ONE FLU: OVER THE CUCKOO’S NEST?

Perhaps it is time to look more carefully at the rhetoric surrounding the avian flu and the spreading doom about the impending influenza pandemic. Daily, media outlets add to the general cacophony of people crying over the evils or negligence of federal governments and the pharmaceutical industry at not being better prepared for the disaster that (forgive the pun) waits in the wings.

 

Didn't you know, they will ask, that 25 to 50 million people died in 1918-1919 from the Spanish flu pandemic—more than died in all the battles of World War I, by some estimates. And don't forget 2003-2004, they will continue, when there wasn't enough flu vaccine to go around, and about 36,000 U.S. citizens died from influenza.

 

But while these numbers are truly a historical tragedy, it seems equally important to me to realize the difference between the two sets of statistics and try to understand the implications.

 

History and science have shown that the 1918 strain of influenza was particularly virulent. At the same time, it is important to realize that this flu outbreak cropped up at a time when modern medicine was still largely in its infancy and many of the great pharmaceutical discoveries lay ahead of us. Likewise, Europe was coming out of a war, and the reality is that the mass financial and human expenditures eaten up by war—any war—do not make for good social or healthcare systems. One need only look at any war-torn region of the world today to realize that in the middle of a conflict, bullets take precedence over bandages.

 

While we continue to play a wait-and-see game with each year's flu virus to determine which strain is most prevalent and from where it will come, the fact is that in 2005, we largely understand the flu virus—its pathophysiology, its construction, its history—from the level of individual atoms to its epidemiological ebb and flow. We may never be able to predict next year's outbreak, but there are thousands of people spread around the globe working for groups like the World Health Organization and the Centers for Disease Control and Prevention, who watch and wait, ready to act when needed.

 

Are there issues about our preparedness to face the next onslaught of influenza? The lessons of 2003-2004 would suggest that the answer is yes. But it must also be remembered that much of this problem stemmed from a simple, but serious, problem in vaccine preparation that led to the entire batch from a single company being tossed on the garbage heap.

 

Learning our lessons from this incident, preparations for the current flu season have been unprecedented. Companies like GSK Biologicals and Novartis have been bolstering their readiness for a sudden influx of vaccine requests by acquiring production facilities left, right and center. Others like Roche and Sanofi-Pasteur are preparing to bolster vaccine supplies by ramping up production at existing facilities or building new facilities. Likewise, these same companies are also making efforts to work more closely with their competitors should the need outpace the capacity to produce.

 

Should we be prepared for the next pandemic? Yes. But statistics suggest that it may not be so much a question of preparation for the future, as much as preparation for the present.

 

In 1918-1919, 25 to 50 million people died from the Spanish flu pandemic. That was a tragedy, but one that probably couldn't have been prevented given the scientific and medical knowledge of the time. Following recent trends, in 2005 alone, up to 2.7 million people will die of malaria. Another 3 million or so people will die from HIV/AIDS. These are tragedies that would be preventable given sufficient resources and global will.