Crying Wolf on swine Flu: Prof. Bragg answers questions on Pandemic Flu

1) Do you believe, since the virus hasn't been as deadly as people have expected (so far) that complacency is setting in?

This could be. If you look at the speed and urgency in the response to this outbreak by the CDC and the WHO, one can get an idea of the seriousness the scientific community places on this virus. Influenza virus remains one of the viruses with the highest potential to cause a very serious pandemic.
At this stage it is still too early to make sweeping statements about this virus and this outbreak, but it appears that the virus is not spreading as quickly as feared (although it is already confirmed on 5 continents - so I am not sure how it could spread more rapidly!).
The virus appears not to be spreading rapidly from human to human. It also appears that the virulence of this virus is not as high as first feared. Normally, when a virus crosses the species barrier it is highly virulent. Fortunately this appears not to be true in this case at this stage.
So to get back to your question - yes I do think that a measure of complacency is setting in. This could also be a problem if the virus decides to change a bit and we start seeing a more virulent form of the virus. This could lead to a "cry-wolf" situation, where during the next outbreak - people don't pay as much attention to it.

2) What measures does South Africa need to implement? Do we have enough anti-virals?

I cannot comment on the supply of anti-virals in South Africa. I also think that your protection is pretty much up to the individual at this stage. Monitoring people with a fever at airports will not work in this case. This worked with SARS - but this was a very different virus with a very different epidemiology. SARS was only infectious when people were showing clinical signs - so monitoring of temperatures could be used.
With Influenza, people are infectious before they show clinical signs. Having said this anything which can limit the spread of the virus will help and should be allied.

3) Is a vaccine worth pursuing given how quickly these influenza's mutate?

This is a very difficult question. Influenza is a very complex virus and one needs the correct combination of heamagglutin and neuraminidase for a vaccine to work. So the vaccine manufacturers need to know exactly what virus is causing the problem. So they cannot start with the vaccine production too soon. Another problem with vaccines against this virus is that it takes time to develop and produce a vaccine. If this virus was really virulent, it would be causing serious problems before a vaccine can be produced.

Currently the vaccines are made in embryonated chicken eggs. These are very special eggs which cost a lot. They are specific pathogen free eggs. These eggs come from chickens which are house in "germ free" facilities and have no antibodies in the eggs. It is a very difficult process to keep these chickens and there is a limited supply of chickens laying these eggs. It is impossible to suddenly get a lot more eggs - the chicken will only lay one egg a day!

4) Isn't the danger that even if this strain isn't 'a worse case scenario', we are moving closer and closer to it (if we're not there already).

The world is expecting a serious Influenza pandemic. Based on the past history of Influenza, a pandemic was expected about 5 years ago. This virus, not necessarily this particular strain - but influenza viruses in general, remain one of the viruses which has the potential to cause a very serious pandemic. Hence the very rapid and urgent response by WHO and CDC.

5) What is your information on the virulence of H1N1?

I do not have any specific scientific information on the virulence of this virus at this stage, but based on the spread and the clinical picture reported on, my feeling is that this is not a highly virulent strain.

6) What is the level of infection currently in SA?

I cannot comment on this. As far as I know there were two suspect cases - one of which tested negative.

7) I am concerned because I read reports that government officials say swine flu (in pigs) never occurred in South Africa, they say it occurred in Kenya in the 1950's. When I interviewed you in 2005 I drove through many border checks for swine flu. There were similar checks at the Free State border in December 2007. So do you have confidence that South Africa can deal with this problem spreading to human beings? And secondly, what source of information should ordinary people follow - ie where can we get reliable, trustworthy information from?

I think that you are confusing Swine influenza with Swine fever. This is a different virus in total. There have been outbreaks of swine fever in South Africa, and I am sure that you are taking about this.

How likely is a flu pandemic?

The World Health Organisation puts the risk level at "phase 3" out of six on its pandemic alert scale, which means that a new flu strain has appeared in humans but is not yet spreading from person to person. It is impossible to predict when the next flu pandemic will happen, but experts say we are living on borrowed time.

The big worry is the particularly deadly strain of H5N1 bird flu circulating mainly in south-east Asia - so far it has infected 335 people and killed 206 (mainly poor farmers who live in close proximity with their poultry). If it were to mutate or swap genes with a human flu virus so that it was more easily transmitted between humans, we could face a pandemic.

by James Randerson for The Guardian

It is this scenario that prompted the government to bolster its plans for dealing with flu last week. Health ministers have ordered that the current stockpile of 14.6m doses of the antiviral drug tamiflu be increased by another 15m at a cost of around £150m. That will allow doctors to give the drugs preventatively to the families of people who become infected and not just people who contract the virus. Estimates of the number of people in the UK who would be killed in a future pandemic range from 55,000 to 750,000.

Last century there were three pandemics. The 1968-69 Hong Kong flu killed up to a million people globally, the 1957-58 Asian flu killed up to 1.5 million and the mother of them all, the 1918-20 Spanish flu, killed around 40 million - more than the first world war. There is no regular cycle governing pandemics, but the long gap since the last one is making experts jumpy. And since the last epidemic in 1968 air travel has become more common, meaning that if a pandemic virus emerged, it could spread around the globe more quickly.

NVDL: I once interviewed an expert at the University of the Free State, Professor Bragg. He said, 'There's basically diddly squat we can do about it'. I called that interview 'A Matter Of When'. I also attended a Tamiflu conference and the expert there, John Oxford, said the same thing.