Global flu plan needed to avert a pandemic<\/p>\n
Michael Richardson, Singapore<\/p>\n
What will happen if the deadly avian influenza virus that has
\ndecimated poultry flocks in China and Southeast Asia mutates so
\nthat it can pass quickly from person to person, triggering alarm
\nbells that a dangerous new flu epidemic is about to start
\nspreading around the world? This will be one of the top agenda
\nitems for the annual meeting this week of ministers and leaders
\nof APEC, the Asia Pacific Economic Cooperation forum in Busan,
\nSouth Korea.<\/p>\n
For some time, the World Health Organization has been working
\non a plan to extinguish local outbreaks of the H5N1 virus among
\nclusters of humans before the flu, which is normally highly
\ninfectious, can ignite a pandemic.<\/p>\n
The prospect of halting a pandemic at its source or delaying
\nits international spread is attractive. But it has never been
\ntried before.The WHO still needs more time to finalize the
\nintervention plan but hopes to do so by the end of this year.<\/p>\n
In August, it was promised 3 million doses (amounting to 30
\nmillion capsules) of Tamiflu - one of two antiviral drugs
\nconsidered most effective in reducing the severity of illness in
\npeople caused by H5N1, which until now has been largely been
\nconfined to birds.<\/p>\n
This stockpile is the basis of the WHO's plan. Tamiflu's
\nmaker, Swiss-based Roche Holdings AG, has promised that the first
\none million doses will be ready early next year, and the
\nremaining two million before mid-2006.<\/p>\n
The WHO has also held preliminary discussions with Roche and
\npotential donor governments to establish a separate stockpile of
\nantiviral drugs in Asia for possible emergency use. The aim is to
\nget richer states to donate, in cash or kind, the equivalent of
\n5 percent of their own Tamiflu stockpiles. Thailand -- which
\nalong with Singapore is one of the few Southeast Asian nations to
\nhave ordered Tamiflu -- has offered to donate 5 percent of its
\n750,000 treatments to a Southeast Asian stockpile.<\/p>\n
Since bird flu became endemic in East Asia in 2003, Australia
\nhas committed $AUD41 million to improve regional detection and
\nresponse capabilities. It has provided Indonesia with bird flu
\nassistance worth $AUD15.5 million, including 50,000 Tamiflu
\ncourses.<\/p>\n
The WHO move to create a stockpile for East Asia comes amid
\nincreasing concern that almost all of the 50 countries that have
\nplaced orders for Tamiflu are in the developed and newly
\nindustrialized world. This leaves developing nations exposed,
\nincluding China and many in Southeast Asia that are considered
\nmost likely to be the epicenters of any new human flu pandemic.<\/p>\n
Epidemiologists say that the world is in a race against time
\nto prepare for a pandemic, although no one knows when it will
\nstart. There have been three flu pandemics in the last century.
\nThe most recent was in 1968. The worst was in 1918 and is thought
\nto have been caused by an avian-like virus. An estimated 40 - 50
\nmillion people died.<\/p>\n
Vaccines offer the best protection against flu. But they must
\nbe tailor made to match any new strain of influenza when it
\nemerges and infects humans. This can take up to six months.<\/p>\n
A number of governments and pharmaceutical companies are now
\ngiving top priority to research and processes that will shorten
\nthe time needed to mass produce flu vaccines. The results of this
\nwork must be shared so that breakthroughs can be rapidly
\nharnessed. If everyone on earth is to be protected, about 6.5
\nbillion doses of vaccine would have to be produced and
\nadministered. This is a huge challenge.<\/p>\n
Meanwhile, the absence of an effective vaccine to protect
\nvulnerable populations creates a gaping hole in global pandemic
\ndefenses. Neither of the two available anti-viral drugs, Tamiflu
\nand Relenza, prevent or cure infection by an H5N1-like pathogen,
\nalthough they may help reduce the severity of illness if taken
\nwithin 48 hours after symptoms begin.<\/p>\n
The best hope of containing any pandemic virus outbreak among
\nhumans may therefore be to place stockpiles of anti-viral
\nmedicines in the hands of the WHO and the national governments of
\ncountries it considers are particularly vulnerable. The aim would
\nbe to rush the drugs to any area of the world where a cluster of
\nhuman-to-human cases is detected in the hope that it can be
\nisolated and quenched until a safe vaccine can be mass-produced,
\ndistributed and administered.<\/p>\n
The WHO says that for intervention to be successful, at least
\nfive conditions will have to be met. The first viruses that can
\njump from human to human will not yet be highly contagious and
\nwill be limited to a small geographical area. The first clusters
\nof human flu cases will be rapidly detected and reported.
\nAntiviral drugs from the stockpile will be quickly administered
\nto all of the affected population. And movement of people in and
\nout of the areas will be effectively restricted.<\/p>\n
Given the unpredictable nature of influenza viruses, it is
\nimpossible to know in advance if the first two conditions will
\napply. And the remaining conditions will depend heavily on the
\nwillingness and ability of both national and local authorities in
\nthe country concerned to cooperate with the WHO.<\/p>\n
The writer is a visiting senior research fellow at the
\nInstitute of South-East Asian Studies in Singapore. He is the
\nauthor of Bird Flu & Bio-Security: Is the World a Dead Duck, a
\nnew report posted on the ISEAS website: www.iseas.edu.sg click on
\nViewpoints.<\/p>",
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