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Vol. LVIII, No. 5
March 10, 2006

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Noel Spearheads Pandemic Influenza Preparedness

On the front page...

To reach the office of the chief of hematology in the Clinical Center's department of laboratory medicine, you trek across the clin path lab, a unit the size of a football field where warrens of scientists, clinicians and techs emit a modulated hum. This vibrant hive has the buzz of continuous progress, and so it's fitting that it holds the office of Dr. Pierre Noel.

Noel is not only chief of hematology, he's also advisor on weapons of mass destruction, disaster planning and biodefense while he serves, concurrently, as flight surgeon in the Air Force Special Operations Command. While it may seem heroic to add even a straw to all that, he recently accepted a leadership role in NIH's influenza pandemic continuity of operations planning team.


Noel, chief of hematology at the Clinical Center, blends his expertise in special ops and bioterrorism to prepare NIH for H5N1 — bird flu.  

"I'm a clinician. An action person," says Noel, who came to the CC in 2000 from the Mayo Clinic, where he held appointments in hematology and laboratory medicine and served as director of its bone marrow transplant program. His medical research in the CC focuses on analysis of bone marrow-related conditions.

The threat he has been asked to confront today is avian influenza, "bird flu," which has infected over 150 million birds worldwide, and killed over 80 people since late 2003, largely in Asia. Although there is no rapid human-to-human spread, people have no immunity against it. If the H5N1 virus mutates enough to "jump" from person to person, it could cause a pandemic. NIH director Dr. Elias Zerhouni has thus tapped Noel to plan a concerted response.

Why assign a bone marrow guy to battle bird flu?

"I don't need to be a subject matter expert," Noel says. "I find the right people, put them in the same room and we develop a plan and establish timelines. I can make that happen."

He continues, "In military medicine you need rapid response, so there's not always a perfect solution. But if you remain calm, you can jump hurdles without tripping."

Vaulting over obstacles began with a hobby back in Canada, where the average yearly snowfall around his hometown Montréal tops 7 feet, with even more in wilderness areas. "I was interested in diving and mountaineering, and as a physician, when you do these things, people count on you to solve problems," he says matter- of-factly. "Twenty years ago there was not a lot of information on wilderness medicine. You might have no access to conventional medical care for several days, so a lot of things you learn to do are unconventional. You can't carry a hospital in your bag."

What can you carry?

"The minimum tools with the most flexibility. You think: what can occur on an expedition? You have an open fracture at 12,000 feet, out there for days with no helicopter. No lab. How can you prepare? So you develop algorithms that are not in textbooks. Things that are a bit unconventional. Sometimes you swim counter-current."

NIAID Offers Answers on Avian Influenza

Q: What is H5N1 avian influenza (bird flu)?
A: The H5N1 virus is one of 16 different known subtypes of avian influenza (bird flu) viruses. As the spread of H5N1 infection among birds increases, so does the opportunity for H5N1 to be transmitted directly from birds to humans.

If avian and human influenza viruses were to simultaneously infect a person or animal, the two viruses might swap genes. The result could be a new virus that is readily transmissible between humans and against which humans would have no natural immunity. Such an event could trigger a worldwide influenza pandemic.

Q: When did NIAID begin testing the H5N1 vaccines?
A: The first clinical trial began in April 2005 in 451 healthy adults ages 18 to 64. A trial in the elderly began in October 2005.

Q: Is the H5N1 vaccine the same as the seasonal flu shot?
A: No. The seasonal flu vaccine contains two strains of the most recent form of influenza A as well as one strain of influenza B. These strains have widely circulated in humans for a number of years.

Q: Are drugs effective in treating avian influenza in humans?
A: Data from the World Health Organization's Global Influenza Surveillance Network indicate that the recently circulating H5N1 strains are susceptible to two antiviral drugs approved for use in the United States to treat human influenza infections — oseltamivir (sold as Tamiflu) and zanamivir (sold as Relenza). However, these medicines need to be started early enough — usually within the first 2 days of infection — to be effective.

In those mountains, he must have bumped into some wildlife, too.

"Oh, I'd rather deal with bears," he quips. "In the military, you get there and not only are people hurt, there are people shooting at you. I took a personal interest in developing preparedness, so I was asked to teach in special operations and how to organize training for combat trauma."

Yet he rejects the notion that his role might be tinged with glamour.

"Everybody in Special Operations gets special skills to survive, but I'm not the one who kicks down the door. My role is much more straightforward. In the U.S. Air Force, I'm a flight surgeon in a special tactical unit. And here, I'm a facilitator."

In that capacity, he's drafted a plan for pandemic preparedness. The document describes policies that, when implemented, will protect the health of employees and preserve continuity of operations for NIH. Noel is working with a large team of preparedness, communication, Clinical Center and administrative staff to implement the plan. Zerhouni heads the senior management group whose decisions cascade throughout both extramural and intramural NIH.

Could the plan affect life on campus? That would depend upon the extent of the pandemic's reach as well as its virulence and transmissibility, he said. In general, operations would be curtailed, while the following would be prioritized as strategic goals: coordinate a high-level leadership team on campus; protect patients, visitors and personnel; protect animal colonies; protect research activities; preserve communications and IT functions; preserve intramural and extramural programs, especially given the opportunity to work offsite by computer access; and maintain scientific data and documentation. Shut-down authority on campus would fall under the NIH director, and no formal quarantine is planned.

"We have the tools [to respond to an emergency]," he says, "and with the Public Health Service being re-engineered even as we speak, we have a much bigger role to play in biodefense, in emergency response and in natural disasters."

This isn't Noel's first brush with disaster planning. After the attacks of Sept. 11, 2001, NIH tapped him as the go-to person for emergency preparedness. Early on, Noel gave a lecture on bioterrorism at the Clinical Center, covering NIH's accomplishments and plans, and offering a vivid history of bioterrorism. (Q: How did Tartar armies lay siege to Kaffa, Italy, in 1346? A: They catapulted plague-infested bodies of their own men over the fortifications, and thereby set off a pandemic.) More recently, as a part of Hurricane Katrina relief, Noel flew with an NIH team to Mississippi to set up an acute care facility.

"There's an expectation from the public that we go out of our way," he says resolutely. "We need to make certain that we are adequately prepared to respond to emergencies arising on our campus, our community and our country."

Mountaineer, diver, bone marrow expert, special ops doc, teacher/trainer, bioterrorism maven and warrior against the pandemic. Realist and idealist. His dedication lights up his eyes. But why all this? Why so much?

"You see," he says, "I want to do the right thing."

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