Three Questions: Nayer Khazeni on Urban Influenza

by Peter Sigrist

As part of our new series called Three Questions, in which we post brief interviews with people doing inspiring work related to cities, today we're fortunate to talk with Nayer Khazeni, pulmonary/critical care physician, researcher, and educator at the Stanford Center for Health Policy (CHP). Dr. Khazeni's research focuses on international health policy, pulmonary infectious disease, and strategic planning for global health catastrophes. More detailed information can be found at her CHP profile.

As public health issues become increasingly global, we see great potential in your work for improving the quality of life in cities around the world. Can you tell us about your current projects?

For the past few years, I've been using computer-simulated mathematical models to examine pandemic influenza preparedness and response strategies for an urban center based on New York City. By spring of 2009, my teams had completed assessments of vaccine and antiviral stockpiling options for a future influenza pandemic [full text of the resulting articles can be viewed here and here]. When the A (H1N1) pandemic started, we were able to rapidly update our model parameters to reflect the spread of the virus and help guide public policy regarding the national vaccination campaign [full text here, with related overviews here and here].

Even though three major influenza pandemics occurred in the 20th century (1918, 1957, and 1968), we have little data from these. Because the 2009 (H1N1) pandemic occurred in a time of advanced technology and health care data collection, we now have a fantastic opportunity to plan and prepare for the next pandemic. In one of my upcoming projects, I will be analyzing data collected during the pandemic in order to model the temporal spread of influenza from urban epicenters to neighboring communities. This type of model can help local health officials plan for surges of pandemic influenza and allocate resources during a more severe pandemic.

Can you share some of the pressing issues related to your research on global threats to public heath?

Both pandemic and intra-pandemic influenza have a much more significant impact on individuals in developing countries than developed ones. Because of the way pandemic influenza viruses come about (close proximity of birds, pigs, and humans facilitate pandemic mutations), they often begin in Southeast Asia. One current pandemic threat virus, influenza A (H5N1) (sometimes called "avian flu" in the press) is having a devastating impact on several Southeast Asian countries. More than 60% of people who are infected with the virus die, and because A (H5N1) is causing a pandemic in birds, frequent poultry slaughters are disastrous to local economies. Many of these and other developing countries throughout the world have very limited access to health care we take for granted. In the case of influenza, this includes antiviral drugs and vaccines.

A few years ago, Indonesia, a country particularly hard hit by A (H5N1) (of 163 confirmed cases to date, 135 have been fatal), made a decision to stop sharing virus samples with the World Health Organization (WHO). The Indonesian government cited that free samples from developing countries were being used by pharmaceutical companies in wealthy countries to develop drugs and vaccines that the developing countries could not afford. Hopefully, in time, international governments can work together to ensure more equal distribution of pharmaceutical resources for influenza and other diseases. In the meantime, I am working on building a statistical model to predict groups at higher risk for complications and death from influenza in developing countries. This information may help public health officials in those countries allocate scarce pharmaceutical resources to groups who need it most.

Are you reading anything interesting at the moment?

Philip Hensher's The Mulberry Empire. It's about the British occupation of Afghanistan in the 1830s. I just started, but I'm enjoying it. Before that, the last fun novel I read was Déjame Que Te Cuente, by Jorge Bucay. It is the story of a young man who goes to a therapist with a new problem each chapter. The therapist helps address his concerns by telling a tale--many of the fables are about ancient times, kingdoms, and faraway places, but the lessons are remarkably relevant to our seemingly more modern dilemmas.

Credits: The photo of women in protective masks is from The photo of children gargling to prevent influenza is from The photo of workers testing an infected bird is from The photo of Red Cross nurses working during the influenza pandemic of 1918 is from


  1. This was a wonderful interview. I was recently in conversation with a public health practitioner and we spoke of the historical connection between planning and public health. Although health planning has infiltrated planning schools to some degree, many urbanists fail to make the connection between our own health and the health of our cities. We need to become more aware of, and more involved with these issues. Thanks for this post.