H5N1

The Pandemic Preparedness Project is readying nations worldwide for an expected global flu epidemic, according to reports on the Science and Development Network website. Researchers agree that it is a question of when, not if, a global flu epidemic occurs.

Many experts, including those of the World Health Organisation, predict the next outbreak will result from the current bird-flu epidemics in south-east Asia.

Leading scientists warn that we are in a race against time to prepare for a global flu epidemic and that current efforts lack both funding and coordination.

But countries in Africa and South America appear to be very poorly prepared for the expected epidemic, warned Nelson Gonzales, Pandemic Preparedness Project coordinator for the United Kingdom Royal Institution's World Science Assembly.

"Some national governments are putting together decent preparations, but that is six to 12 countries at most," said Gonzales, referring to vaccine research and drug stockpiling that is under way in North America and Europe.

"We are dealing with a 'weakest link' phenomenon," said Gonzales. "It doesn't matter how prepared you are if your neighbour is unprepared."

One of his major concerns is making sure that governments outside Asia, Europe and North America are prepared for an eventual pandemic. The initiative will not hand out funds.

"Our responsibility is to catalyse the interest, momentum and partnerships that need to happen," explained Gonzales. "We feel the science has done a really good job of determining what the needs are. What is lacking is the political will."

The Pandemic Preparedness Project is chaired by Rita Colwell, former director of the United States National Science Foundation, and includes Klaus Stöhr, coordinator for the World Health Organisation's Global Influenza Programme.

Commenting on the absence of representatives from south-east Asia, where epidemics are currently occurring, Gonzales said the project is waiting for replies to invitations to representatives in the region to join the steering committee.

Bird flu is caused by a virus, H5N1, now believed to be widespread in poultry in parts of south-east Asia. It has killed 21 people in the region since December last year, and 53 in total since December 2003.

Although the virus does not easily jump from human to human, it kills about half of the people it infects, and some researchers say it is only a matter of time before the virus becomes able to spread from person to person.

While some drugs are available, doctors in many countries are not familiar with administering them. The medicines need to be used as soon as possible, but flu symptoms are notoriously vague. In addition, if a pandemic occurs, the drugs may need to be combined with quarantine of the victim and his or her family.

Overdue pandemic

There were three flu pandemics in the 20th century and experts say the next one is overdue. The pandemic in 1918 -- the year of Nelson Mandela's birth -- killed 20-million people. The 1957 and 1968 pandemics were mild in comparison, each claiming one million lives.

Earlier this year, leading researchers issued a series of stark warnings that the world is unprepared for an "inevitable" global bird-flu epidemic, which even optimistic estimates predict could kill millions of people -- hitting developing countries hardest.

Ron Fouchier and his colleagues at the National Influenza Centre in The Netherlands have called for a "global task force" to translate scientific findings into effective policies.

Fouchier and his team said the costs of an integrated approach to the bird-flu threat would be "dwarfed" by the economic losses brought by a full-blown pandemic. They point out that bird-flu outbreaks in 2003 cost The Netherlands, Thailand and Vietnam $1,3-billion in agricultural costs alone.

Thailand and Vietnam have been at the centre of debates over whether to respond to H5N1 outbreaks in poultry by mass vaccination or culling of birds.

There are concerns that vaccines could promote the evolution of H5N1 into a more deadly form. But Robert Webster and Diane Hulse, virologists based at the St Jude Children's Research hospital in the US, argued in a separate article in the journal Nature that high-quality vaccines might reduce the amount of the virus circulating to a manageable level.

"The technology for producing inexpensive agricultural vaccines using reverse genetics is available and should be developed," they wrote.

China used poultry vaccines to control an H5N1 outbreak in 2004 and has not reported any outbreaks in domestic poultry since. But with memories of China's 2003 outbreak of severe acute respiratory syndrome still fresh, many believe that how China — which has 13-billion chickens — faces bird flu could have a major impact on other countries.

David Ho of the Aaron Diamond Aids Research Centre at Rockefeller University in the US said that while China's disease surveillance system looks good "on paper", many faults remain.

"The disease surveillance system is grossly underfunded, and consequently lacks sufficient human resources and technical capacity," said Ho in his contribution to Nature.

Ho called on China to spend more money on microbiology research to understand bird flu and other pathogens better, and to create enough Chinese experts able to advise policy-makers.

"China must make microbial threats to health a top priority in its national research agenda," said Ho. "It has a moral obligation to its own people, and to the world, to rectify the situation as soon as possible."

Vaccine

Creating a vaccine to prevent people from becoming infected with bird flu is the most important challenge, said Michael Osterholm of the Centre for Infectious Disease Research and Policy at the University of Minnesota in the US.

Currently, just 5% of the world's population living in a handful of rich nations receive flu vaccines, said Osterholm. But he warned that a vaccine against a pandemic strain of the bird-flu virus will not be ready for at least six months after the pandemic begins. Even then, there will only be enough vaccines to protect 14% of the global population.

Wherever the predicted pandemic begins — likely to be in one of the Asian nations where the virus is currently circulating — a vaccine will not be delivered fast enough.

By acting now, said Osterholm, we might be able to change its course. He urged the rich nations of the Group of Eight most-industrialised nations to recognise the threat and act decisively by investing in vaccine research and other efforts to minimise the number of people the epidemic kills.

We are in a race against time, agreed Anthony Fauci, of the US-based National Institute of Allergy and Infectious Diseases.

"Unlike the situation before previous flu pandemics, we now have the knowledge and technology to develop countermeasures for this disease," he said. "However, unless we improve our capacity to produce such countermeasures, we may experience again the devastation of past epidemics."

But rich governments are not inclined to help poor countries monitor animal viruses because they see it as a form of economic assistance. In this, they ignore the global threat posed by these viruses.

The journal Nature called the state of global inaction on this issue "scandalous". -- SciDev.Net