Sunday, August 28, 2005

Too important to ignore

Mike the Mad Biologist has Another Anecdote About Public Health:
Recently, members of [the Alliance for Prudent Use of Antibiotics] Mexico chapter were desperately trying to find a source of colistin, the only antibiotic effective against multi-drug resistant A. baumannii. Colistin is not readily available since it is rarely used and has toxic side effects. Currently, some hospital wards (I don't have figures, sorry) in Mexico are having to be closed due to A. baumannii contamination. In the U.S., closing a ward is an inconvience because other hospitals can usually pick up the slack, but in the developing world (Mexico has First World talent, but too often, Third World resources), temporarily closing a ward in a regional hospital can be a public health disaster since there isn't any redundancy–there's one hospital, and if its ICU ward closes, well...

Anyway, the Mexico membership contacted our International Director with their situation, and he posted their message. Very shortly thereafter, members of our Brazil chapter contacted the Mexican members and moved to alleviate the colistin shortage. I don't want overplay APUA's role here, since all we did is post a message (although if you want to donate to APUA, I won't stop you); that's not the point.

The point is that this 'international' response wasn't mediated by a massive organization with a satellite communications system, 18 computer servers, and a mini air force. It was mediated by one guy at a small, non-profit organization. Hardly the stuff of Medical Investigation. And if the listserv moderator had been on vacation, who knows how much time would have been lost (or maybe the contact might not have been even made). Again, I don't want to overplay APUA's role: if necessity is the mother of invention, then medical desperation is yo' daddy. A way would have been found eventually (Probably. Maybe).

So what's the point of this story? I don't think the public realizes how fragile and tenuous much of the U.S. and global public health structure is (and part of the fragility stems from a lack of redundacy). When the anthrax attacks happened, the CDC's diagnostic response was slowed because a power supply broke on a piece of equipment (and, of course, Congress blamed the CDC, not themselves for cutting overall funding and changing the CDC's priorities so frequently that the CDC's resources were misallocated).
Obviously, the shoestring funding of the global public health infrastructure has important impacts on our ability to respond to emerging threats. Think of Ebola, or avian flu. Heck, think of antibiotic resistant bacteria in our military hospitals.

New Orleans is about to turn into a submarine city because years of warnings were ignored and the cheap was preferred to the good. Rather than making good plans for evacuating the city, or hurricane proofing it, we're left with a good shot that the levees will be overrun in the next few days, causing various mayhem: bodies will float out of graves.

the geographical "bowl" of the Crescent City would fill up with the waters of the lake, leaving those unable to evacuate with little option but to cluster on rooftops -- terrain they would have to share with hungry rats, fire ants, nutria, snakes, and perhaps alligators. The water itself would become a festering stew of sewage, gasoline, refinery chemicals, and debris.

Chris Mooney surveyed some of the projects that no one undertook before this happened.

We need to learn to respond to crises before people are dying. I said that about Darfur the other day. It's a mental block people have, and people are dying now and will die in the next few days because of it.