By David Brown
WASHINGTON — Public-health officials preparing to battle what they view as an inevitable influenza pandemic say the world lacks the medical weapons to fight the disease effectively, and will not have them anytime soon.
Public-health specialists and manufacturers are working frantically to develop vaccines, drugs, strategies for quarantining and treating the ill and international cooperation plans, but these efforts will take years. Meanwhile, the most dangerous strain of influenza to appear in decades — the H5N1 "bird flu" in Asia — is showing up in new populations of birds, and occasionally people, almost by the month, health officials say.
If the virus were to start spreading in the next year, the world would have only a relative handful of doses of an experimental vaccine to defend against a disease that, history shows, could potentially kill millions. If the vaccine proved effective and every flu-vaccine factory in the world started making it, the first doses would not be ready for four months. By then, the pathogen would probably be on every continent.
Theoretically, antiviral drugs could slow an outbreak and buy time. The problem is only one licensed drug, oseltamivir, appears to work against bird flu. At the moment, there is not enough stockpiled for widespread use. Nor is there a plan to deploy the small amount that exists in ways that would have the best chance of slowing the disease.
The public, conditioned to believe in the power of modern medicine, has heard little of how poorly prepared the world is to confront a flu pandemic, which is an epidemic that strikes several continents simultaneously and infects a substantial portion of the population.
Since the current wave of avian flu began sweeping through poultry in Southeast Asia more than 18 months ago, international and U.S. health authorities have warned of the danger and tried to mobilize. Research on vaccines has accelerated, efforts to build drug supplies are under way, and discussions take place regularly on developing a global response.
The U.S. Department of Health and Human Services will spend $419 million in pandemic planning this year. The National Institutes of Health's influenza research budget has quintupled in the past five years.
"The secretary or the chief of staff — we have a discussion about flu almost every day," said Bruce Gellin, head of HHS's National Vaccine Program Office. This week, a committee is to deliver to HHS Secretary Mike Leavitt an updated plan for confronting a pandemic.
Despite these efforts, the world's lack of readiness to meet the threat is huge, experts say.
"The only reason nobody's concerned the emperor has no clothes is that he hasn't shown up yet," Harvey Fineberg, president of the National Academy of Sciences' Institute of Medicine, said recently of the world's efforts to prepare for pandemic flu. "When he appears, people will see he's naked."
Other scientists are sounding the alarm as well.
The most outspoken is Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. In writing and in speeches, Osterholm reminds his audience that after public calamities, the United States usually convenes blue-ribbon commissions to pass judgment. There will be one after a flu pandemic, he thinks.
"Right now, the conclusions of that commission would be harsh and sad," he said.
In hopes of slowing a pandemic's spread, public-health specialists have been debating proposals for unprecedented countermeasures. These could include vaccinating only children, who are statistically most likely to spread the contagion; mandatory closing of schools or office buildings; and imposing "snow day" quarantines on infected families — prohibiting them from leaving their homes.
Other measures would go well beyond conventional boundaries of public health: restricting international travel, closing transit systems or nationalizing supplies of critical medical equipment.
Osterholm argues such measures would fall far short. He predicts a pandemic would cause widespread shutdowns of factories, transportation and other essential industries. To prepare, he says, authorities should identify and stockpile a list of perhaps 100 crucial products and resources that are essential to keep society functioning until the pandemic recedes and the survivors go back to work.
Since late 2003, 109 people are known to have been infected with the emerging H5N1 virus in Asia. About half — 55 — have died.
Pandemic influenza is not an unusually bad version of the flu that appears each winter. Those outbreaks are caused by viruses that have been circulating for decades and change slightly year to year.
Pandemics are caused by strains of virus that are highly contagious and to which people have no immunity. Such rare strains arise from the chance scrambling and recombination of an animal flu virus and a human one.
If H5N1 never becomes easily transmissible in human beings, it will never become a pandemic. If it does become transmissible, the consequences are difficult to imagine. But history provides clues.
The "Spanish flu" in 1918 and 1919 was the biggest and, along with AIDS, the most important infectious-disease outbreak of the 20th century. At least 50 million people, and possibly as many as 100 million, died when the world's population was 1.9 billion, one-third its current size.
Copyright © 2005 The Seattle Times Company
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