The Only Cure for Pandemic Flu is Prevention

(Article is also published here.)

Many people assume that the “threat” of bird flu is nothing more than another fear-mongering tactic concocted by our government and perpetuated by the media. After all, the bird flu is so-called because it’s really good at infecting birds – not humans. But since 1997, the bird flu strain known as H5N1 has managed to jump species to humans almost 150 times, and because our immune systems are not used to fighting it, bird flu is especially deadly: more than half the people who have been infected have died.

In order to become a real threat to us, though, bird flu needs to “learn” how to spread easily between people. Although there has not been more than one case of this happening to date, viruses like H5N1 are notoriously good at mutating, or modifying their genetic information, and can also recombine or merge with human flu strains. The fear is that, through one of these two mechanisms, bird flu could acquire the ability to spread human-to-human. And with each new person that the virus infects comes a new opportunity for the virus to achieve this.

If it happens – and the World Health Organization suggests it is only a matter of time, either with H5N1 or a similar viral subtype – the WHO predicts that the virus could kill between two and 7.4 million people worldwide.

Wait, you say. By the time it happens, we will have effective antiviral drugs and vaccines to keep us healthy, right?

Probably not. The most promising antiviral drug, Tamiflu, which also happens to be associated with serious side effects, would be only potentially effective, and only if administered before or within the first 48 hours of infection.* Dr. Margaret Chan, the WHO’s Representative of the Director-General for Pandemic Influenza, admits in this month’s WHO Bulletin that “no one knows if it will be effective against the pandemic strain and it should not be regarded as a silver bullet.”

Even if Tamiflu does work, our government is planning to stockpile only enough to treat approximately seven percent of the US population. In fact, due to the risk of antiviral resistance, which renders a drug completely ineffective, it could be counter-productive to treat too many people anyway. Three people infected with bird flu in Vietnam died because the virus became Tamiflu-resistant.

What about vaccines, then? Unfortunately, an effective vaccine must be closely matched to the pandemic strain that emerges, but we don’t yet know what that will look like. The French pharmaceutical company Sanofi Pasteur has begun clinical trials for a vaccine against H5N1 viral strains isolated in 2004, but there is a decent chance that the pandemic strain will be different enough to render it useless. Even if it does end up working, “commercial production cannot begin prior to the emergence and characterization of the pandemic virus,” Chan explains in the WHO Bulletin – a process that will take approximately six months. Given the WHO’s speculation that a pandemic virus would “encircle the globe within three months,” this is not very reassuring. Indeed, Chan admits that “it is highly unlikely that there will be any large quantities of pandemic vaccine available during the first wave of a pandemic.”

The bottom line is, we need to stamp out bird flu before acquires the ability to spread easily among people. And because the risk grows with every animal infected, we need to do this now. But how?

Eradication of bird flu can only be achieved by building the infrastructure necessary to monitor outbreaks and cull infected animals. Farmers around the world need to be educated about bird flu, taught how to properly handle their livestock and encouraged to report potential outbreaks. And because a farm that reports an outbreak might lose all of its poultry, governments need to be able to compensate their farmers appropriately for doing so. Wealthier governments like ours can help by providing poor countries with the financial means necessary to do all of these things.

Fortunately, it appears that our administration has recently realized this too. While earlier US efforts focused on flu prophylaxis and treatment, last week marked a noticeable shift towards prevention. An international conference held in Beijing last week raised $1.9 billion to fight bird flu, and the US was the most generous donor. Our government agreed to provide $334 million in grants to poorer Asian countries, some of which had refused previous loan offers due to fears that they would not be able to repay them.

Indeed, the success of the fight against pandemic flu will depend more on global cooperation than on the efforts of individual countries. It makes sense for wealthier countries to use a fraction of the money they would inevitably spend dealing with the pandemic on a serious effort to prevent it from happening in the first place. ☼

*As I mentioned, Tamiflu may only be potentially effective against a future pandemic flu, and some are skeptical of its efficacy as an antirval drug in general. But nevertheless, fears over pandemic flu have skyrocketed Tamiflu's sales in the past six months, making it one of the most sought-after drugs in the world -- with the US government as one of its biggest consumers.

Interestingly, few realize that Secretary of Defense Donald Rumsfeld is a major shareholder in Gilead Sciences, the company that first developed oseltamivir (the generic name for Tamiflu). The California-based company now licenses the drug to the pharmaceutical company Roche, who manufactures and sells it under its well-known name.

Because Roche has to pay royalties to Gilead Sciences, our Secretary of State is making a fortune. It has been estimated that Tamiflu sales have increased Rumsfeld's net worth by over $1 million just in the past six months.