Junk medicine: Flu virus

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http://www.timesonline.co.uk/article/0,,8122-1406075,00.html

Junk medicine: Flu virus

by Mark

For once, scare stories about a flu pandemic should be taken seriously

When headlines scream that a new threat to our health is putting millions at

risk, it is usually time to reach for the salt.

The axiom that the bigger the scare, the bigger the appropriate degree of

scepticism, is safe to follow for most medical stories, from MMR to mobile

phone masts.

There are, however, glaring exceptions to this rule, and one of them is a

disease over which few of us lose much sleep. The flu virus barely registers

on the scale of health concerns: most people see it as one of winter’s

inconveniences, a few days of misery in bed. Demand for flu jabs remains

low, even when they’re offered to employees for free.

Our familiarity with the disease makes it easy to forget the devastation

that it can inflict. The worst pandemic in human history was caused not by

smallpox or bubonic plague, but by influenza: the “Spanish flu” of 1918-19

killed between 20 million and 50 million people. And the nature of this

virus makes it all but certain that something similar will happen again.

The question is not if, but when. As the virus is endemic in Asia’s vast

stocks of poultry, and mutates rapidly,it is a matter of time before a

particularly infectious or virulent human strain emerges.

The Department of Health claims to be aware of this danger and is updating

its contingency plans. But there are alarming signs that it is dragging its

feet. It is just possible that a pandemic strain may already be with us: the

H5N1 variant circulating in Thailand, China and Vietnam has started to

spread from person to person, and has a 73 per cent mortality rate. It is

not yet known whether it poses a global threat, but the World Health

Organisation has advised of a potential pandemic that could cause seven

million deaths. Yet the Government is still balking at the measure that

provides the most reliable defence.

To stand a chance against a pandemic, experts agree that countries need a

stockpile of antiviral drugs. This new class, of which the simplest to

deliver is oseltamivir, or Tamiflu, works by blocking the action of a key

flu protein. While they do not confer immunity, they reduce symptoms

substantially and stop sufferers passing the virus on. They are effective

against every known strain, giving them an important advantage over

vaccines: these must be developed for new variants as they emerge, limiting

their usefulness against a fast-spreading threat.

New research from the Harvard School of Public Health published in Nature

this week indicated that giving antivirals to between 50 and 75 per cent of

the population would check a 1918-style virus. But as the epidemiologists

pointed out, “there is a dearth of global antiviral stores”. While Australia

and Japan have started to buy stockpiles, Britain is still “considering

their role”. The NHS has enough for groups particularly vulnerable to

ordinary flu — the elderly and infirm — but only a tiny fraction of the 30

million doses that might be needed against a pandemic.

This procrastination in the face of a near-certain threat contrasts with the

breakneck speed at which it has reacted to one that is much less likely. The

Government has bought enough smallpox vaccine to immunise Britain’s entire

population of 60 million — even though the disease was eradicated 25 years

ago and there is no evidence that terrorists possess the virus.

It is wise to make plans for smallpox, notwithstanding doubts about whether

an attack will happen. To prepare for a fashionable but improbable threat

ahead of one that seems assured, however, is an inversion of proper

priorities. The next flu pandemic is a considerably graver danger than the

more hypothetical hazard of bioterrorism. Ministers should be treating it

with the urgency it deserves.

Mark is The Times science correspondent