Financial Times on Flu Pandemic

[Guest guest]

Global Agenda 2008

Pandemics: Blowing hot and cold over the flu threat

By Jack, Financial Times, November 7 2008

With the financial crisis diverting politicians' attention, and no

sign after a decade that the H5N1 virus is set to trigger a pandemic,

public health specialists are worried that the world is turning its

back on the continued threat of a lethal flu outbreak.

Getting the bird: A quarantine inspector in China

It was in Hong Kong in 1997 that researchers identified the first six

human deaths confirmed from H5N1, a year after they had isolated the

virus in a goose in China, and before Sars (Severe acute respiratory

syndrome) provided a warning of how far and fast lethal new infectious

diseases could spread.

Since then, against the backdrop of warnings that it was a case of

" when not if " a potent new human flu pandemic would strike, hundreds

of millions of dollars have been spent by governments, helping fuel

new investment by pharmaceutical companies and countless meetings,

contingency plans and simulations.

Yet since 2003, only around 387 people have been confirmed infected

with H5N1 around the world, and 245 have died from the virus. From a

peak of deaths in 2006, incidents have also since declined, with

deaths and infections so far this year at the lowest levels since 2004.

That has led to concern about " crying wolf " . Even Nabarro, the

United Nations' " flu tsar " who has led the calls for a stronger

international response, has been devoting much of his time to other

matters in recent months, notably the question of global food security.

A number of scientists are now downgrading the likelihood of a

pandemic specifically caused by H5N1, given its continued and expanded

presence over a decade in animals without the emergence of any

mutation that has proved lethal and highly transmissible among humans.

But that does not eliminate the danger of a pandemic caused by H5N1,

nor reduce the risk from other viruses, whether flu or entirely

different infections. Heymann, assistant director general for

health security and environment at the World Health Organisation

(WHO), warns that there is no room for complacency.

The money invested so far as a result of H5N1 has helped curtail its

spread; and strengthened preparations against alternative threats. " We

need to broaden the understanding of pandemics to areas other than

influenza, and make sure it is clearly understand that we have to

improve health systems for reasons of public health security, " he says.

A fresh assessment by the World Bank in September doubled the

potential cost of a pandemic on the global economy to $3,000bn, with

an estimated stunting of nearly 5 per cent of gross domestic product.

At a time of global economic slowdown, the diversion of resources away

from health, and broader stresses on systems around the world, could

further undermine the response and exacerbate the consequences.

Much work has already been conducted in the past few years to prepare

for a pandemic. While H5N1 has disappeared from the headlines,

activity has continued behind the scenes. The WHO is finalising a new

version of its " pandemic influenza preparedness and response " plan.

New International Health Regulations imposed obligations on countries

to co-operate.

In the UK, which still considers a pandemic the top security threat,

contingency plans and simulations originally launched by the

Department of Health nationally have been replicated and broadened

across the public sector region by region, and into many business

sectors. Similar initiatives have been made by many other developed

countries, and parts of the developing world.

The pharmaceutical industry has also been active. After a series of

false starts, BioCryst, a US-based biotech company, is moving to

late-stage clinical trials of Peramivir, an injected antiviral that

would complement two existing drugs that appear useful in alleviating,

treating and potentially preventing flu.

Several H5N1 vaccines have been approved, and others designed to

immunise against a broader range of flu viruses are under research.

Methods to devise faster methods of production are also being developed.

Nevertheless, much remains to be done. Technology and production

capacity in the next few years will still be overwhelmed by any

pandemic. Continued weak links – including those countries in

south-east Asia where infection may be most likely to begin – mean the

prospects for stemming an outbreak in its early stages are limited.

" Solidarity " stockpiles of vaccines and antiviral drugs held by the

WHO remain extremely limited. That has sparked concern by a group of

countries led by Indonesia, and followed by Thailand and several

African states, that they will be unable to gain access to treatments

and vaccines.

In response, Indonesia – one of the worst affected countries – has

refused to share samples of the H5N1 virus, jeopardising an

international system based on goodwill but essential for reliable

research and the development of effective vaccines. The latest attempt

to resolve the stand-off takes place next month.

More collaboration is still required between UN agencies and their

local counterparts, to ensure that human surveillance is supplemented

by, and linked to, detection and reaction to virus outbreaks in animals.

Even in far richer countries, such as within the European Union, many

cross-border issues have yet to be addressed, leaving inconsistencies

in detection, information sharing and pandemic response.

Coker of the London School of Hygiene and Tropical Medicine,

who is co-ordinating a network of specialists in south east Asia,

says: " A lot of attention has been paid to increasing surveillance,

but relatively little to improving the capacity to respond. We should

be focusing on the long term. "

http://www.ft.com/cms/s/0/cd214d32-aac1-11dd-897c-000077b07658,s01=1.html