Global flu plan needed to avert a pandemic

Global flu plan needed to avert a pandemic

Michael Richardson, Singapore

What will happen if the deadly avian influenza virus that has
decimated poultry flocks in China and Southeast Asia mutates so
that it can pass quickly from person to person, triggering alarm
bells that a dangerous new flu epidemic is about to start
spreading around the world? This will be one of the top agenda
items for the annual meeting this week of ministers and leaders
of APEC, the Asia Pacific Economic Cooperation forum in Busan,
South Korea.

For some time, the World Health Organization has been working
on a plan to extinguish local outbreaks of the H5N1 virus among
clusters of humans before the flu, which is normally highly
infectious, can ignite a pandemic.

The prospect of halting a pandemic at its source or delaying
its international spread is attractive. But it has never been
tried before.The WHO still needs more time to finalize the
intervention plan but hopes to do so by the end of this year.

In August, it was promised 3 million doses (amounting to 30
million capsules) of Tamiflu - one of two antiviral drugs
considered most effective in reducing the severity of illness in
people caused by H5N1, which until now has been largely been
confined to birds.

This stockpile is the basis of the WHO's plan. Tamiflu's
maker, Swiss-based Roche Holdings AG, has promised that the first
one million doses will be ready early next year, and the
remaining two million before mid-2006.

The WHO has also held preliminary discussions with Roche and
potential donor governments to establish a separate stockpile of
antiviral drugs in Asia for possible emergency use. The aim is to
get richer states to donate, in cash or kind, the equivalent of
5 percent of their own Tamiflu stockpiles. Thailand -- which
along with Singapore is one of the few Southeast Asian nations to
have ordered Tamiflu -- has offered to donate 5 percent of its
750,000 treatments to a Southeast Asian stockpile.

Since bird flu became endemic in East Asia in 2003, Australia
has committed $AUD41 million to improve regional detection and
response capabilities. It has provided Indonesia with bird flu
assistance worth $AUD15.5 million, including 50,000 Tamiflu
courses.

The WHO move to create a stockpile for East Asia comes amid
increasing concern that almost all of the 50 countries that have
placed orders for Tamiflu are in the developed and newly
industrialized world. This leaves developing nations exposed,
including China and many in Southeast Asia that are considered
most likely to be the epicenters of any new human flu pandemic.

Epidemiologists say that the world is in a race against time
to prepare for a pandemic, although no one knows when it will
start. There have been three flu pandemics in the last century.
The most recent was in 1968. The worst was in 1918 and is thought
to have been caused by an avian-like virus. An estimated 40 - 50
million people died.

Vaccines offer the best protection against flu. But they must
be tailor made to match any new strain of influenza when it
emerges and infects humans. This can take up to six months.

A number of governments and pharmaceutical companies are now
giving top priority to research and processes that will shorten
the time needed to mass produce flu vaccines. The results of this
work must be shared so that breakthroughs can be rapidly
harnessed. If everyone on earth is to be protected, about 6.5
billion doses of vaccine would have to be produced and
administered. This is a huge challenge.

Meanwhile, the absence of an effective vaccine to protect
vulnerable populations creates a gaping hole in global pandemic
defenses. Neither of the two available anti-viral drugs, Tamiflu
and Relenza, prevent or cure infection by an H5N1-like pathogen,
although they may help reduce the severity of illness if taken
within 48 hours after symptoms begin.

The best hope of containing any pandemic virus outbreak among
humans may therefore be to place stockpiles of anti-viral
medicines in the hands of the WHO and the national governments of
countries it considers are particularly vulnerable. The aim would
be to rush the drugs to any area of the world where a cluster of
human-to-human cases is detected in the hope that it can be
isolated and quenched until a safe vaccine can be mass-produced,
distributed and administered.

The WHO says that for intervention to be successful, at least
five conditions will have to be met. The first viruses that can
jump from human to human will not yet be highly contagious and
will be limited to a small geographical area. The first clusters
of human flu cases will be rapidly detected and reported.
Antiviral drugs from the stockpile will be quickly administered
to all of the affected population. And movement of people in and
out of the areas will be effectively restricted.

Given the unpredictable nature of influenza viruses, it is
impossible to know in advance if the first two conditions will
apply. And the remaining conditions will depend heavily on the
willingness and ability of both national and local authorities in
the country concerned to cooperate with the WHO.

The writer is a visiting senior research fellow at the
Institute of South-East Asian Studies in Singapore. He is the
author of Bird Flu & Bio-Security: Is the World a Dead Duck, a
new report posted on the ISEAS website: www.iseas.edu.sg click on
Viewpoints.