BIRD FLU, LIBERTY, AND QUARANTINE
America is handling Bird Flu much as medieval Europe handled Black Plague. In the great bubonic plague year of 1348 some cities lost 40% of their populations to the horrendous contagion. Medieval quarantines, sanitary cordons, and health passports were necessary to keep sick people in their homes or cities where they lived, suffered, and died, and well people kept out of the quarantined areas and away from the infected. Brute force was required. Today the World Health Organization sounds loud alarms over a likely Bird Flu (Influenza A H5N1) pandemic, and the United Nations encourages countries to prepare vaccines and medications. President Bush has asked Congress for special powers to use the military to create medieval-style quarantines.
To control a lethal contagious disease, only three methods routinely work. Vaccine prevents the disease. Medicine treats the disease. Quarantine contains the spread of disease. America is woefully unprepared with modern vaccines and medications. So our President must resort to the medieval technique of quarantine that in the 14th through the 16th centuries saved lives but thoroughly disrupted commerce, private enterprise, and human rights.
President Bush is asking Congress to supersede the American traditional possee comitatus and allow federal use of armed troops to perform the police function of keeping sick people in and well people out of those streets, towns, cities, or sections of the country where Bird Flu will rage, sicken, and kill.
The Patriot Act has a clause that allows a Governor to declare a state of medical emergency that imposes martial law, requires each person's submission to the National Guard, demands relinquishing of personal firearms, and mandates involuntary vaccination, treatment, or quarantine. The President wants to commandeer each state's National Guard and with the military perform those acts in case of Bird Flu.
Quick review of politics of preparedness for disaster, problems of vaccine preparation, and methods of administering our pitifully meager supplies of medication suggest why our President is considering draconian medieval quarantine.
POLITICS AND PREPAREDNESS
Why ever in our proud scientific 21st century America should we use a 14th century European technique? We have not prepared vaccines. The United States through the National Institutes of Health has contracted with two firms, Chiron Corporation in Emeryville, Califorina, and Sanofi Pasteur in France, for a mere 4 million doses of vaccine. In the best of circumstances, if Bird Flu H5N1 becomes pandemic, the vaccine could protect only a mere 5% of our population. I discuss the origin, meaning, and types of avian flu in "Bird Flu and Illegal Aliens," www. NewsWithViews.com, October 6, 2005.
Political problems both current and future are sinister. Only nine countries manufacture vaccines: America, Australia, Britain, Canada, France, Germany, Italy, Japan, and the Netherlands. Europe makes about 70%. America belongs to the Global Health Security Action Group that consists of the G-7 nations plus Mexico. The Group is coordinating trials of vaccines.
When terrors of disease and death afflict treaties, will each country decide to keep its vaccine manufactures for its own people? Will countries that hate America refuse to provide what contracts demand? Will poor, dependent countries through the United Nations riot and try to commandeer vaccines or medications they consider "their right" Will rich Muslim countries such as Saudi Arabia preemptively "steal" their "share" by buying at any price?
Who in America will decide who gets what vaccine or medicine? Power to decide determines who lives and who dies. Will rationing be by age? By wealth? By social position? Will first responders and the military get first doses, as the current plan now provides? Who in government gets protected? Who rejected? Who far down in the local chain of command is considered "critical" to protect and who is expendable? Do city mayors get protection? Town councilmen? All physicians? All police and fire-fighters? All garbage collectors? Do you count? Do I?
Finland will vaccinate its entire population against Bird Flu even though the precise flu strain is not known. Current vaccines may be partially or totally ineffective. Apparently Finnish medical authorities decided that partial immunity with a premature vaccine is better than no preparation. Finns also might need less new vaccine when one is finally created if they already have built up some immunity to earlier Bird Flu variants. They may be "teaching" Finnish immune systems to be better prepared when the actual mutational variant is discovered that will create a more exact antigen against the disease.
Canada has a ten-year contract with its major vaccine manufacturer, ID Biomedical of Vancouver, and pays a special annual "pandemic readiness fee." That stipulates that in case of pandemic, the company has the capacity and will produce 8 million doses of vaccine per month for 4 months, thereby assuring a portion of the Canadian population its likely protection.
PRODUCTION OF VACCINES AND ADJUVANT
A vaccine consists of inactivated virus injected into a healthy person to stimulate his body's immune reaction in the form of antibodies to protect him against catching the real live virus. Think again if you imagine vaccine production taking place quickly and efficiently in hyper-sterile laboratories with giant vats of chemicals monitored with high-tech devices overseen by white-suited and gloved scientists. Picture chickens. In fact, picture healthy hens. Modern flu vaccines are grown during a slow course of weeks in fertilized chicken eggs.
No other organism can grow in those eggs or the vaccine product will be contaminated. The virus that grows in the eggs first must be extracted live from the cells it attacked. Then the virus must be inactivated. Only then when the vaccine is complete can that inactivated virus be injected in a live healthy person to create immunity from contagion.
