Saturday, December 03, 2005

Rx for AIDS and flu pandemic fatigue

World AIDS Day just passed (but left all the AIDS cases still around). It is depressingly easy to get pandemic fatigue, so maybe it's worthwhile to consider ways we can multiplex our efforts--attack several problems at once.

AIDS and influenza are very different diseases, of course. But one prerequisite to dealing with either is a robust and resilient community. When there are strong networks of social support and a sense of solidarity, the impact of both diseases is blunted. And with solid public health infrastructures and social support systems the same is true.

An article in The Hartford Courant by Garrett Condon makes exactly this point:
"Certainly, there are some things associated with the HIV/AIDS investment that translate to a flu pandemic," said John Stover, a senior fellow at the Futures Group in Glastonbury, an organization that provides technical assistance for public health and social service programs in countries around the world. Stover named two possible cross-over areas: improving public health systems and disease surveillance. (Hartford Courant)
We're not just talking about parts of the public health and social service infrastructure. We mean ALL of it. One of the baneful effects of bioterrorism money is that it has shifted priorities, personnel and attention from routine public health activities to "preparedness" efforts with marginal contributions to public health and uncertain or unlikely benefit even for its intended purpose. Consider some of the things that have received short shrift in the process, like Maternal and Child Health services. MCH is an essential component in responding both to HIV/AIDS and influenza. The mother-child relationship is both a nexus for disease spread in both diseases and a point of application for preventive and curative measures. The current avian influenza strain, H5N1, even more than its 1918 predecessor, is targeting the very young, including infants and toddlers through young adults. Robust MCH services are the point of contact with this high risk group, as HIV/AIDS workers have long since learned.

Clearly some public health services are more germane to one or the other of these diseases (substance abuse, for example), but for the most part both benefit from strong public health services, even those not directly related to their at-risk populations. These services don't exist in hermetically sealed compartments. They have penumbral effects. And of course weaknesses also have cross effects. Lack of adequate facilities and services for AIDS patients spill over to critical care needs for flu patients and vice versa. Lack of outpatient services and health care workers affects both.

There is a tonic for pandemic fatigue. It is the vitamin of a commitment to rebuild our social infrastructures, a renewed sense of social solidarity, which is not just missing but hs been systematically destroyed by the last 30 years of conservative politicians abetted by weak and sometimes cowardly liberal counterparts. Just the medicine we need.