Since 1997, an RNA virus has been spreading through bird populations, starting with migratory flocks in East Asia. While the virus has been evolving, its two coat proteins have remained of the types "H5" and "N1." The H5N1 avain flu virus is lethal to nearly 100% of some birds (chickens), while sparing others (ducks). Like all avian flu viruses, it can sometimes establish a weak infection in domesticated mammals, particularly pigs--and that's where the real trouble may be brewing.
If a pig cell is infected with both the H5N1 avian flu and a mammalian influenza virus, a genetic mix-and-match will ensue. This assortment might--or might not--produce an amalgamated virus with the H5N1 surface coat, the avain virus' lethality, and the porcine virus' high infectivity. Some anonymous farmer would get unknowingly inoculated with this new variant. It would then spread to farms, markets, cities--and around the globe.
Because there has been no H5N1 infection of humans within living memory, nobody has a pre-existing immunity. So if these circumstances develop, the stage will be set for an influenza pandemic of the scale of the 1918 Spanish Flu. Or worse.
Warnings of this potential crisis are being sounded by a small chorus of informed voices, including Randall Parker and Hugh Hewitt. He links to the July 2005 issue of Foreign Affairs, which includes The Next Pandemic by Laurie Garrett--well worth reading. From a companion article by Michael Osterholm:
Can disaster be avoided? The answer is a qualified yes. Although a coming pandemic cannot be avoided, its impact can be considerably lessened. It depends on how the leaders of the world -- from the heads of the G-8 to local officials -- decide to respond. They must recognize the economic, security, and health threat that the next influenza pandemic poses and invest accordingly. Each leader must realize that even if a country has enough vaccine to protect its citizens, the economic impact of a worldwide pandemic will inflict substantial pain on everyone. The resources required to prepare adequately will be extensive. But they must be considered in light of the cost of failing to invest: a global world economy that remains in a shambles for several years.
We can't know what this virus has in store for us. But with the best available information showing that the probablilty of a pandemic is much higher than zero, it would be prudent for our leaders to take the steps that would blunt its ferocity. That's what I'll be asking my representatives to do.
"So if these circumstances develop, the stage will be set for an influenza pandemic of the scale of the 1918 Spanish Flu. Or worse."
Sigh...
Spanish Flu- 1918
Mass production of penicillin- 1948
Antibiotics are useful in supportive therapy for people recovering from influenza infections that do moderate amounts of damage. While penicillin and its cousins don't act against the virus, they can hold off opportunistic bacterial infections that invade the flu-damaged lungs.
According to the author of "The Great Influenza," most victims of the Spanish Flu died from a combination of the virus' destruction of lung cells, and the body's own over-reacting host defenses, not from bacterial infections. The concern about an H5N1 pandemic is that many patients would be overcome in the same way.
That said, you're right, adequate stocks of modern antibiotics would help.
I remember swine flu.
No money in it- wont be done. Remember, we get all of our regular vaccines from Europe or Canada, because our local BigPharma doesnt feel that the margin is high enough. Granted, once people start dieing, then it is a go.
"By the end of last year, over 190 thimerosal cases were pending, including at least 12 class actions. One class-action claim demanded $30 billion—that's five times the entire vaccine market itself! The tort tax on vaccines combined with government-imposed price controls makes vaccine manufacturing increasingly unprofitable and underlies the eight vaccine shortages we've seen since 2000."
http://www.manhattan-institute.org/html/_dmn-liable_to_infection_flu.htm
Our friends the trial lawyers.
Good post, AMac.
Max is correct in that it probably won't be done, but the idea that vaccines aren't made because the margin isn't high enough displays a profound misconception of why we have no vaccine manufacturers anymore. When in doubt, blame the corporate fatcats, right? Mark is partially right. The problem is, that once again, socialist policies stifle modern economics. In 1990, there were 15 vaccine manufacturers. By 2000 there were 4, and by last year there was 0ne. During the 1990s, the US government insisted on becoming the biggest buyer of vaccines so as to insure "universal" vaccinations through social programs. Problem was, they offered a price that was below cost. Vaccines are not high profit items, and the incentive for them to be continued to be manufactured, especially in the context of removal of protections from liabilities as Mark mentioned, was simply not there.
