| |  | | Opinions columnist | | For months, top scientists, including former government officials appointed by presidents Joe Biden and Barack Obama, have called on the outgoing administration to make bird flu vaccines available to farmworkers exposed to animals infected with the H5N1 avian flu. The administration has consistently said no, citing a low risk to the public despite a growing number of human cases. | | I sought to better understand the rationale behind that stance by speaking with David L. Boucher, a scientist and senior director of the Administration for Strategic Preparedness and Response, which leads the nation’s response to potential public health emergencies. | | Boucher confirmed that the Food and Drug Administration already approved three bird flu vaccines, though they are “not really great matches” for currently circulating strains, and contrary to what a former agency leader, Rick Bright, told me in a recent interview, there aren’t millions of doses of those vaccines available to be deployed. | | The good news is that the same companies that made those original vaccines have updated them and already manufactured about 5 million doses of the updated vaccines, and that the administration has contracted with them to produce another 5 million by this spring. Ten million shots of a two-dose vaccine won’t come close to meeting demand if bird flu became a pandemic, but in that horrific situation, the virus likely will have evolved further, and a new vaccine would have to be developed anyway. The initial 10 million can at least be used for those at highest risk. | | To do so, the FDA would have to approve these updated vaccines, and the Centers for Disease Control and Prevention would have to recommend them. Boucher says a key reason the administration has not proceeded with these steps is because they have not yet seen severe disease among farmworkers. Plus, there have been no documented cases of human-to-human transmission. | | Boucher is right that the cases among farmworkers have predominantly manifested as mild respiratory symptoms and conjunctivitis. But two people not associated with commercial operations have became severely ill. One was a Louisiana man over 65-years old with chronic medical conditions who likely contracted H5N1 through a backyard flock. He died on Jan. 6. | | Another is a 13-year-old girl in Canada who had no known animal exposure. Her only medical conditions before infection were mild asthma and obesity. She initially presented with conjunctivitis and fever, but then her symptoms progressed to multi-organ failure. She required intubation and other treatments reserved for patients with critical illness. Thankfully, she survived — but this case is a sobering reminder of how ill generally healthy people can become with bird flu. | | I don’t think it’s a good idea to wait for more people to become seriously sick before beginning vaccination. Both the Louisiana man and Canadian girl were found to have a mutated versions of the virus that could spread more easily among humans. Though this strain has not yet been found in others, the more the virus spreads, the more chances it has to mutate. Former Biden official Nahid Bhadelia likens the current situation to Russian roulette. | | Bhadelia, who directs the Center on Emerging Infectious Diseases at Boston University, has been advocating for a small voluntary vaccination program. I found her rationale convincing: Not only would such an effort protect farmworkers and their family members who choose to be vaccinated, but it could also reduce infection and thus the chance of the virus acquiring more dangerous mutations. Plus, such a program would give health officials more data on vaccine efficacy should a wider campaign be necessary. | | Boucher assures me that he and scientists in other government agencies regularly meet to discuss the situation. If circumstances change for the worse, the process to authorize and recommend the vaccine would be “very quick,” he said. “We have had a lot of hypothetical game planning with our FDA colleagues” and with the CDC and industry partners. He predicts that it could take as little as “a couple few days” to go through the approval process if needed. | | That, to me, is both encouraging and frustrating. I am glad these discussions are ongoing and that regulators can quickly green light the vaccines, but I worry government scientists are making a costly miscalculation to wait. The incoming Trump health team might well be led by people hostile to vaccines who might downplay the seriousness of bird flu. Why not authorize the vaccines now and make them available to states that want to pilot vaccination programs? | | “My opinion is that the processes are strong, they are in place and we need to follow them and trust that they are strong enough and will be followed,” Boucher said. I hope he’s right. We will find out soon enough. | | “When I was a child in the 1950s, the polio vaccine was considered a priceless gift to humanity and everyone was eager and thankful to get it. There’s been so much talk lately about vaccines of every kind and how some in the upcoming administration might attempt to take away requirements for childhood vaccines, even for polio. The thought of a polio pandemic is frightening, to say the least. This raises a question for those of us in the baby boomer generation who received the vaccine a long, long time ago: Are we still protected? Is there lifelong immunity associated with the polio vaccine?” — Rosanna from Maryland | | While it’s not known exactly how long protection lasts after polio vaccination, most evidence points to lifetime protection. A booster dose of the polio vaccine is not recommended for most people unless they have higher risk of polio exposure (for instance, if there is an outbreak in their area). | | “I am an 84-year-old woman and have bronchiectasis. My doctor says I am starting to develop emphysema. I like to walk a least two miles a day in the outdoors. Is the exercise still worthwhile if I have slowed quite a bit down because I get out of breath quickly? And more important, I seem to get out of breath more quickly in cold weather (below 40 degrees). Is it still healthful for me to walk in cold weather, or should I remain indoors? I don’t want to walk indoors because I am most careful about masking indoors and I have a hard time walking with a mask. Will the cold damage my lungs further? I am afraid not just afraid of getting covid but also any respiratory disease.” — Jennifer from Massachusetts | | To your first question, yes, it is definitely a good idea to keep exercising even if you are getting out of breath more quickly. Listen to your body and take breaks as needed. | | Cold weather may pose challenges for people with emphysema and other lung conditions. Breathing in cold, dry air can cause airways to narrow and induce bronchospasms. Some ways to reduce the discomfort include using a medication such as albuterol 30 minutes before heading outside and trying to breathe in through your nose instead of your mouth to better humidify the air entering your lungs. | | And, of course, check with your physician. As long as your health-care provider says walking outdoors is fine to do, I encourage you to continue getting physical activity in the ways that you find most enjoyable. | | “I wear a mask when handling dead beached birds (I’m doing a survey on these birds for Washington State University). No H5N1 notification so far in this Pacific Northwest region. Should I wear a mask and gloves while handling dead beached birds?” — Bruce from Washington | | In 2022, the Washington State Department of Agriculture confirmed H5N1 infections in wild birds in the state. They are prevalent among wild aquatic birds, including ducks, gulls and shorebirds. | | As a general rule, people should stay away from sick or dead wild birds. If you must be in contact with them for work purposes, it is essential that you wear personal protective equipment. That includes masks and gloves, both of which should be thrown away after use. You should also consider safety goggles for eye protection. | | A new study published in the European Heart Journal found that limiting coffee drinking to the morning hours might be protective for heart health. Researchers examined dietary habits and health outcomes from a large national survey and found that, compared to non-coffee drinkers, people who drink coffee in the morning have a 16 percent lower risk of premature death from any cause and a 31 percent decreased risk of dying from cardiovascular disease. Interestingly, those who drank coffee throughout the day did not have reduced risk. | | On the other hand, a Nature Medicine study finds that sugar-sweetened beverages were related to approximately 340,000 deaths globally in 2020. Sugary drinks were also associated with 2.2 million new cases of Type 2 diabetes and 1.2 million cases of cardiovascular disease across 184 countries. From 1990 to 2020, the area with the largest proportional increase in these illnesses attributed to sugary drinks was sub-Saharan Africa. | | A JAMA Health Forum article explored the impact of increasing the minimum age for accessing tobacco products to 21. It concluded that if such a law were comprehensively enforced in the United States, it could save up to 526,000 lives by the year 2100. This is more than double the result calculated in a previous study. Fully enforcing the policies would also reduce geographic disparities and help more people realize health benefits. | | Guest Column Lisa Strauss | | | | Advertisers and sponsors play no role in the content or production of the newsletter. | | | |
