Free-Floating Hostility

Monday, March 06, 2006


And the Band Played an Encore

Today, the WHO announced that Avian Flu was its highest priority, explicitly promoting it over AIDS. Read the AP story if you like. I hope your first question was "what does it mean to prioritize one disease over another?" It doesn't make a whole lot of sense from the point of view of the sick. Would I rather dies of bird flu or AIDS? Well, bird flu will kill me faster but in the company of my dying friends and family. Neither scenario represents a peaceful end, and both would kill me prematurely.

Prioritizing from the point of view of the well, which disease am I most likely to contract? Well, it all depends on where I live and what my socioeconomic status. On the one hand, avian flu is potentially highly infectious. 173 people have contracted it worldwide. HIV is, as contagious diseases go, pretty hard to contract. I really have to be intimate with someone infected to get HIV, unlike hypothetical pandemic flu. On the other hand, if I live in Botswana, then an estimated 39% of my countrymen are already HIV positive. How sure am I that I'm sleeping with the right 61%? How sure am I that my husband is? Do I have a condom budget in my average annual income of $4,300--which by the way makes Botswana a middling prosperous country--assuming I'm not one of the many earning less yearly money? And will my husband beat the shit out of me for asking him to wear a condom? Oh, wait, were you talking about birds?

Epidemiologists are not fools (well, mostly not). They know that they're comparing apples and oranges when they try to characterize one disease as more dangerous than another. They also know that AIDS is only going to get worse until a good, really good vaccine is produced, because drug regimens are tough enough to follow for rich patients and hardly plentiful among poor ones. Prevention as it currently exists is not working well enough to control the spread of the disease worldwide. If I may borrow from E.M. Forster, I say two cheers for prevention. And when will there be a vaccine? We'll get back to you on that one.

To say that Avian Flu is now the WHO's highest priority means nothing about the diseases themselves. It means that's where the money's going to go. And the labor. That is the policy makers' job, poor bastards. They know they can't get what they need to save everyone, and they have to decide which people to save. You all know from my many long posts how seriously I take flu preparation. But you'll pardon me if I'm less than surprised that AIDS has been explicitly demoted. Where is Avian Flu spreading today? Europe. Where is AIDS spreading? Africa. How exactly do you wind up with a 39% prevalence of a preventable, treatable (though not curable!) disease? Two guesses. Now what do you need to fix it? One guess. I have a feeling the resources that will now be devoted to Avian Flu will not be diverted from the WHO's Acupuncture program. We'll see. But a lot of other people won't.

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