Report: Drugs Won't Stop A Pandemic
# 1518
Today's announcement will not surprise many who have been closely following the pandemic influenza story, but will no doubt be a wake-up call to some who expected vaccines or antivirals to save the day.
First, excerpts from the article by Maggie Fox, then some discussion.
Don't rely on drugs to delay flu pandemic-US gov't
WASHINGTON, Jan 22 (Reuters) - Vaccines and drugs will not be enough to slow or prevent a pandemic of influenza, according to a U.S. government report released on Tuesday.
The report from the U.S. Government Accountability Office confirms what most experts have been stressing for years -- that the pharmaceutical industry cannot be relied on alone to protect the world from bird flu.
The GAO, the investigational arm of Congress, reached its own conclusion independently.
"The use of antivirals and vaccines to forestall the onset of a pandemic would likely be constrained by their uncertain effectiveness and limited availability," the GAO report reads.
Health experts almost universally agree that a global epidemic -- a pandemic -- of influenza is inevitable and even overdue. Flu is always circulating but, every few decades, a completely new strain emerges and makes millions sicker than usual.
One prime suspect is the H5N1 strain of avian influenza. It is entrenched in poultry across much of Asia, the Middle East and Africa, pops up regularly in Europe and has forced the slaughter of hundreds of millions of birds.
<snip>
"Current antiviral production capacity is inadequate to reach the number of antivirals WHO (World Health Organization) estimates will be needed to contain a pandemic," it added.
"Increasing global production capacity of vaccines and antivirals will take several years as new production facilities are built, materials necessary for production are acquired, and the necessary approval is received to market these medical products in various countries."
(Reporting by Maggie Fox, editing by John O'Callaghan)
The numbers right now are grim.
Except for a few million doses of a stockpiled pre-pandemic vaccine, of uncertain efficacy and reserved for the military and essential workers, there won't be any pandemic vaccine for at least 6 months into a pandemic.
Even then, the amount of vaccine coming off the manufacturing lines will be small, it will will take additional months before enough can be created for the entire nation.
The antiviral situation is just as uncertain.
Most countries aren't stockpiling Tamiflu in any huge quantity. The US and the UK have bought significant amounts, but even so, not enough to treat all who are likely to be infected.
In the United States, we currently have enough Tamiflu on hand to treat 15% of the population (with a 10-pill course), and should have enough by the end of 2008 to treat nearly between 20% and 25% of the nation.
Unfortunately, a number of states have not ordered antivirals, and the original goal of having enough on hand for 25% of the nation may not be met.
Worse, the WHO now believes that a `double the dose for double the duration' course of treatment may be needed in order to get the best results with Tamiflu. Instead of a 10-pill course, you'd need a 40-pill course.
And that would reduce the amount of Tamiflu coverage down to about 6% of the population of the United States.
And then there's the worry that the virus will develop resistance to our antiviral drugs. We've seen a few instances where this has already happened with the H5N1 virus.
The CDC and the HHS recognized these problems and it was decided that the only viable alternative would be the use of NPI's, or Non-Pharmaceutical Interventions.
These include:
- Social distancing.
- Closing of Schools
- Limiting public gatherings
- Isolation of the sick and voluntary at-home quarantine of those exposed
- Frequent Handwashing, and possibly the use of masks, and latex or vinyl gloves.
No, it doesn't sound like much to throw at a pandemic. But in reality, it should help slow the spread of the virus, and `flatten' the curve of those sickened at any given time, making it easier for society to cope.
NPI's were instituted in some cities during the 1918 pandemic, and they saw correspondingly fewer deaths. So there is reason to believe they will be at least partially successful.
And besides, it's likely to be the only game in town.
The GAO Reports can be accessed here:
- Influenza Pandemic: Efforts Under Way to Address Constraints on Using Antivirals and Vaccines to Forestall a Pandemic
- GAO-08-92, December 21, 2007
- Summary (HTML) Full Report (PDF, 71 pages)
