Sunday, July 17, 2005

Unprepared for a Flu Pandemic

The New York Times

Unprepared for a Flu Pandemic

If a much-feared pandemic of avian influenza starts sweeping through the world's population anytime soon, neither the United States nor international health authorities will be prepared to cope with it. There is not enough vaccine or antiviral medicine available to protect more than a handful of people, and no industrial capacity to produce a lot more of these medicines quickly.

The best that can be hoped is that no pandemic will materialize for the next several years, allowing time to become better prepared, or that a potential pandemic can be spotted early enough to allow international health officials to snuff it out before the virus runs amok.

It has been 37 years since the last influenza pandemic, or widespread global epidemic, so by historic patterns we may be due for another. And a particularly ominous strain of avian influenza that has devastated poultry flocks in Asia seems poised to wreak havoc in humans. This strain, known as H5N1, first became a matter of health concern in 1997 when it was found to have jumped from birds to humans in Hong Kong in an outbreak that failed to spread widely. Since then, the virus has looked more and more threatening. It has infected poultry, domestic ducks and migratory birds in nine countries, making the virus almost impossible to contain. More ominously, the virus has developed the ability to jump to a range of mammals, including pigs, mice, tigers and domestic cats.

The human toll has been slight. Only 108 people have been infected, of whom 54 have died, an alarmingly high mortality rate but one that seems to be diminishing. It is reassuring that millions of people have lived and worked in close proximity to infected birds without harm and even more reassuring that the flu strain has not yet developed the ability to spread easily from one person to another, the sine qua non for a pandemic to take off. But that could change in a trice if the virus mutates or combines its genes with a human influenza virus.

No one knows whether the world is headed toward a health disaster or a false alarm, but virtually all experts agree we need to strengthen our defenses. American health authorities have taken the lead in testing vaccines against two strains of avian flu and have contracted to buy two million doses of a vaccine against H5N1. That is a tiny fraction of the amount that would be needed if a pandemic hit, but will give the manufacturer experience that would prove useful in a crisis. Officials have also stockpiled enough antiviral medicine to treat 2.3 million people, again a fraction of what would be needed in a pandemic.

Yet the best defense might be to go on the offensive. The most urgent need is to control the disease in poultry and other animals that might spread the virus to humans. Some countries have done a good job. Others, including Vietnam, which accounts for almost 80 percent of the human cases, need more prodding and international assistance. If the virus breaks through this line of attack, authorities should try to quench an incipient outbreak before it can really get started. The Bush administration is wisely pumping millions of dollars into an international effort to improve surveillance of the disease in humans and animals in the infected regions of Asia, and the World Health Organization has amassed a small stockpile of antiviral drugs that will soon be enlarged and could be rushed to the scene of any outbreak.

Many experts are doubtful that it would be possible to detect and contain an outbreak of transmissible influenza in time to head off a pandemic. But that may be the best hope we have until we are able to upgrade today's fragile and unreliable vaccine production system with new processes that can expand output quickly to meet a crisis.