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We should be talking prevention, not reaction

George Bush says he would impose sweeping quarantines and call in the military to help enforce them during an influenza pandemic.

A fat lot of good that will do.

The "kill bugs dead" machismo is no doubt motivated by domestic political concerns, but the U.S. President's comments demonstrate a fundamental lack of understanding of public health that is all too common in political circles.

"The best way to deal with a pandemic is to isolate it and keep it isolated in the region in which it begins," Mr. Bush said.

That's not true.

The best way to deal with a potential pandemic is to prevent it in the first place. And, because the spread of viruses is not entirely avoidable, mitigation is essential.

In public health, the most successful war is the one that is averted.

Averting disease is not as sexy as sending in the troops, and avoiding the spread of potentially deadly bugs is not going to garner as many headlines as imposing quarantines. But it is a heck of a lot more effective.

We know who is most vulnerable to outbreaks of infectious disease: The frail and elderly, the poor, people with chronic illnesses such as asthma and heart disease, and young children whose immune systems have not yet developed.

Once an outbreak or epidemic hits, it will be virtually impossible to help them. The best defence against the feared avian influenza pandemic is to improve the health of all citizens, with a particular emphasis on the most vulnerable.

That means employment opportunities, income support, decent housing, breaking isolation, home care, chronic-disease management plans, vaccination and other basic ealth measures that are not related to a pandemic per se.

We also need to build a sound public-health infrastructure so that we are ready if and when a pandemic strain of influenza does strike. Yet, in Canada, the infrastructure has been decimated by decades of indifference, a situation that was flagrantly exposed by the 2003 SARS outbreak, and that is only being slowly redressed.

Canada, to its credit, has a good pandemic preparedness plan. The Public Health Agency of Canada would likely respond quickly and efficiently to the arrival of a pandemic strain of influenza. (And it would be helped by the fact that flu strains almost always originate in Asia and travel from east to west.) The PHAC has stockpiled the antiviral drug oseltamivir phosphate, better known as Tamiflu. The agency has also made provisions for emergency production of a vaccine as soon as one is available for the new strain.

But drugs and vaccines are only part of the equation. How are we going to get them to people during a public-health emergency?

The most logical approach is easily accessible public institutions such as schools. But schools in this country are public-health wastelands: Most no longer even have a nurse, and can barely handle nitpicky duties, let alone a pandemic strain of influenza.

Another key element of dealing with a public-health emergency is good communication. The performances by Mr. Bush, and one last week by World Health Organization official David Nabarro, demonstrate the dangers of hyperbole.

Mr. Bush talked about people being confined to their homes and guarded by armed soldiers. Dr. Nabarro speculated that the pandemic flu could kill an astonishing 150 million people.

The WHO later said the actual figure was two million to 7.4 million deaths.

In Canada, the PHAC estimates that a pandemic strain of influenza could kill 11,000 to 54,000 people. It could leave as many as 138,000 in hospital, and 10.6 million Canadians so sick they would be unable to work.

A pandemic obviously has the potential to be devastating, economically and otherwise.

But we need to keep our wits about us.

It is not at all clear whether H5N1, the current strain of influenza sweeping through poultry populations in parts of Asia, is the big one. Since 2003, millions of birds have been slaughtered as a preventive measure, and 65 people have died. But there is no clear evidence yet of human-to-human transmission that would lead to a pandemic.

"The most menacing bioterrorist is Mother Nature herself," science journalist Madeline Drexler says.

A pandemic strain of influenza -- or something worse -- will come sooner or later.

But now is not the time to talk of soldiers and quarantines. Now is not the time for Chicken-Little-like cries of the "pandemic is coming."

Politicians, policy-makers and public-health officials need to get a message out: Now is not the time to talk of how we will react, but how we will prevent.

Now, more than ever, is the time to invest in prevention, health promotion and public-health infrastructure. The healthier are we are as a population, the better prepared we will be for whatever threats come our way.

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