Bird flu on the wing

Danger of pandemic is real, but technology exists to deal with it if sufficient resources are allocated

A flu pandemic is a global outbreak of disease that occurs when a new influenza A virus appears in the human population, causes serious illness, and then spreads easily from person to person worldwide. Pandemics are different from seasonal outbreaks of flu that are caused by a new variety of an old flu that already has circulated among people.

The 1918 worldwide flu pandemic, called the “Spanish flu,” killed more than 500,000 people in the United States and up to 50 million people worldwide. Nearly half of those who died were young, healthy adults.

A new strain of flu was identified among birds in 1997 and dubbed H5N1. H5N1 is considered the most likely source of a future flu pandemic. Although the virus is hosted by birds, it may be found in other species of mammals, including pigs. Symptoms in birds range from mild illness to a highly contagious and rapidly fatal disease. Domestic poultry, including chickens and turkeys, are particularly susceptible to epidemics of this rapidly fatal influenza. The virus that caused the 1918 pandemic also originated in bird populations.

A severe disease

When H5N1 passes from poultry to humans the result is a very severe disease. Direct infection of humans from H5N1 has resulted in pneumonia and multi-organ failure, and frequently death. H5N1 has been implicated in about 120 human cases of flu since 2003. Approximately half of these patients died. Most cases occurred in previously healthy children and young adults.

Most human cases have occurred in rural areas where chickens and other domestic fowl live closely with people, sometimes entering homes or sharing outdoor areas where children play. Infected birds shed large quantities of virus in their droppings. But there is no evidence that properly cooked poultry or eggs can be a source of infection. The number of human cases in the current outbreak is relatively small compared with the huge number of birds affected and the numerous associated opportunities for human exposure.

How a pandemic could develop

Nevertheless, the widespread presence of H5N1 in poultry populations poses the possibility of a human pandemic. Why? As viruses reproduce in humans and animals, their genetic composition changes. The existing strain is constantly replaced with a new type of virus. (This is why we have to get a “new” flu shot every year.) Even though so far there have been no documented cases of human-to-human transmission, the H5N1 virus — if given enough opportunities — will mutate into a form that does spread easily from person to person.

The World Health Organization warns that a human influenza pandemic could be ignited if the H5N1 virus mutates into a form transmitted between humans. “We do not know when it will come. But, we think that it will come,” said Ian Simpson, WHO spokesman.

So there is a very real risk of pandemic flu. The virus is firmly entrenched in large parts of Asia, has been found in Europe, and is bound to spread as birds, wild and domestic, travel around the world. The occurrence of more human cases gives the virus an opportunity to improve its transmissibility in humans, and thus to develop into a pandemic strain.

Vaccine development

Although a vaccine against the H5N1 virus is under development in several countries, no vaccine is ready for production. Some clinical trials are now under way to test experimental vaccines. However, the vaccine needs to closely match the pandemic virus, so large-scale production cannot start until the new virus has emerged and a pandemic has been declared. Current global vaccine production capacity will not meet the world’s needs if a pandemic does occur.

“What this pandemic could do to us as a people is even more threatening than what a few terrorists could do, even a few terrorists with a nuclear device,” said Sen. Tom Harkin (D-Iowa). Harkin led the drive to attach an emergency measure to a fiscal 2006 funding bill for the Department of Health and Human Services and other federal agencies. The Senate was expected to approve the measure, but it is not yet clear whether the House of Representatives will go along. The measure would provide $3.3 billion to stockpile avian flu vaccines, or about 120 million doses, as they are created, and about $3 billion for anti-viral drugs — enough to serve half of the American population of nearly 300 million. Obviously, much more is needed.

Pharmaceutical profiteering

The first response of pharmaceutical company Roche to the risk of an avian flu pandemic was to sell off stockpiles of its product Tamiflu in a highly profitable panic sale while limiting production. Fortune magazine reported that Defense Secretary Donald Rumsfeld pocketed at least $1 million in the last six months since Tamiflu became the world’s most sought-after drug. Rumsfeld is a major stockholder in Gilead Research, which has a development and licensing agreement for Tamiflu with Roche.

Sen. Charles Schumer (D-N.Y.) accused Roche of “putting profits ahead of world safety” and threatened legislation compelling Roche to boost world production by allow generic producers to make Tamiflu. In response to the pressure, Roche said it would talk to four generic drug manufacturers about increasing production. It is unclear, however, how quickly Roche will comply or even whether Tamiflu will actually have an effect on a spreading pandemic.

WHO recommends strategic actions

In August, WHO outlined a comprehensive response to the avian influenza pandemic threat. It recommended that countries strengthen national preparedness, reduce opportunities for a pandemic virus to emerge, improve the early warning system, delay initial international spread, and accelerate vaccine development. Every one of WHO’s recommendations relates to building a strong public health infrastructure.

In the U.S., public health departments on local and state levels have responded to WHO’s recommendations by developing extensive public health plans incorporating the applicable recommendations and building on existing programs. An example of this is the bird surveillance plans in place since the appearance of the West Nile virus in the U.S. Surveillance for sick and contaminated birds is key in the prevention of the spread of bird flu.

Bush’s bird-brained proposal

But on the national level, the Bush administration has yet to release any plan at all except his suggestion that the U.S. military be used to enforce quarantines of bird flu victims. This raises the frightening image of soldiers cordoning off communities hit by disease, stopping commerce, travel, and day-to-day activities including voting.

Bush’s proposal would truly endanger the population by taking the implementation of health measures out of the hands of public health departments, which have the necessary expertise.

The president’s suggestion is an “extraordinarily draconian measure,” said Dr. Irwin Redlener, associate dean of Columbia University’s Mailman School of Public Health and director of its National Center for Disaster Preparedness. It would be unnecessary, he said, if the nation had built the capability for rapid vaccine production, ensured a large supply of anti-virals like Tamiflu, and not allowed the degradation of the public health system.

Evidence of human-to-human transmission would give the world time to take defensive action through appropriate public health measures. But the development and production of bird flu vaccine cannot be left in the greedy hands of the pharmaceutical industry. Money and resources must come from the international community, especially the United States government, to build the urgent worldwide project necessary to prevent a pandemic.

On the other hand, putting the power of a military response to disease in the hands of an increasingly unpopular, desperate and out-of-control president endangers the people of the U.S. in a way that the controllable specter of a bird flu pandemic doesn’t.

Carolyn Trowbridge, RN, BSN is a health care activist in Arizona and a member of her county’s Board of Health.