CDC cautions against White House H1N1 death forecast

Yesterday, we wrote about the report issued by the President's Council of Advisors on Science and Technology (PCAST) on H1N1 (swine) flu preparedness. We argued that the daily stream of reports, recommendations, and announcements from an ever-changing cast of government bodies ought to be replaced (or at least supplemented) by a single source and spokesperson for H1N1 information and guidance from the federal government.

It took only a day for the potential hazards of offering so much information from so many different government sources to become clear. In today's New York Times, Donald McNeil's story, "Agency Urges Caution on Estimates of Swine Flu," details efforts by CDC officials yesterday to ever-so-politely distance themselves from the rather alarming estimates of H1N1 impact included in the White House advisors' report.

The PCAST report wrote that in a 'plausible scenario,' H1N1 influenza could infect up to half the American population, causing 1.8 million hospitalizations, and as many as 90,000 deaths. In today's Times, CDC staff respond:

“We don’t necessarily see this as a likely scenario,” said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases.

A press officer for the disease centers, speaking carefully to avoid a feud with the White House press office, said, “Look, if the virus keeps behaving the way it is now, I don’t think anyone here expects anything like 90,000 deaths.”

The story later quotes Harold Varmus, the Nobel Prize-winning former NIH director and co-chairman of PCAST. Varmus defended his group's report but expressed displeasure over the way it was released.

These types of intra-governmental squabbles are all but inevitable given the number of agencies involved in some aspect of H1N1 planning, many such groups having little in-house experience or expertise regarding public health or disease control and prevention. (PCAST, with its illustrious roster of members from fields in science and technology, has not traditionally addressed clinical medicine or public health in its work. Its reports dating back to 1995 have focused on R&D issues, biotechnology, and energy policy.)

So while disagreements such as this CDC/PCAST debate over H1N1 forecasts may be inevitable, it is greatly preferable that they occur somewhere other than the pages of the New York Times. While the diversity of opinions on the severity of the H1N1 threat reflects, to some degree, the uncertainty that continues to abound, this public back-and-forth is unhelpful. To an American population already seemingly unconcerned by the threat of H1N1 flu, the lack of a single, coherent voice from government makes the challenge of educating and preparing the public in the coming months that much more difficult.

Vaccination programs rely foremost on public trust in the importance of vaccines and confidence in the individuals crafting policy. H1N1 influenza vaccination will be no exception. Implementing a mass vaccination program so quickly is already a staggering logistical challenge, saying nothing of addressing the ethical and safety debates sure to emerge. A federal government seemingly at odds with itself regarding its messages to the public only adds to the difficulty of building support for the programs it eventually hopes to implement.