Many governments around the world
are stockpiling antiviral drugs and some companies are trying
to speed up vaccine production but these measure give a false
sense of security and will do little to counter a flu pandemic,
an expert cautioned on Monday.
Michael Osterholm, an infectious disease expert who has
been studying the risk of pandemic flu for decades and is a
U.S. government adviser, said governments should be preparing
to cope with the pandemic instead of relying entirely on the
hope of using vaccines and drugs to control it.
French doctor Alix Greder-Belan demonstrates the use of a protective face mask to be used by hospital staff in case of a bird flu pandemic at the Mignot Hospital in Versailles October 10, 2005. The Mignot Hospital in Versailles, west of Paris, received a shipment on October 10, 2005 of some 130,000 of the face masks for use by hospital employees for protection against contagious avian influenza. The European Commission announced a ban on Monday of all imports of live birds and feathers from Turkey into the 25-nation EU on Monday after Ankara confirmed an outbreak of a highly contagious avian influenza. REUTERS/Franck Prevel
If the H5N1 avian flu begins to easily infect humans, it
will move too quickly for drugs and vaccines to be of much use,
"It doesn't matter if we have a vaccine now or not. We
can't make it," Osterholm said in a telephone interview.
The H5N1 bird flu virus has killed at least 65 people in
four Asian nations since late 2003, and has killed or forced
the destruction of tens of millions of poultry.
Experts say it is mutating steadily and fear it will
eventually acquire the changes it needs to spread easily from
person to person.
If it does, it will sweep around the world in months or
even weeks and could kill millions of people -- as many as 150
million, according to the most dire forecast by the World
When avian flu infects people it looks like any other flu
with respiratory symptoms, fever and other common effects but
it will kill many more than the 500,000 people who die of
ordinary flu each year around the world.
People have known about the risk of an influenza pandemic
for a very long time, said Osterholm, an infectious disease
specialist at the University of Minnesota who advises the
federal government on such issues.
"We have had a pandemic flu plan as a planning process
since 1976," said Osterholm. "Nobody has completed it. It been
one of the most long-standing incompleted processes in
Washington. Nobody wants to believe that modern medical science
can't handle something."
But it cannot, said Osterholm, who has seen the current
U.S. flu plan. The plan has not been published yet but leaked
versions suggest the country has done little to prepare for an
Osterholm and other experts have long been complaining that
there are not sufficient hospital beds, equipment or trained
workers to cope with a major epidemic.
"The one thing I worry desperately about it is the impact
of overreliance on neuraminidase inhibitors," he said.
There are two drugs in the class -- Roche and Gilead's
Tamiflu, known generically as oseltamivir, and
They work to reduce the severity of annual influenza and
may prevent infection if used at the right time. Tests suggest
they also work against H5N1, but no one knows how well.
"I think that potentially neuraminidase inhibitors may work
if you are already on them as prophylaxis (prevention),"
Osterholm said. That would mean taking them daily for days or
"That means that very, very limited supply is going to
become a lot more limited."
FIGHTING OVER SCARCE SUPPLIES
The United States has enough courses of Tamiflu to treat
about 2.3 million people. The Health and Human Services
Department says another 2 million treatment courses are on
order and will arrive by the end of the year.
But some 90 million people would need the drug in the event
of a flu pandemic, University of Virginia flu expert Dr.
Frederick Hayden told a meeting on Saturday.
At current capacity, it would take about 10 years to
produce enough oseltamivir to treat 20 percent of the world's
population, Hayden said.
"Now people are saying whoever has the most Tamiflu wins,"
Osterholm said. "I worry so much that Tamiflu is a surrogate
And vaccines are not an answer yet and will not be for
years. There is an experimental vaccine against H5N1 but there
are only a few thousand doses of it.
It takes months to make influenza vaccine and H5N1 kills
chickens -- the source of the eggs that are needed under
current old-fashioned production methods to make flu vaccines.
Companies are trying to develop more modern methods but are
years away from doing so. And work cannot begin on a true
vaccine against H5N1 until it actually starts infecting many
people, because the vaccine must match the virus precisely and
no one can predict just how H5N1 will mutate.
And it is mutating.
A study published last week showed that the H1N1 virus that
caused the 1918 flu pandemic, which killed at least 40 million
people globally and may have killed more, depending on
estimates, was a purely avian virus that acquired a few
mutations that gave it the ability to infect people easily,
spread among them and cause highly fatal disease.
H5N1 is mutating in a similar way and experts believe it is
only a matter of time before it, too, infects people easily.
© Copyright 2005 Reuters Ltd