Yeah, great. Now there's affordable vaccines for everyone, except for one problem. There aren't any. Karl Marx, call your office. Long live the People's Revolutionary Struggle.
We are long overdue for a pandemic. But one wonders, if, as many believe, it emerges in China, whether it will be able to escape the denial of the communist government there long enough for it to be caught in time. China's economy depends on the belief that there are no internal concerns in the country. A major pandemic would threaten that and every effort will be made to deny it until it can no longer be denied, much in the way, again referring to SARS, as has been done in the past. A flu pandemic will be far more virulent and widespread before being discovered than SARS was, and even available flu vaccine will give limited, if any, cross coverage for those immunized. As always it will be the infants, elderly, and infirm who will be most at risk.
Mark raises a good point about critical care and modern antibiotics, but let's be realistic. In any given hospital in a major city in january, utilization is full, with a significant percentage of the filled beds being flu patients. What happens when that percentage increases by a factor of 10? 20? Modern medicine isn't equipped to handle an infectious crisis of that magnitude at this point.
Joe,
I was a civil defense volunteer 1983-93, and even published in the Journal of Civil Defense.
The magnitude of this, coupled with globalization, is such that effective preparation against a worst case scenario (high lethality plus no immunity resulting from prior exposure) really isn't possible unless the epidemic is snuffed out at the point of origin. The likely points of origin are in China and southeastern Asia where the ability to snuff out something like that is at best marginal.
Worse, the secretive xenophobic nature of the Communist regimes of China and Vietnam are the chief obstacle to effective preparation against a pandemic from a new flu strain. They need outside help to develop the ability to move fast enough to snuff out a pandemic at the source, but they won't permit that outside aid to enter and create the necessary public health C3I infrastructure. Their track record to date proves this.
The most we can do, IMO, is to create the necessary foreign-funded C3I infrastructure in places like Malayasia and a smaller, mobile one, to intervene in other areas AFTER a pandemic starts there, and if and when the host governments permit it.
I dont know Johnny. I dont believe in the looming pandemic any more than i believe global warming is about to sink Manhattan or killer bees are gunning for my family. Compared to 1918, the quality of life, healthcare, wealth, sanitation, hygene, and knowledge of infection in general is just apples and oranges. Look at the dreaded SARS and how it petered out with a whimper as soon as it jumped the Pacific.
Pandemics generally kill off the young, the old, and the sick. The Spanish flu was anamalous in this regard. Either way people as a whole are stronger, better nourished, and healthier than we were 90 years ago. We are certainly more germ conscious. Sure its possible that some super bug could spread airborn and defy all medical defenses, but a giant meteor could blast into us tomorrow too. Its an interesting topic, but i dont feel the hype.
Thoughtful comments. Per Mark #8, I don't believe in believing in imminent pandemics (etc.), but I don't believe in disbelieving them, either. It makes a difference when knowledgable people are marshalling facts and making informed guesses that are within their areas of expertise, and seem to meet fairly high standards of reasonableness. Check the linked articles and posts.
Human nature may not have changed in 90 years, but in important respects, the world has. One of the most important novelties is intercontinental travel by large numbers of people, rapidly enough that they reach their destination before the inoculation period of many communicable diseases has passed.
Another change is in the population rise, from ~1 billion at the time of the Spanish Flu to ~6 billion (?) today.
On a smaller scale, China's prosperity has meant that its populations of chickens and pigs have skyrocketed since the Deng era began. And, worryingly, the population of chickens, pigs, and people living in close contact with one another.
A point not brought up so far is that, while some of the measures proposed are flu-specific, others will serve to increase preparedness for any public health crisis, whether natural or malign in origin. This especially holds true for surveillance, and for C3I.
The points raised on the factors stifling vaccine production strike me as sad, and true. If there is a will to address them, they are all emininently solvable, and at moderate expense.
Mark Buehner, your ignorance of this subject should have cautioned you against writing about it!
Antibiotics are useless against H5N1, or any virus for that matter. What you need are antivirals, the best of which against the current strains of H5N1 is marketed as Tamiflu by Roche. Hong Kong has enough stockpiled for everybody in the area, the UK has ordered, but not yet received, enough for 25% of it's population and the USA enough for just 1%.
