Stick Your Arm Out For Public Health

Our View: Swine Flu Testing In Baltimore Will Be Crucial If We Are To Stop A Pandemic

July 23, 2009

Here's the pitch: All those interested in being human test subjects for an unproven vaccine against a disease that might or might not be a huge public health threat, roll up your sleeves.

Don't think you'd have many takers? You'd be wrong. The University of Maryland School of Medicine's Center for Vaccine Development was named Wednesday as one of eight sites for testing of the H1N1 (aka swine flu) vaccine in the U.S., and officials there say they are confident they'll find the 1,000 volunteers they need. The higher-profile the public health threat, the more interest people show in volunteering to combat it.

That's good to hear in an era when an increasingly interconnected world is facilitating the mutation and spread of communicable diseases. For most of its existence, UM's Center for Vaccine Development has focused on creating vaccines for diseases prevalent in developing countries and in adapting vaccines common in wealthier nations for use there. But, particularly since the Sept. 11 terrorist attacks and the anthrax scare that followed shortly afterward, it has become one of the premier locations for rapid response to emerging public health threats.

As soon as the H1N1 vaccine is available from manufacturers, the center will begin human trials in healthy volunteers, first adults and then children. Results of the tests will be reported almost instantaneously so that public health officials can make rapid decisions about which vaccine formula is most effective and what dose is optimal to protect against the swine flu. Other research will focus on the safety and efficacy of simultaneous vaccination for swine flu and the regular seasonal flu.

Final recommendations for an immunization protocol could come as early as October, in time for the traditional flu season in the Northern Hemisphere. It is, according to Dr. Karen L. Kotloff, the chief of the center's Community Studies Division, the shortest time she knows of for the development, manufacture and testing of a vaccine for a new health threat.

The fact that the nation's public health apparatus has been able to respond so quickly is a testament to the work done by the Bush administration to prepare for a pandemic. In the wake of the avian flu scare, President George W. Bush allocated billions to develop pandemic response plans and to stockpile antiviral drugs. But after that initial push, preparedness funds have been the target of cuts by both parties in Congress.

So far, the swine flu has been a relatively mild illness in the United States, but Dr. Kotloff said there's no guarantee it will stay that way. The 1918 flu followed a similar pattern, she said, with an initial spread in both hemispheres that mutated in the fall to become 10 times more deadly. Much of the problem then was due to secondary bacterial infections - less of an issue in the age of antibiotics - but the swine flu exhibits some characteristics that make it troubling, such as the high percentage of deaths that have been seen in the young.

The emergence of H1N1 should be a warning to Congressional leaders and the Obama White House that funding for pandemic preparedness is not a waste. But it should also serve as a reminder to the public that it, too, plays a crucial role in protecting public health. Not only do we need volunteers to make sure vaccines are safe and effective, but once they are proven, we all need to make sure they are widely used. Unless we stick our arms out for the vaccine, all the preparation in the world won't make a difference.

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