U.S. not ready for bird flu
Friday, October 14, 2005
Printable FormatCHICAGO TRIBUNE
By Jeremy Manier and Tim Jones
Drugs, vaccines in low supply; officials scramble to mount defense
In the face of an uncertain threat that avian flu could cause a new pandemic, political leaders at every level are grappling with the disquieting fact that the United States has almost no ability to stop an outbreak of the disease if it strikes here soon.
No one knows if bird flu, which is more dangerous than ordinary flu because people have no natural immunity to it, will ignite an epidemic like the one that swept the world in 1918.
Hundreds of millions of birds infected with the new strain have spread through Asia in recent years, and on Thursday, European Union officials confirmed that the virus has struck birds in Turkey, the strain's first appearance in Europe. The widespread bird problem could provide a breeding ground for the virus to mutate into a form able to spread among humans.
Congress and the Bush administration are scrambling to improve the nation's scant supply of vaccines and anti-viral drugs that could fight such infections. Lawmakers said the government's sluggish response to Hurricane Katrina highlighted weaknesses in disaster readiness.
But for now, experts say the response to bird flu would consist mostly of unproven measures such as closing schools, canceling most large indoor gatherings and isolating the estimated one-fifth of the population that would fall sick. If better medications are not in place, ordinary citizens could do little beyond practicing good hygiene or wearing protective masks, epidemiologists said.
In one sign of the heightened awareness of flu--and the uncertainty over what to do about it--President Bush this month made an impromptu suggestion that the military could help quarantine entire regions of the country. Yet flu experts within and outside government said such quarantines would accomplish little because of flu's ability to spread quickly.
"Quarantine will be playing a very limited role," said Michael Osterholm, an adviser to the U.S. Department of Health and Human Services and director of the University of Minnesota's Center for Infectious Disease Research and Policy.
"Influenza is such an infectious disease that unlike some diseases where quarantine can work, with this one it will not," he said.
The most effective preparation, according to Osterholm and other experts, is for citizens to pressure politicians into taking the threat seriously. Last month the Senate allocated $3.9billion to build a stockpile of anti-viral drugs--a move that would have been unthinkable a year ago, many advocates said. In June, Illinois appointed the state's first full-time pandemic response coordinator.
HHS chief visiting Asia
This week HHS Secretary Michael Leavitt is meeting with health officials in Southeast Asia, where the avian flu virus has killed 60 people. Most victims caught the virus from ducks or other animals. Although the bug cannot yet spread among humans, officials in Leavitt's office said the U.S. wants to help detect any outbreak in its earliest stages--which could be the only way to prevent wider spread.
Rep. Jim Leach (R-Iowa), who heads the House subcommittee on Asia and the Pacific, said disease control has surpassed war and terrorism as the nation's top priority.
"Everything else pales in significance," Leach said.
Few other lawmakers were focused on the issue last March, when Sen. Barack Obama (D-Ill.) proposed $25 million in foreign assistance to help prevent an outbreak.
Obama said he was concerned in part because as a child he lived for five years in Indonesia, which recorded its first human cases this year.
"I knew that part of the world and was familiar with how the livestock operations are--they're in people's back yards," Obama said. He said the problem in Southeast Asia is urgent because wherever a pandemic starts, it's likely to arrive in the U.S. within four to six weeks.
No one knows whether a new flu outbreak would kill as many as the 50 million killed by the 1918 pandemic worldwide, though some estimates are that the toll would be far higher. Daniel Lee, the new pandemic coordinator for Illinois, said models from the federal Centers for Disease Control and Prevention suggest the virus would kill up to 9,000 people in the state and sicken as many as 4.5 million.
Previous influenza pandemics have started when a virus from birds or another animal mutated to infect humans and spread from person to person.
Limits in production capacity mean it's unlikely that a vaccine against such a newly mutated strain would be available for at least the first year of a pandemic, experts said.
Lacking a vaccine, stopping an outbreak at its source may offer the best chance to prevent a pandemic. Two studies published in August suggested that giving millions of doses of anti-viral drugs such as Tamiflu to people in the region of an outbreak could stop the disease from spreading.
Such a response would require intensive disease surveillance in Southeast Asia and other at-risk regions to detect the outbreak early. That may be difficult in the rural, impoverished areas where bird flu often thrives, said Martin Meltzer, a senior health economist at the CDC who has modeled the effects of pandemic flu.
"Unless you get there very fast, you likely will miss that initial chance," Meltzer said. "So your sole plan had better not be stamping this out at the source."