Also, pandemic flu does not necessarily "kill off the young, old and the sick". Normal seasonal flu does, but pandemic flu has a history of affecting the working age population disproportionally. In the 1918 'Spanish Flu' (H1N1) outbreak, the main age range of fatalities was between 20 and 40 years old.
Finally, with all the top health professionals in the USA, UK, and WHO screaming that this is "when, not if", don't you have the slightest doubt that you might not be right? Sure, they could be wrong, like the swine flu in the 1970's, but if you start second-guessing your scientists, who are you going to listen to?
Ask questions, research the facts for yourself, make your own mind up, but remember that if the scientists are right and shock you're wrong, the consequences will be dire.
ukcz,
Whether Mark is right or wrong won't make a bit of difference.
If a flu pandemic starts, it won't be stopped until it has burnt itself out. And it can't be stopped once such a flu variety appears.
You are rearranging deck chairs on the Titanic.
I pointed out that our only chance, if something that bad appears, is to snuff it out quickly, but that the most likely places for it to appear are among the least likely places to permit that to happen, for Communist tyranny political reasons.
Mark is correct that it is more likely that a less lethal but still highly dangerous flu variety will appear. That was in the articles. There antibotics would be useful against the opportunistic infections which will be the chief direct causes of mortality among flu victims.
We DON'T need flu vaccines right now. That requires us to know precisely what type of flu we are vaccinating against. What we need is the capability of developing new vaccines against new varieties of flu on extremely short notice, and to then immediately mass-produce those new vaccines.
Neither such capability exists now nor am I aware of ANY plans to develop either such capability. Which means our only chance is snuffing out an epidemic at its source.
Which would entail the forcibile overthrow of the Communist governments of China and Vietnam long before a new highly lethal variety of flu appears.
Fat chance of either.
Try a little reality. That was Mark's point.
vaccines aren't made by "big pharma".
the markets might be in a position to respond a little better (ie fast and massive production) if government didn't have price controls on vaccines. while keeping prices low supposedly helps the poor, in reality the result is that no one bothers to produce the vaccine because there is no money in it. and so the poor don't have access anyway. this is why we had a vaccine shortage in 2004 or whenever that was.
in a free market supply always meets demand. in a market that that isn't free like the vaccine market, we get lines and shortages.
we would have a better chance against this possible pandemic if someone thought there was some money to made from it. as it is now, no one cares, because there is no money in it.
the best thing to ask your representative to do is to remove the price controls. but that won't win them any donations from special interests so its unlikely to happen.
I posted something similar this morning-and was met with cries of derision. "Oh, no "
I would suggest folks take a look here:
http://www.recombinomics.com/whats_new.html
The commentator on the site is Dr. Henry Niman, one of the foremost virologists in the USA, and an expert in "recombined" viruses-which this "bird flu" has become.
Take your time. Browse his site carefully,and don't be put off by the technical stuff.
You MIGHT need to change your shorts before you finish reading...
I read in news.com.au this evening that Russia reports the first cases of bird 'flu, possibly from migrating birds.
The migration paths take birds into Southern Europe and the Middle East, so there's a very good chance that any attempt to control the outbreak in China would already be too late.
ukcz, I seriously doubt mark was arguing that antibiotics could be used to treat viral infections. rather, I think he was making the point, as I'm sure you will agree, that most flu victims die of secondary bacterial respiratory infections, rather than acute respiratory failure.
Mark,
I do not think you are ignorant on this subject as some have suggested, (rolls eyes) but neither do I think that the suggestion of a major pandemic is a pie-in-the-sky black helicopter theory either. Pandemics/epidemics are known quantities, caused by recombinations of non-genotypic DNA (or RNA, as the case may be,)into the viral genome. Most observations have put flu epidemics (which usually result from introduction of previously unknown viral genetic material) at every 20 years. By that standard we are over 20 years overdue, anyway. Just for an epidemic. But As AMac pointed out, if you get cross-species introduction of new genetic matrial, that can cause a pandemic, only because there is less likely to be cross-immunity to the new antigens.
You make excellent points about the advent of modern medicine, access, detection methods, and critical care. But we also have liabilities in 2005 that we didn't have in 1918. Like frequent same day international travel and higher population density (in areas) which will allow a virulent strain of respiratory virus to spread uncontrollably.
