I personally don’t think he has broken his promise. Even though I haven’t had a private audience with Barack about this, I tend to think that he has to put some things on hold, and all the hysteria with the swine flu hasn’t helped matters.

The paragraphs in bold letters are the way they were written for the press release, and not my handiwork.

Global HIV/AIDS & TB Experts Disappointed With Obama Budget Call on Congress to Overturn Short-Changing of PEPFAR, Other Health Programs

Leading disease experts said President Barack Obama’s 2010 budget proposal for global health falls far short of what is needed to combat the deadly twin epidemics of HIV/AIDS and tuberculosis.

Details on global health spending were released by the White House today, and a preliminary analysis indicates the President is proposing only $165 million in additional funding for bilateral AIDS as well as the US contribution to the Global Fund.

“This proposal is even worse than we had feared. With this spending request, Obama has broken his campaign promise to provide $1 billion a year in new money for global AIDS, and he has overlooked the growing threat of tuberculosis,” said the Center for Global Health Policy’s Director, Christine Lubinski.

While malaria receives a significant boost, Obama’s call for a meager increase in the President’s Emergency Plan for AIDS Relief (PEPFAR) budget is no match for the scope of the AIDS crisis, which killed 2 million people in 2007, nearly 5,500 a day.

Obama’s detailed budget blueprint comes as developing countries are struggling to preserve their fragile health systems. In several countries, drug shortages and treatment program cutbacks now threaten the lives of millions of HIV/AIDS and TB patients.

This unfolding health crisis could quickly spread, as people who stop treatment become far more infectious. Treatment disruption can also lead to drug-resistance, an extremely expensive and potentially deadly development.

“Increases in the PEPFAR budget are needed to continue progress in expanding treatment access and to invest in prevention interventions, like male circumcision, that will save money in the long run,” said Ken Mayer, MD, co-chair of the Center’s Scientific Advisory Committee. “Sadly, this budget is bound to stall the fragile progress made in saving lives with antiretroviral drugs and could force a self-defeating choice between providing treatment or greater prevention.”

The President’s proposed budget includes only a very small, $10 million increase for bilateral TB programs, which is woefully inadequate for a disease that killed more than 1.7 million people in 2007. With drug-resistant TB on the rise across the globe, a much more aggressive commitment is needed to battling this deadly, debilitating ailment.

Investments in preventing and treating HIV and TB are urgent because they strengthen underlying health systems in the developing world, bolstering their ability to respond to other disease outbreaks such as influenza.

“Short-changing the response to TB is extremely shortsighted, since last month the World Health Organization called drug resistant TB a ‘time bomb,’” noted Carol Dukes Hamilton, MD, co-chair of the Center’s Scientific Advisory Committee. “Today’s Obama proposal contradicts the bill that the President co-sponsored last year when he was a U.S. Senator, which promised $4 billion over 2009-2013 for TB programs,” she said.

AIDS and TB experts were also disappointed by Obama’s proposed US contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has saved an estimated 3.5 million lives from these three deadly diseases since its 2002 inception. The Fund also provides significant resources for health system strengthening.

Increased support for the Fund is vital to increasing capacity in poor countries to develop and support large-scale health programs. The Fund is facing for this year and next a $5 billion donation gap, jeopardizing a program that provides a quarter of all international financing for AIDS globally and two-thirds for tuberculosis. Leaders at the Center for Global Health Policy vowed to press Congress for an emergency infusion of resources into the Fund through the 2009 supplemental budget and a $2.7 billion commitment to the Fund in fiscal year 2010.

Even though some people receive anti-viral treatment for the flu, most do not need it and recover on their own–or would recover on their on without any drugs. So without any comparative information, there is really little to go on here. Just the number of actually proven cases, which is quite low. There may be more cases, but if so, then they must be fairly mild if the patient did not seek medical care or testing.

It is unfortunate that there have already been blatant false alarms which leads people to lose faith in our infectious disease experts, and the media for fanning the flames of hysteria. The 1976 panic over swine flu was a fiasco, and the dire warnings of the bird flu–that we were in imminent danger of a massive pandemic that would kill millions upon millions–never happened. And lest we forget the small pox vaccine initiative, when we faced imminent danger of a bioterrorist attack, and the call was out to vaccinate the so-called first responders. When the vast majority flatly refused, and started asking questions about risk, side effects, paid time off, manufacturer liability, etc, and when less than 10% of the number projects were actually vaccinated, the plan was quietly shelved. Amazing how the threat of a bioterrorist attack also vanished, and nothing has been said since.

So in lieu of these past events, it is not unusual that many are quite skeptical. I think we should remain guarded and watchful, but that’s it. Considering the despicable environment of factory farming, it is not surprising that pigs get ill and when you have thousands crowded together in unsanitary conditions, not unusual that viruses will mutate. Add that to the overload of antibiotics that are fed to commercially raised farm animals to fatten them up, and to keep them from getting sick (an attempt to make up for the unsanitary and cruel environment), and we’ve got a perfect mix for breeding new and resistant diseases. The virus jumped species and seems to have quickly adapted itself to a human to human transmission, which is something that did not happen with the avian flu.