If a new flu strain escapes that first line of defense, it would be almost impossible to prevent its spread around the world. An early draft of the federal government's still-unfinished pandemic response plan, released last year, noted that in previous pandemics, "Successful quarantines were rare."
In 1918, local governments tried shutting schools and many other ways of averting the deadly flu. One Chicago Tribune article from the time referred to an "anti-spitting campaign" in New York. Yet virtually no community was spared.
The main purpose of defensive measures, according to the draft flu response plan, would be to buy time for development of a vaccine tailored to the new strain.
Without a vaccine, "You're talking about ameliorating the impact, not stopping it," Meltzer said.
Drugmaking capacity low
Anti-viral drugs such as Tamiflu and Relenza could save the lives of people infected with the virus. But drugmaker Roche's capacity to produce Tamiflu is low, and the U.S. is behind nations such as France and the United Kingdom, which placed early orders to stockpile the drug.
"Because we did not get on this quickly enough, we're at the back of the line," Obama said.
If the world is lucky, Osterholm said, the flu won't acquire the mutations needed to start a pandemic for another 10 years. That would give enough time for new vaccine production techniques that could cut the turnaround time to a few months.
Although no one can say whether a pandemic will occur, the previous record of about three such outbreaks per century suggests it's a matter of time, Meltzer said.
"I think it's near certain we'll have one by 2025," he said. But "every year it doesn't happen gives us breathing room to prepare."
The bird flu threat: Questions and answers
1. What's a pandemic?
It's a global outbreak of a disease, in this case influenza. Flu pandemics have occurred when a new form of the virus appears. Unlike seasonal flu epidemics, a flu pandemic causes more illness and death because people have no natural immunity to the virus.
2. How serious is the threat?
Former Health and Human Services Secretary Tommy Thompson named pandemic flu and food safety the top health threats facing the U.S.
3. How well-prepared is the government?
Current HHS Secretary Michael Leavitt has conceded that the nation is not prepared for a pandemic--and neither is the rest of the world. Better surveillance of potential outbreaks in Asia is needed, along with more anti-viral drugs to treat the disease and faster production times for vaccines targeted to a new strain.
4. Is there a chance of overreacting?
No one really knows if another pandemic will hit. Even so, experts hope that precautions taken now will result in better preparedness for ordinary flu or other major disease outbreaks.
5. What should people do to guard against it?
They should take ordinary precautions against infection such as washing hands and covering the mouth when coughing. If a pandemic hit, officials might recommend that workers telecommute when possible in order to avoid contact with infected people. But many experts said individuals have no power to prevent a pandemic beyond demanding that governments and businesses be prepared.
6. What is the government's plan?
The U.S. Department of Health and Human Services is finishing an official pandemic response plan. A draft version proposed isolating infected people, closing schools in affected areas and briefly quarantining people exposed to the virus.
7. Would quarantines work?
A quarantine would be most useful at the original source of an outbreak, to prevent further spread. But experts say quarantines would be of limited use once a pandemic strain spread to many countries. Such measures would be intended to delay the spread of the outbreak, buying time for production of a targeted vaccine.
8. Is there a vaccine?
An experimental vaccine exists against the bird flu circulating in Asia, a subtype called H5N1. Although that might provide some protection against a pandemic, experts believe the disease may mutate into a form that would require a new version of the vaccine.
9. How long would a modified vaccine take to produce?
Once the new strain is identified, it would take about a year to produce enough doses to protect the U.S. and other countries.
10. How many people could die if a pandemic hit?
No one knows, in part because it's impossible to say how the virus might change. If the outbreak were as lethal as the 1918 pandemic, it could kill 180 million to 360 million people worldwide. But if the disease followed the pattern of the far less serious 1968 pandemic, the toll might be roughly equal to that of a normal flu season--about 20,000 to 40,000 deaths in the U.S.
11. When could it hit?
Again, no one knows for sure. Flu researchers say it's almost certain a pandemic will hit by 2025. If it struck next year, the U.S. would be poorly prepared. If it struck 10 years from now, new technologies might permit a faster response.
Advance of avian flu
Hundreds of millions of birds with the H5N1 strain have spread through Asia, infecting 117 people since late 2003. The virus recently has spread to Europe, and officials fear it will continue to widen its reach.
ROMANIA
A subtype of the virus was identified recently in dead birds
TURKEY
The presence of the H5N1 strain was confirmed in birds Thursday.
HUMAN CASES OF H5N1 BIRD FLU
Cases Deaths
Cambodia 4 4
Indonesia 5 3
Thailand 17 12
Vietnam 91 41
Total 117 60