What forms of knowledge are being brought to bear in public health responses to the current pandemic? Stephen and I have distinguished between an “archival-statistical” model of knowledge production that is characteristic of much of traditional public health decision-making, on the one hand, and an “enactment” model that is brought to bear in efforts to manage risks whose likelihood cannot be calculated based on archival knowledge. One source of contemporary methods of enactment (such as scenario planning and catastrophe modeling) was US civil defense. But these methods have reached into many new domains. As Stephen writes in “Enacting Catastrophe“:
The Next Phase
One of the interesting questions is the following: If this virus (which we are not allowed to name anymore …) continues to circulate among humans, will the WHO announce phase 6, i.e. a full-scale pandemic? With a virus that seems to cause not much mortality, this will be a difficult question. I really doubt that they will announce phase 6, even if all the criteria of phase 6 are essentially met. The pandemic alert scheme might soon need extensive revision …
Here is the WHO description of phase 6:
Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region. Designation of this phase will indicate that a global pandemic is under way.
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Google Flu Trends–Mexico
In a remarkable feat of a posteriori “early warning,” Google.org has just released ‘Experimental Flu Trends in Mexico‘. Their visualization shows a spike in “aggregate search queries likely to be associated with influenza-like illness (ILI)” around April 20th. As the NYTimes notes, this is after the Mexican government was well aware of an outbreak. Unlike the Flu Trends system in the U.S., Flu Trends-Mexico has not been “verified” by matching trends from a previous years with flu isolate data. Of course, we have yet to see any impact on U.S. Flu Trends, even as cases increase and media attention heightens. To date, the role of biosurveillance systems in epidemic event detection has been minimal–a point I will raise in greater detail on our forthcoming influenza page.
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The Work of Classification
I have now encountered a couple of times the following argument. This is from an article in the LA Times: “The question of whether politics overtook science in 1976 has been the fodder of books, articles and discussions for 33 years. The panic in 1976 was partly because of the belief — now known to be erroneous — that the 1918-19 flu pandemic, which killed half a million Americans and as many as 50 million worldwide, was caused by a virus with swine components. Recent research suggests instead that it was avian flu, but that seems unlikely to assuage the current anxiety.”
The argument is absolutely a-historical. The 1918 virus infected swine in 1918 and circulated ever since in swine. Where the 1918 virus originally came from, is not clear and isn’t actually important to understand the 1976 reasoning. For those of you who are interested in error: it lies somewhere else.
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Vaccine Prioritization in the US
As some of you know, I have been doing some work on the question of vaccine prioritization before the current swine flu outbreak. The question of who would get vaccine first in the case of a pandemic has been discussed extensively in and out the public health community in the past few years.
The prioritization scheme for the allocation of pandemic vaccine developed by the US government has taken a particular form. The logic informing it is largely, but not exclusively, a logic of – what a surprise! – security. This is particularly true for a severe pandemic, less though for a moderate pandemic; i.e. they developed three different prioritization schemes for three different types of pandemics (severe, moderate, less severe). Although it appears to make sense at first sight to differentiate between diffferent types of pandemics, this move actually comes with its own problems, if you keep in mind that pandemics tend to come in waves. So a moderate wave may be followed by a severe wave. Which scheme are you going to implement? What if the moderate pandemic suddenly becomes a severe one?
The prioritization scheme with its three distinctive types of pathological events is based on the idea of a pandemic as the realization of a possible rather than the actualization of a virtual event, to use the Deleuzian distinction.
The logic of security at work in the prioritization scheme means basically that if you are not working for the police, the military, homeland security, the fire department, or some other “essential service,” you will most likely not be among the group that will get pandemic vaccine first. Maybe time to change your job!
Of course, it will be interesting to see if there will be any resistance to the prioritization scheme should it ever be implemented. An “ethical prophylaxis,” to use Sarah Franklin’s term, has already been built into the scheme, so contestation will certainly be difficult.
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Are we having a panic yet?
The register also has a lovely article lamenting the lack of really good panic.
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Preparing for a Cyber-Attack
I thought this piece in the Times (on the vulnerability of the nation’s vital infrastructure systems, such as the electric grid, telecommunication networks, air control system, or the banking systems (e.g. payments and settlements systems), against cyber attacks organized by anonymous hackers) would be a “pleasant” distraction from those of you who are busy following the epidemic.
As you might have noticed, there has been a rising concern on how vulnerable the nation is to such cyber-attacks given the increasing dependency on computerized infrastructures nearly in all domains of collective life and who should have jurisdiction over the intelligence gathering and security activities over these infrastructures. As another Times piece from December 2008 indicates, these efforts seem to be originating from a series of break-ins into the government computer systems. (You might be interested in checking a report written by Center for Strategic and International Studies, a Washington policy group, under the title of “Securing Cyberspace in the 44th Presidency“.) Finally, “thousands of daily attacks on federal and private computer systems in the United States — many from China and Russia, some malicious and some testing chinks in the patchwork of American firewalls,” including a recent attack on the air transportation network, apparently “have prompted the Obama administration to review American strategy” by bringing this report back to the forefront of national security discussions on the internet as a source of vulnerability for the vital systems of the nation.