One major problem with the H5N1 vaccine is that it takes two huge shots separated by a few weeks to create immunity. The large doses of H5N1 vaccine require about 90 micrograms each injection. That is about 12 times the usual flu shot vaccine dose. If the current flu vaccine capacity is a mere 300 million doses, the gigantic quantity per dose required for current Bird Flu H5N1 yields a paltry 25 million doses. Furthermore, one is vulnerable to infection between the two flu vaccine doses.
Chiron's Dr. Rino Rappuoli, based in Italy, reported in the Journal of Infectious Diseases that it is possible to cut the dose in half and create an effective low-dose vaccine if it is injected with an adjuvant. That would immediately double available doses.
The adjuvant is an addition to the vaccine injected at the same time. Of the 3 beneficial adjuvants, two are proprietary drugs owned, respectively, by Chiron and GlaxoSmithKline. These would add expense. The third adjuvant to work with Bird Flu vaccine and stretch it is common alum, a salt containing aluminum.
What about side-effects? What about individual allergic reactions to eggs and to adjuvants? What about adverse drug reactions? What about drug interactions for diabetics and people immuno-suppressed with chemotherpy? What about injuries caused by vaccination? What about deaths caused by vaccines? By vaccines plus adjuvant? All such questions remain unknowns since we do not even know which strain of H5B1 flu will be the base inactivated virus for the vaccine.
No vaccine, no immunity. No successful inoculation with the vaccine, no immunity. Then what? A person with no immunity to the Bird Flu virus who contracts the deadly disease might fight it with medication. That depends on how serious the disease is, how strong or debilitated the person is to begin with, and how fast the medical treatment gets into his blood stream.
Influenza H5N1 is resistant to two of the four major drugs used to fight Bird Flu, amantadine and rimantadine. The H5N1 virus fortunately will be killed by proper use of oseltamivir and zanamivir.
Tami-Flu is made from oseltamivir If you have access to this Roche medication, it may protect you. Only about 2 million doses per year are produced. Government is stockpiling them for use only for first responders and the military in case of an epidemic in America. Relenza, made from zanamivir, is an inhaled anti-viral that also works on some strains.
Method of administering medication determines its effectiveness. If you take a pill or a liquid, that oral drug takes 3 to 4 hours to reach its optimum blood concentration. Some of the drug may be destroyed along the way by travel from your mouth through esophagus to stomach with its many potent acids. Injectable Relenza would take about 30 minutes to reach maximum blood concentration. Intravenous Relenza would be the swiftest method of administration.
We have ludicrously small amounts of medication stockpiled and we are awaiting the advent of the vaccines. So only quarantine is left.
In his October 4 Rose Garden news conference, President Bush announced that in case of the potential disaster of a Bird Flu epidemic, he favored the military rather than local and state responders because, as he stated, quarantines would be necessary.
A quarantine today, just as in the Middle Ages, is an official legal restraint on people entering and people leaving a particular place. A house can be quarantined and everyone inside prohibited from leaving and no one permitted to get in. A block can be cordoned off and similarly quarantined. A section of a city, an entire city, or a geographic region can be quarantined. The idea is to keep the disease raging where it is and not spreading to the rest of the population outside the site of quarantine.
Quarantine through the centuries has lead to murders of those who impose and maintain the quarantines. Naturally everyone inside the quarantine wants to escape. Those cordoned out of the place of contagion do not want to get near it, or accept products from it, unless their family or their valuables are inside. That is powerful incentive to risk entrance to the forbidden place.
In case of a Bird Flu epidemic, President Bush intends to preempt state and local officials, assure a declaration of martial law, and force people to be imprisoned in their quarantines with the armed force of the American military. Contemplate what that means to you and to this nation.
The greatest danger to American liberty is not Bird Flu or even our ludicrous lack of preparedness for natural and terrorist disasters. The greatest dangers to personal liberty lurk in the insidious encroachments by leaders who are well-meaning but without sufficient passion for the Constitution, and without sufficient honor to defend to the death each American citizen�s precious, vulnerable freedoms.
© 2005 Madeleine Cosman - All Rights Reserved
Dr. Cosman is a medical lawyer located in California. Her forthcoming book in 2005 is Who Owns Your Body?: Doctors and Patients Behind Bars. She lectures worldwide on medical law and medical policy, has testified before Congress on medical law issues, and has spoken in Washington for Cato Institute and Galen Institute. She wrote the ABCs of the Clinton Medical World for Congress in 1993. A Director of California Rifle and Pistol Association, she writes "Guns and Medicine" for Firing Line. One of her 15 published books was nominated for the Pulitzer Prize, National Book Award, and was a Book of the Month Club Dividend Selection.
Madeleine promotes free-market, patient-centered medicine, and Health Savings Accounts.
Her J.D. is from New York's Cardozo School of Law, Ph.D. from Columbia University, M.A. from Hunter College, and B.A. from Barnard College. She is a member of the New York State Bar, New Jersey Bar, American Bar Association's Health Law Section, and American Inns of Court. Madeleine is Professor Emerita of City College of City University of New York and a Life Fellow of the New York Academy of Medicine.
In case of a Bird Flu epidemic, President Bush intends to preempt state and local officials, assure a declaration of martial law, and force people to be imprisoned in their quarantines with the armed force of the American military.