The 1918 flu struck down the strong and people in their prime primarily because they were the ones most likely to be exposed. Yes, the infirm and sick were most at risk IF exposed, but the flu is not the common cold. Even people with a bad lower respiratory infection can take weeks to recover. But to your point, these days, very few people die, less than 175 in 2003, and most of them were children with existing respiratory problems. But that's mostly because of detection and vaccination. What happens when those two advantages are neutralized?
I don't think the concern is actually treating it or vaccinating against it necessarily, but rather allowing for the political realities that will allow it to be identified before it gets out of control. That currently, as I and others have pointed out is, what will be the rate-limiting step here is governments- otherwise known as human stupidity.
Tom Holsinger #11:
We don't know if a supervirulent H5N1 strain will arise next year, or in the next ten years--only that it's a non-zero probability. And we can't know how widespread or how severe the illnesses it would cause might be. So, yes, it's possible to imagine an awful strain, spreading tomorrow, such that nothing meaningful can be done ('deck chairs'). BTW, this argument has also been applied to the circumstances of The Next Terror Attack, where some of the same issues exist.
Here are examples of cost-effective steps that Western societies could take, if our leaders can be persuaded that this issue merits outlays of political capital:
Short run:
Medium/long term:
Much more info here: http://pundita.blogspot.com/
One other angle to this discussion is that some of the proposed strategies are "dual use". Wise investments made to combat threats like H5N1, particularly regarding countermeasure and surge response capabilities, help us prepare against deliberate downrange threats as well.
Without effective countermeasure development, we will eventually get nailed with a devestating, intentional bio attack.
We know several things that no expert disputes:
1) Soviet scientists were able to make nasty, nasty bugs, diabolical in their ingenuity.
2) Biotech equipment needed to make these nasty bugs are on their own Moore's Law-like downward slope in size and price. Sophisticated bug factories will soon be able to be rapidly assembled in basements using off the shelf, uncontrolled equipment. Arguably, we're already there.
3) The know-how to do this kind of bio-engineering is routinely taught, with straightforward modifications and a bit of trial and error, in graduate programs around the world.
4) There are people willing to patiently attain this training and then use it for mass murder. (Not to mention the possibility of "bio-mercenaries".) This doesn't need to be an extreme Islamist. It could be someone like the Unabomber who is basically off his meds.
Whether or not we ever face a severe H5N1 threat -- certainly possible -- most of the work we begin to do in this area -- especially with regard to getting the incentives right for countermeasure development -- may make a critical difference against these related threats.
We basically have to make sure that the capabilities of the good guys (capabilities that must look qualitiatively different from our current countermeasure and public health infrastructures) outpace developments by the bad guys.
We are in an arms race, whether we want to be or not. We just don't know who or what we are racing against.
Johnny, did mean that to come off as a blame the corporate overlords rant. I do not know about all the price controls etc. I assume the reason we buy from Europeans is that they do not have to comply? More a basic corporate/capitalism rant I guess (we can complain about what we love right?). I feel it is criminal to be beholden on other countries for our security and wonder what we can do to change the playing field to make it so that our BigPharma (sorry it is easier than writing out all the names) can produce the meds we need. Or may need- which may be the crux of the problem. Needless to say, I have alot of reading to do now.
Good points all.
Max, it did come across that way, particularly the use of term "big Pharma". Don't get me wrong. I'm no shill for the pharmaceutical industry, but the reason we buy vaccine elsewhere is because those companies can make vaccines and not sustain a loss (not a profit loss, but an actual loss) or be required to assume an unacceptable liability by making them. The reason American companies don't is because the government imposed price controls in the 1990s. And they removed legal protection from legal liability. there simply is not enough profit in vaccines to justify the risks of a baseless class action lawsuit. And price controls are guaranteed to create a shortage because it defies the market. Its not an issue of profiteering. Its an issue of freemarket economics. The Clintons thought they could create universal vaccinations, an admirable idea, and now we have shortages as a direct result of the price controls that were imposed in that era to achieve that. Big hearted and empty headed. The result being that if there is a crisis, we cannot accommodate it, because we don't have the remaining infrastructure to immediately start manufacturing extra. I, too, find it appalling that we have unwittingly outsourced a major public health issue to other countries that we are now beholden to. But it is a conundrum of our own making.
"Road to hell.." and all that I guess.