The article treats the issue mostly as one that is pertinent to sovereign security and, consequently, draws national security discussions on whether such attacks can be deterred or not. And if they cannot be deterred to what extent a policy of pre-emption, much discussed during the Bush presidency as a national security alternative, is more appropriate. Interestingly enough, the article points out much of the discussion resembles the debates over how to program national security against nuclear war in the 1950s and the 60s–a theme that we have visited in the OEP episode. However, or rather to be more precise just because of the reason preparedness had slowly mutated into an autonomous logic of security in the 60s thanks to the irreducible uncertainty of knowing exactly to whom a nuclear missile had belong (with the introduction of submarines) or merely an accidental launch, it seems to be the case that intelligence and national security community does not have much faith in deterrence. As it turns out, as an event a cyber-attack is pretty much an threat without enemy in the VSS language, since the origin of an attack is often impossible to know. And furthermore as far as pre-emption through destruction of the rival’s computer systems before an expected attack is concerned the asymmetrical dependence of the US to digital systems, according to experts, seems to assure the certain defeat of the US in such a cyber-war.
Therefore, the recent efforts of the Obama administration to reform the cyber security policy seems to be an acknowledgement that the problem one faces does not fit so well neither into the domain of sovereign security (as neither a matter of deterrence nor pre-emption) nor to the mode of prevention as a broader approach to security. A senior military officer who has been deeply engaged in the debate for several years, according to the Times, warns of the limitations of a cyber-security approach based on the logic of prevention: “The fortress model [based on building firewalls, better virus detectors, and further restrictions to access to government computers] simply will not work for cyber. Someone will always get in.†Despite these limitations, as the above mentioned report implies (it argues that this issue cannot be left to DHS’s jurisdiction for critical infrastructure security), in what mode security will conducted seems to be a still open issue. Hence, it would be interesting to speculate on how preparedness and VSS might look like in the case of the internet and digital systems…
The irony of the situation in my mind is the fact that internet as a vital communication infrastructure today was invented by the MIT based electrical engineers who were developing a theory of survivable telecommunications and electric networks in the 1960s in the first place as a response to the vulnerabilities a potential nuclear war had posed. Just as a caveat, those experts were the same ones who were at OEP in 1967 designing the plans of a natural gas pipeline through tools of network modeling that was also conceived as a “survivable network” in the face of a nuclear attack or internal and unexpected network failures. Thus, I think what we are seeing is a typical example of the historical process in which vital system security emerges first as a response to specific set of primary problems of the social, such as possible network failures, and then a secondary set of problems and vulnerabilities emerge as different systems become interdependent upon each other.
Before finishing, I also thought it was an interesting piece of data in the light of our conversation on the financial crisis as to what extent the financial system has more and more come to be seen as a vital system not only for the well-being and resilience of the “real” economy, but also a system worthy of national security: Mike McConnell, the former director of national intelligence, apparently had briefed Bush as early as May 2007 on the threat that  if a single large American bank were successfully attacked “it would have an order-of-magnitude greater impact on the global economy†than the Sept. 11, 2001 as “the ability to threaten the U.S. money supply is the equivalent of today’s nuclear weapon.†According to McConnell, the events that took place in the face of the near-collapse of Bear Stearns (and we can add Lehman) invite hackers to sabotage payments and settlements system of the Fed and computer systems of individual banks. In a study began last summer right before the Bear Stearns epsiode in which markets froze on their own accord, they have seemed to simulate a scenario in which the system that clears the market trades freezes.
Given the new set of financial system reforms will create payments and settlements systems for exotic instruments such as derivatives, such a study on the possible secondary vulnerabilities of such systems that are offered as solutions to systemic crisis and risk management gains further importance. Obviously McConnell and his intelligence community is not the only ones doing this work; a group of economists in the Fed, systems analysts circulating between different central banks and a group of scientists calling their discipline complexity science at the National Infrastructure Simulation and Analysis Lab of DHS are also engaged in similar simulations of the financial system with the help of network analysis.
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Vaccine Development
One more question for the resident experts: What are people hearing about vaccine development? I know that the CDC has created a seed stock. What precisely is the timetable for development and production? And what are the chances that a vaccine that they begin to develop now would be relevant to whatever the flu looks like in, say, six months?
Just musing about possible futures…
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What is NYCDHMH actually doing?
I wanted to throw out a question to those of you who are following this closely: what are the public health authorities actually spending their time doing at this point, in what remains a kind of pre-pandemic mode? I have been lightly following things in New York. What I know is that they continue to do surveillance, both through the usual mechanisms and through daily conference calls with every hospital in the area to keep up on possible new cases. I imagine that there must be some work involved in getting emergency supplies in place (doses of anti-virals and so on). Then there are some other things that they are not doing. For example, they are not closing schools and there are no steps to limit public gatherings (this would be pretty futile in New York). Are there other things that they are up to? For example, are they trying to track down people with whom the known cases had contact?
Part of the reason I am asking is that this seems to me an interesting moment in the development — or non-development — of a pandemic. Based on a conversation I just had with Andy, it seems that the mode right now might correspond to a situation in which: (a) authorities know that the disease cannot be contained or isolated; (b) they think that — or are hoping that — it’s severity is much less than the reports out of Mexico seem to suggest. So the calculated risk is that they can continue to be in a mode of preparing for emergency rather than shifting to a disciplinary lock-down (which would involve much more severe interruptions). Does this sound right? I imagine a death or two in New York would change everything here.
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Preparedness
Here are a couple of interesting quotes from the NYT regarding “preparedness.”
“We’re seeing a payoff of the original investment made in pandemic preparedness by the Bush administration,†said Jeffrey W. Levi, executive director of Trust for America’s Health.Â
“If this gets worse, you’ll see the weakness of our system,†said Dr. Jeffrey P. Koplan, a former director of the Centers for Disease Control and Prevention. “In an event like this, where everyone’s well-being is dependent on everyone else’s, we will both feel and see the problems our system creates.â€
Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, said federal officials reported six years ago that hospitals would need far more beds, ventilators and personal protective equipment to respond to a pandemic. Hospitals never got nearly enough extra equipment, Dr. Redlener said
“We will pay a very heavy price for this if we get the big one,†he said.
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