World has slim chance to stop flu pandemic

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World has slim chance to stop flu pandemic

By

Reuters

Tuesday, September 20, 2005; 1:56 AM

NOUMEA, New Caledonia (Reuters) - The initial outbreak of what could

explode into a bird flu pandemic may affect only a few people, but

the world will have just weeks to contain the deadly virus before it

spreads and kills millions.

Chances of containment are limited because the potentially

catastrophic infection may not be detected until it has already

spread to several countries, like the SARS virus in 2003. Avian flu

vaccines developed in advance will have little impact on the pandemic

virus.

It will take scientists four to six months to develop a vaccine that

protects against the pandemic virus, by which time thousands could

have died. There is little likelihood a vaccine will even reach the

country where the pandemic starts.

That is the scenario outlined on Tuesday by Dr Hitoshi Oshitani, the

man who was on the frontline in the battle against SARS and now leads

the fight against avian flu in Asia.

" SARS in retrospect was an easy virus to contain, " said Oshitani, the

World Health Organization's Asian communicable diseases expert.

" The pandemic virus is much more difficult, maybe impossible, to

contain once it starts, " he told Reuters at a WHO conference in

Noumea, capital of the French Pacific territory of New

Caledonia. " The geographic spread is historically unprecedented. "

Oshitani said nobody knew when a pandemic would occur, it could be

within weeks or years, but all the conditions were in place, save

one -- a virus that transmitted from human to human.

The contagious H5N1 virus, which has killed 64 people in four Asian

countries since it was first detected in 2003, might not be the one

to trigger the pandemic, he said. Instead a genetically different

strain could develop that passes between humans.

While bird flu cases continued to spread throughout Asia, with

Indonesia this week placed on alert after reporting four deaths,

Oshitani said the winter months of December, January and February

would see an acceleration in cases, and the more human cases the

greater risk that the virus would mutate.

Vietnam, Indonesia and Cambodia were most vulnerable due to the large

domestic poultry populations, he said.

MASSIVE, RAPID CAMPAIGN

When a pandemic is first detected, health authorities will need to

carry out a massive anti-viral inoculation campaign within two to

three weeks to have any chance of containment, said Oshitani.

" Theoretically it is possible to contain the virus if we have early

signs of a pandemic detected at the source, " he said.

Scientists estimate that between 300,000 and one million people will

immediately need anti-virals, but there are only limited stocks. WHO

will receive one million doses by the end of 2005 and a further two

million by mid-2006.

Even when an avian flu vaccine is fully developed, production

limitations will mean there will not be enough vaccine.

" Right now we have a timeframe of four to six months to develop and

produce a certain quantity of vaccine and that may not be fast

enough, " said Oshitani.

Last week French drug maker Sanofi-Aventis won a $100 million

contract to supply the United States a vaccine against H5N1. The

United States has also awarded a $2.8 million contract to Britain's

GlaxoKline for 84,300 courses of an antiviral. The purchases are

part of a U.S. plan to buy vaccine for 20 million people and

antivirals for another 20 million.

Oshitani said the early vaccines were unlikely to protect against the

pandemic virus. " The vaccine should match the pandemic strain. So a

vaccine developed for the virus in Vietnam now may not protect you

from another virus, " he said.

But Oshitani fears that once a pandemic occurs, the world's rich

nations may dominate vaccine supply.

" The distribution of a vaccine will be a major issue when a pandemic

starts. There is no mechanism for distribution, " he said. Asked

whether poorer Asian nations such as Cambodia and Vietnam would get a

vaccine, Oshitani said " probably not. "

Avian flu has moved west from Asia and into Russia, with many fearing

migratory wild birds will spread the virus to Europe and possibly the

United States via Alaska.

But Oshitani casts doubt on the impact migratory birds are having on

the spread of avian flu, saying different sub-types of the H5N1 virus

are in Asia and Russia.

" There are so many uncertainties about the pandemic. We don't know

how it will start. We don't know exactly how it is spreading, " he

said.

Oshitani said that the successful containment measures used against

SARS, such as quarantining those infected and cross-border checks,

would fail against an avian pandemic, as people spreading bird flu

may not show early symptoms.

" The pandemic is likely to be like the seasonal influenza, which is

much more infectious than the SARS virus, " he said.

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