World Unprepared for "Bird Flu" Pandemic, Experts Say

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In today's increasingly mobile world such actions are unlikely to slow disease transmission but may well devastate the international economy. Institutions, from businesses to relief agencies, would likely stagnate as illness became widespread.

No Panacea

Vaccines can be effective against some influenza strains, but they currently promise little help in the event of an avian flu pandemic.

"[Medical] technology has improved, but the capacity to make vaccines is not great," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the Bethesda, Maryland-based National Institutes of Health.

"We have to be careful we don't assume we have everything that we need—because we don't."

Common-flu vaccines are routinely produced from poultry eggs but under systems that are far too slow to cope with the rapid spread of a bird flu pandemic.

"You can't make vaccine in advance, because you don't know for sure which virus will eventually be the cause of a new pandemic," explained Albert Osterhaus, director of the Netherlands' National Influenza Centre in Rotterdam.

"Once you have data showing that a new influenza virus is spreading rapidly, you need to develop a vaccine as soon as possible on the basis of the information you have on the virus."

The vaccine-production process is likely to take six months or a year. Even with a robust vaccine stockpile, health workers would be able to vaccinate perhaps only 15 percent of the global population, the new report says. That timetable is too slow for an efficient response to a pandemic that could circle the globe in months.

Other protective tools could help the world cope with a new virus pandemic. These include respirators, which could be worn to avoid inhaling viruses, and antiviral drugs, which could slow the rate of infection. Neither of these, however, is stockpiled in sufficient quantity, according to the study.

Some countries, particularly in Europe, are beginning to increase antiviral-drug reserves against a future pandemic. Other countries are attempting to create vaccines to innoculate their citizens in advance of a pandemic.

The United States is now testing specific vaccines for the H5N1 avian flu virus. "We need to prepare by developing a vaccine against the best bet—the H5N1 strain now circulating in Vietnam," said NIH's Fauci.

A pandemic strain is unlikely to be an exact match for an H5N1 vaccine or any other premade vaccine. There is hope, though, that such vaccines would be specific enough to afford some protection.

"Naysayers ask why we'd even stockpile [the vaccine], because the virus may change itself," Fauci said. "Well, I'd rather have a partially effective vaccine than no vaccine, and this is the only thing we have in our hand right now."

Heeding Global Wake-Up Call?

Despite such national efforts, experts agree that vastly improved international coordination is essential to preparing for the next pandemic. The issue is on the agenda for this summer's G8 summit in Scotland. (The G8 are the world's major industrial democracies: Canada, France, Germany, Italy, Japan, Russia, the United Kingdom, and the United States.)

Osterhaus, of the Netherlands' National Influenza Centre, calls for an international task force that could create and coordinate the many aspects of pandemic preparation, surveillance, and response.

"Rather than creating ad hoc responses, we need to really create a task force that's coordinating surveillance data of wild birds, domestic poultry, and humans, to link them," he said.

Experts call for plans for emergency services, food distribution, and temporary hospitals. They add that governments should determine who should first receive the limited supplies of vaccines and antiviral drugs—particulary with respect to health workers, who would be at great risk of infection.

Vaccine manufacturers must be encouraged to revamp operations in a way that would allow greater and more flexible production, several of the new Nature reports say. Last flu season's widely publicized vaccine shortages may offer a hint of the drawbacks of the current vaccine-production systems.

Vaccine makers are generally for-profit businesses that have to deal with an unpredictable demand for their products. Without financial incentives—such as guaranteed product demand, tax breaks, or protection against lawsuits—the vaccine-supply situation appears unlikely to improve.

"At this moment if we were to face a pandemic outbreak of flu in the next year or so, the world would be basically unprepared," Osterhaus said. "I think WHO [the UN's World Health Organization] is doing a tremendous job, but they are completely underfunded."

Stepped-up international efforts might also supplement weak or nonexistent national programs in countries that lack resources. Such countries include several Southeast Asian nations, where an avian influenza pandemic is likely to originate—and where it might be easiest to fight, in its early stages.

"We seem to be doomed to repeat these kinds of experiences time and time again, not just as countries but as a world," said the University of Minnesota's Osterholm.

"This is really a clarion call to the entire world—not just to governments but to the business community, to university presidents, to HMO medical directors," he said. We need to understand what needs to be done to get through the next pandemic."

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