Is Canada Ready?????

[Guest guest]

Is Canada Ready for a Flu Pandemic?

By Ed Ungar

WebMD Canada Medical News

Some Experts Not So Sure

Reviewed by Tepper, MD

Oct. 14, 2000 -- In the last week of December 1997, masked death squads,

armed with plastic garbage bags and canisters of poison carbon monoxide gas,

fanned out over the rural New Territories surrounding Hong Kong. Their

mission -- to save the world from what might well have been the most

virulent strain of influenza virus since 1918-19.

They descended on poultry farms and, while glum farmers looked on, they

proceeded to kill every chicken they could find, in an attempt to eradicate

the H5N1 influenza virus. Health officials had already established that the

virus, which was unlike anything anyone had seen before, had somehow spread

from the birds to humans. Eighteen Hong Kong residents would be infected by

the virus and six of these individuals would ultimately die from the

disease.

If the H5N1 virus were to spread among humans, health officials feared this

would not be just another yearly flu outbreak. Instead, this had the

earmarks of a pandemic -- a country-wide or worldwide outbreak -- like the

Spanish Flu epidemic of 1918-19 that killed more people than all the bombs

and bullets of the First World War.

The quick action by Hong Kong public heath officials may have saved Hong

Kong and the world from such a disastrous situation.

Should all of this serve as a warning for Canada?

" We don't know where the strain might have gone, " says McGeer, MD,

director of infection control at Mount Sinai Hospital in Toronto. " We only

know it looks like it might have been the next pandemic strain. "

In fact, McGeer says there is evidence that the virus may have been mutating

to even more virulent strains even as the poultry was being killed, because

" that's what influenza viruses do. " The poultry slaughter, says McGeer,

" fixed a particular Hong Kong problem, and it may have averted the next

pandemic. "

As viruses replicate, they undergo small spontaneous changes. Some of these

small changes can make the virus far more dangerous in terms of how it

affects the body or how easily it is transmitted. This is why the virus

poses different risks year to year and why identifying specific strains is

important. It is also why the flu vaccine must change each year.

" The events in Hong Kong were a wake-up call to public health officials in

Canada and around the world, " Schabas, MD, tells WebMD. Schabas was

Ontario's chief medical officer from 1987 to 1997 and is currently head of

preventive oncology at Cancer Care Ontario in Toronto.

There have been three pandemics in the last century. By far the worst was

the 1918-19 Spanish flu. But there was also the 1957-58 Asian Flu and the

1967-68 Hong Kong Flu. Health officials do not know when the next pandemic

will come. But they are certain it will come.

If a pandemic strain were to emerge this year would Canada be prepared for

it? " I don't think we're as ready as we could be, " says Schabas.

" It will be ugly, " says McGeer. In 1918-19 people died from what looked like

influenza pneumonia. " It would be nice to think we could do better, but

there would be no guarantees. "

Unless there is mass vaccination, says Schabas, when a pandemic influenza

hits Canada " we can expect literally tens of millions of people to become

ill with the disease. We can expect hundreds of thousands of

hospitalizations, and we can expect up to 40,000 deaths. Just imagine what

that can do to our health system and our society.

" We know that in a pandemic we are going to have to produce a brand new

influenza vaccine, and we will have to do it very quickly, " Schabas tells

WebMD. " That's the part of the planning that I think has been inadequate. "

It is possible that Canadians would be substantially protected if a pandemic

were to occur in the near future, according to Fedson, MD. Fedson is

director of medical affairs for the world's largest vaccine maker, Aventis

Pasteur MSD in Lyon, France.

Fedson points out that a typical annual flu vaccine has three viruses. A

pandemic vaccine would only need to account for one virus. Thus pandemic

vaccine production can be tripled immediately. Then, " if we're lucky and I

mean really lucky, " Fedson tells WebMD, " we'll be able to use the vaccine at

half strength. So for every single dose today we might get six doses for the

pandemic virus. "

Fedson notes that Canada is one of the few countries in the world that in an

average year can inoculate 16.7% of its population. Multiply that by six and

it might be possible to inoculate all 30 million people in Canada over six

months of age.

But Schabas says even that would only work if the pandemic virus were

" considerate enough " to give us four or five months warning at precisely the

right time of the year.

" What vaccines do is to expose [your body] to the virus or bacteria that

causes the infection, " he says. " It gives your immune system a look at what

the virus looks like and your immune system remembers that so when you are

exposed to the real infection your immune system is ready and it will

quickly produce the antibodies necessary to prevent you from getting sick. "

At present, flu vaccines are produced in hens' eggs from specially grown

bacteria-free flocks. It takes over 100 days to grow the virus. " If we are

fortunate enough to have the pandemic come just as our chickens are laying

their eggs and ready to go, then we'd be all right, " says Schabas.

" But the problem is if it happens any other time of the year ... we simply

would not be able to produce the vaccine in any sort of reasonable

quantities in time for when the pandemic would reach Canada. "

The solution is " almost silly, " according to Schabas. " We should have

chicken flocks standing by waiting for a pandemic. "

At a few million dollars a year " it's an added expense, but not a huge one, "

he says. With a price of an estimated three dollars per dose, Schabas adds,

the flu vaccine and other mass vaccines are the best bargains in medicine.

Louise Pelletier, MD, is the chief of the division of respiratory diseases

at Health Canada's Centre for Infectious Disease Prevention and Control in

Ottawa. She tells WebMD that a joint federal/provincial working group is

making " substantial progress " at ensuring a year-round supply of pandemic

vaccine.

Will that progress be adequate and in time for the next pandemic? If it

isn't, public health officials can use new antiviral drugs. However

Pelletier, Schabas, and McGeer all agree that there is too small a supply at

hand to meet the nation's needs. In any case these drugs could only provide

at best temporary relief or protection to those that will take them.

" If we have an influenza pandemic next week or next year, then there are

going to be a lot of hard questions asked as to why we didn't take the

necessary and obvious steps to be prepared, " says Schabas.

Click here for information on Canada's flu vaccine supply.

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