocks of birds. Things seem to be improving now, but there’s a long way to go.

It seems very likely that, sooner or later, bird flu will make the jump that permits human-human transmission, and quite likely that a major flu pandemic will result. The world, including Australia, is very poorly prepared for this. One thing we could do to prepare is to adopt a national program encouraging annual flu vaccinations for everyone, instead of just for limited categories of vulnerable people.

The main benefit of this is not that the shots would provide immunity against a new and deadlier flu variant (though there might be some limited benefit of this kind) but that we would have the infrastructure, production facilities and so on to undertake a mass vaccination against such a variant if it arose. As it is, it seems likely that many countries will be scrambling to get access to an inadequate world supply of vaccines, but if Australia and other developed countries ramped up normal levels of production, it would be much easier to generate extra supplies for our neighbours.

I haven’t looked into it, but my guess is that, even without considering the possibility of a pandemic, the benefit-cost ratio from such a measure would be pretty high. Flu is very costly in economic terms, and I suspect that, if pain and suffering were thrown into the balance, a program of universal free vaccination would come out looking pretty good.

Notes  I wrote this in 2005 thinking about new flu strains. The only difference I see with “novel” viruses is that the time taken to produce the initial batches of a vaccine is likely to be longer. As is usual with my policy advocacy, little if anything has been done along the lines I suggested.

{ 15 comments }

1

ozajh 02.28.20 at 7:05 am

It seems to me that there are other differences, which if anything make things yet worse. It appears that infected people become infectious several days before they show symptoms, which I understand is hugely significant in terms of epidemiology once the disease has entered the general population. In conjunction with Dr Quiggin’s point about the likely timeframe for a vaccine . . .

More speculatively, there are also (very!!) recent stories indicating the possibility of re-infection and/or patients testing positive after recovery. To me the latter is the most troubling; if we have a true positive and the viral load is transmissible, then we have people turning into carriers after recovering from the infection. Cue the Zombie movie theme of your choice.

2

Cranky Observer 02.28.20 at 12:21 pm

I currently work in a highly technical facility that serves the medical world. The two most common things I hear from my coworkers when I mention I am signed up for the (free) autumn flu vaccination: (1) “why do you get a flu shot – what good does it do?” (2) “I did that once and it gave me the flu – never again”.

I despair for the human race.

3

Chris Adams 02.28.20 at 2:05 pm

Along similar lines, in the United States simply expanding paid sick leave to restaurant workers showed a 5% decline in flu cases for the entire city:

https://www.nber.org/papers/w22530.pdf

It really seems like a good angle for public health would be prioritizing transmission risk: a healthy 25 year old working in a restaurant or public school would be worth targeting from the angle of exposure even if they’re not likely to have an especially bad personal experience.

4

Alan White 02.28.20 at 4:30 pm

How things have changed over my 6-decades lifetime. As I child I remember people flocking to my local rural high-school for the sugar-cube polio vaccine, and that disease has been nearly eradicated. Today in my 30k+ Wisconsin community there is a local alternative-medicine person with a show every week on the radio proclaiming that vaccines don’t work and are harmful, among lots of other nonsense. My own anecdote? I’ve had a flu shot every year for the last 20+ years. All that time I was a professor, in close contact with 100s of people every week–and though I had my share of colds and such, not one instance of the flu.

5

Jim Harrison 02.28.20 at 6:14 pm

As of this morning, there are still no reported cases of corona virus in Indonesia. This is quite unbelievable. Of course, maybe, as its president suggested, God is protecting that nation; but my money is on another cover up reflecting the “ill effects of authoritarian habits combined with the timidity of weak politicians.”

6

Orange Watch 02.28.20 at 7:57 pm

Cranky Observer@5:

I have some sympathy for (2), though it is limited. When in the military I was required to get a flu vaccine annually. and being overall healthy I was required to get the cheaper nasal spray. Without fail, every year I’d get a mild flu – and when I was required to get an H1N1 vaccine, I got a comparatively mild case of that which was noticeably worse than my normal annual mild flu. I knew that this came down to the nasal spray being a weakened live virus versus the dead virus in the shot, so while I hated it I didn’t begrudge doing it – and I still get a flu shot every year even though I no longer have to. Happily, it’s now actually shot so I don’t get sick. I wonder if some of your co-workers had similar experiences but without the background information to understand why some of those vaccines make some people sick. That doesn’t really justify the “never again” as vaccines aren’t just about the person taking them, but it would be less despair-inducing to me than alternate interpretations.

7

ccc 02.28.20 at 10:38 pm

The root cause is the same now as it was then.

Massive reduction in zoonotic pandemic risk would be only one among several beneficial side-effects from doing what we already have supremely strong independent moral reasons to do: Abolish all human exploitation of animals for food.

8

Glen Tomkins 02.29.20 at 2:12 am

“As of this morning, there are still no reported cases of corona virus in Indonesia.”

Well, if you want to keep your number of reported cases down, two very effective measures are:
1) Don’t look for cases.
2) Don’t report any cases impolite enough to stumble into the system.

These are obviously not sound public health measures, but you can understand the temptation to see them as sound public relations measures.

9

bad Jim 02.29.20 at 8:25 am

Because I am not a good person, I made sure I had a copy of the James Tiptree Jr. story, The Last Flight of Doctor Ain to share with my family. Whenever I near the edge of despair, I recall to mind this heart-warming story of a scientist circling the globe to feed the birds.

10

Benjamin C Kirkup 02.29.20 at 1:30 pm

There are several avian flu strains currently causing culls of domestic birds and also associated with some human deaths recently. The conjunction of these with coronavirus and african swine fever virus disease is non-trivial; the strains on agriculture, the public health systems, and the population temperament are non-trivial.

11

Dr. Hilarius 02.29.20 at 11:43 pm

bad Jim, thank you for the link to the Tiptree/Sheldon story. A friend of mine mentioned the story yesterday in the same context. The remark by HHS Secretary Azar that a coronavirus vaccine might not be affordable for everyone brought up an image of the wealthy retreating into gated compounds. That image, in turn, reminded me of Edgar Allen Poe’s “Masque of the Red Death.” Cheery times.

12

John Bowman 03.02.20 at 5:01 am

bad Jim@9 – Thank you for the link. For some reason, that strikes me as a rather sweet story. Heart-warming indeed…

13

Chris Bertram 03.02.20 at 5:23 pm

John Quiggin lookalike Simon Wren-Lewis on the economic effects of a pandemic

https://mainlymacro.blogspot.com/2020/03/the-economic-effects-of-pandemic.html

14

Raven 03.03.20 at 10:23 pm

15

John Quiggin 03.05.20 at 9:02 am

“John Quiggin lookalike Simon Wren-Lewis ” Simon has kept his beard, whereas mine went the moment it ceased to be black. On the other hand, I think we have converged in terms of weight – he’s always looked lean to me.

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