Instead of panic, wringing hands, and trying to find the ultimate vaccine, we should be devoting some energy to eliminating the cause and cleaning up farming.

In the photo below, a Seattle streetcare conductor is refusing to let passengers on board who do not have a mask. Like those flimsy masks were really going to keep the flu bugs away, but I suppose better than nothing.

From the blog of Dr. Joseph Kim:

The World Health Organization (WHO) is raising the pandemic alert to phase 5 (and phase 6 is the highest level).

“Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.”

What started as a buzz late last week has grown into full-on shrieking as this year’s SARS has stepped up to the plate. With confirmed cases coming in from all over the country – including two in Kansas – the panic over the swine flu is rising. Which is fair enough: so far, 100 people are reported to have died in Mexico from the disease and it seems to be spreading fast. The threat of a pandemic even has the European Union urging cancellation of “nonessential travel” to North America.

It’s difficult to figure out exactly how many people in the continental US have actually come down with it, and more importantly, if it is really any more virulent than the ordinary winter time flu. Is it? I don’t know.

We also don’t know how serious and large the outbreak will get. Does it spread like normal flu? Is there more reason to worry? It’’s hard to say with so many mixed reports and so much misinformation.

But in 1976, there was another bout of swine flu, which led to a decision to mass vaccinate the public. What happened was that in 1976, 2 recruits at Fort Dix, New Jersey, had an influenzalike illness. Isolates of virus taken from them included A/New Jersey/76 (Hsw1n1), a strain similar to the virus believed at the time to be the cause of the 1918 pandemic, commonly known as swine flu. Serologic studies at Fort Dix suggested that >200 soldiers had been infected and that person-to-person transmission had occurred. A 19 year old private died of the infection.

However, it seemed that the vaccine was more deadly than the flu. According to the LA Times, “More than 500 people are thought to have developed Guillain-Barre syndrome after receiving the vaccine; 25 died. No one completely understands the causes of Guillain-Barre, but the condition can develop after a bout with infection or following surgery or vaccination. The federal government paid millions in damages to people or their families.”

So it seems that another bout of swine flu is brewing. Time magazine has an interesting article on how to avoid the mistakes of 1976, when dealing with the current outbreak.

So far, only 12 cases, primarily in Dade County (Miami area). But 4 of the 12 infected died, so it is a virulent bug and one not to mess around with. The W135, which accounts for about 3 percent of all meningitis strains, can kill within hours of symptoms–which include  severe headache, fever, nausea, vomiting and a stiff neck. If that applies to you, stop reading my blog and get to the ER pronto.

The troubling part is that it doesn’t seem to be confined to one geographic location. The people infected were all over the place. But since the W135 strain is so rare, health officials believe there is some connection by which it was passed on from Patient Zero to the other 11 victims.

From MSNBC:

A new swine flu strain that has killed as many as 68 people and sickened more than 1,000 across Mexico has “pandemic potential,” the World Health Organization chief said Saturday, and it may be too late to contain the sudden outbreak.

Now, lest you think that this is just “south of the border” and of no importance to those of us living in the northern regions, its important to note that microbes have no knowledge of national borders. Or state borders. And they can travel very quickly, especially when airborne.

The disease has already reached Texas and California, and with 24 new suspected cases reported Saturday in Mexico City alone, schools were closed and all public events suspended in the capital until further notice — including more than 500 concerts and other gatherings in the metropolis of 20 million.

So it’s here. Watch out.  KevinMD has a nice report about it on his blog.

A few interesting tidbits. First, it seems that Earth Day had its humble beginnings in Seattle. Yes, Seattle of all places, during its pre-Microsoft days, when the waterfront was a bawdy spot for drunken sailors looking to get laid, and Starbucks just a mere twinkle in the eye of a caffeine lover. The city was green, because of all the rain, so perhaps that was the idea behind the green revolution.

Second, the person who first announced that there would be an Earth Day, in September 1969 at a conference in Seattle, was  U.S. Senator Gaylord Nelson of Wisconsin. Note, he has the same last name as me, so that must be some kind of omen that I was meant to be a radical veggie savior of the environment.  Anyway, at this meeting in rainy pre-Microsoft pre-Starbucks and pre-grunge Seattle, he  announced that in spring 1970 there would be a nationwide grassroots demonstration on the environment. This occurred during a time of great concern about overpopulation–that concern gets less press these days, but never fear, reproduction is alive and well and an out of control population still remains the greatest environmental threat.

Nelson viewed the stabilization of the nation’s population as an important aspect of environmentalism and later said:

“The bigger the population gets, the more serious the problems become … We have to address the population issue. The United Kingdom, with the U.S. supporting it, took the position in Cairo in 1994 that every country was responsible for stabilizing its own population. It can be done. But in this country, it’s phony to say ‘I’m for the environment but not for limiting immigration.’”

Senator Nelson first proposed the nationwide environmental protest to thrust the environment onto the national agenda.” “It was a gamble,” he recalls, “but it worked.”

Finally, the third most vital point is that the date chosen was April 22. No accident or coincidence, I assure you. That is today, and it is the day right before my birthday. So Earth Day is sort of the opening ceremony to my birthday, and then the real celebration is tomorrow.