Of birds and men
A deadly virus is brewing in Asia. Could this be the next killer pandemic?
Of course, the world is not the way it was in 1918. This time around, humankind has weapons that can be deployed against a killer flu, rather than having to just wait and endure. We know how to track a virus's spread and work across borders to fight it--a technique that proved hugely useful in halting the spread of SARS in 2003. We know how to make antiviral medications and flu vaccines that could radically reduce the risk of serious illness and death. Last week, the National Institutes of Health launched tests of an experimental vaccine for H5N1 flu. New manufacturing techniques such as reverse genetics could also speed up production (box, Page 46). But if a killer virus strikes anytime soon, none of those 21st-century defenses will be ready. "We're clearly not adequately prepared," says Andrew Pavia, chairman of the pandemic task force for the Infectious Diseases Society of America. "About the most hopeful sign is that we have a lot of good and well-placed people who are beginning to get concerned."
All this casts harsh light on long-standing weaknesses in the nation's medical defense system, which include an unreliable vaccine supply and insufficient hospital surge capacity. Many hospital emergency rooms are already hard pressed to treat the influx of patients from a normal flu season, let alone a contagion that could send as many as 10 million people to the hospital. And the country's vaccine production capability is woefully inadequate, with only two manufacturers in the market and little financial incentive for other companies to enter. When contamination shut down one company's plant last year, obliterating half the nation's flu vaccine supply, the United States' entire influenza immunization program was thrown into chaos.
Under present circumstances, it will take at least six months from the start of a pandemic to get vaccine to the public. Global production is now approximately 900 million doses a year, enough for only about 15 percent of the world's population. Most of that is produced in Europe, and no one expects vaccine to be traveling across borders if things go bad. On March 17, the federal government asked vaccine companies to submit proposals to increase domestic production. The sole U.S.-based plant, in Swiftwater, Pa., can produce about 60 million doses per year. Many of the first doses produced would probably go to healthcare workers and emergency-service providers. "We have to get the message out loud and clear that vaccine will not save us," says Michael Osterholm, an infectious-disease specialist who heads the Center for Infectious Disease Research and Policy at the University of Minnesota. "We will have very little of it, and it will get here too late."
Meds and money. Federal officials say in the absence of a vaccine, antiviral medications like Tamiflu (oseltamivir), which can reduce the severity of flu symptoms and is effective against H5N1, would be the best option. Last week, the Infectious Diseases Society of America said the country should stockpile enough of the drug to treat 50 percent of the U.S. population, or about 150 million doses. Right now, the country has just 2 million doses stockpiled. Britain, by contrast, has ordered up 14.6 million doses, enough for 25 percent of its population (box, Page 48).
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