Scientists Warn the World Isn't
Ready for Avian Flu Outbreak
By MARILYN CHASE
Staff Reporter of THE WALL STREET JOURNAL
May 25, 2005 1:28 p.m.
Five world experts in influenza, writing in the journal Nature, warn that despite stepped-up disease monitoring and research, the world is far from prepared to cope with a possible pandemic of avian flu that is smoldering -- and now mutating -- in Southeast Asia.
Experts worry that avian flu, which is highly lethal to humans but so far difficult for humans to catch, could mutate to a form that makes it easily transmittable from person to person.
Besides posing a health crisis, an outbreak of pandemic flu could trigger an economic crisis, according to Michael Osterholm, head of the University of Minnesota's Center for Infectious Disease Research and Policy. Dr. Osterholm wrote that the 2003 outbreak of SARS, or Severe Acute Respiratory Syndrome, gave a warning shot across the bow. Despite its relatively light toll -- 8,000 sick and 800 dead -- SARS snarled air traffic, paralyzed cities and cost billions.
Pandemic flu, which could sicken a billion people or more, could "change the world overnight...reducing or even ending foreign travel and trade,'' Dr. Osterholm.
Frozen trade and travel could worsen shortages of vaccines, antiviral drugs, antibiotics for secondary bacterial infections, ventilators and vital basics like food and water. Temporary hospitals, contingency staffing and allocation plans for scarce supplies are needed to survive 12 to 36 months of a pandemic.
Dr. Osterholm called on the Group of Eight industrialized nations and Russia to seize the initiative at its July meeting in Gleneagles, Scotland, warning, "Time is running out.''
Writers in Nature tried to estimate how many people would be sickened or killed by a powerful, pandemic avian virus. Albert Osterhaus and his colleagues at the National Influenza Centre and Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands, warned that a flu pandemic could cause 20% of the world's 6.45 billion people to become ill, put 30 million people in the hospital and kill 7.5 million.
In a normal year, garden-variety flu and complications such as pneumonia kill an estimated 1.5 million people world-wide.
Dr. Osterholm argued that a pandemic could even surpass the toll of the 1918 flu, which he says killed at least 50 million people. He cited the boom in people and poultry living together in Asia, giving the virus room to grow. During a milder 1968 flu pandemic, China had 790 million people and 12.3 million poultry. Today, it has 1.3 billion people and 13 billion poultry.
Dr. Osterholm said a vaccine against the pandemic strain wouldn't be available for six months due to requirements of egg-based production, and would only reach 14% of the world. He urged acceleration of new cell-based technology that can lead to quicker production of vaccines.
The World Health Organization last week reported that avian flu strains circulating in Vietnam show signs that they are evolving toward greater transmissibility from human to human. More human clusters are growing in northern Vietnam and lasting longer, suggesting possible human spread. The virus is also attacking people ranging more widely in age, and is showing signs of antiviral resistance to the best available drug, Roche's Tamiflu (oseltamivir).
While not yet a red alert, many experts agree such changes indicate potential evolution or mutation toward a pandemic is under way.
Anthony S. Fauci director of the National Institute of Allergy and Infectious Diseases, said a new avian flu vaccine from Sanofi Pasteur, now in human safety tests, still relies on eggs. "Unless we improve our capacity to produce such countermeasures,'' he writes, "we may experience again the devastation of past pandemics.''
Robert Webster and colleagues at St. Jude Children's Research Hospital in Memphis, Tenn., blasted failures to control avian flu at its source in poultry and wild birds, which some fear have let the virus become entrenched. Avian flu circulates from wild quail and geese to domestic ducks and chickens.
Mass culling -- as Hong Kong did in the slaughter of 1.5 million chickens in three days in 1997 -- may be too costly for poor countries. Agricultural vaccines are inconsistent, and poor ones simply suppress telltale symptoms while allowing animals to spread the virus undetected.
Control works. Since December 2004, Vietnam has suffered 41 cases and 16 deaths, but Thailand has had none due to massive surveillance and control -- which is costly and must be repeated since the virus returns from neighboring countries.
Political barriers thwart research, Dr. Webster said, citing "free-trade embargoes, national pride, intellectual property, lack of political will, biosafety and bioterrorism considerations and inadequate infrastructure.'' He urged the creation of disease-free zones for poultry, selective culling and vaccination, with greater harmony between countries and global groups.
Dr. Osterhaus of Rotterdam said this lack of international harmony in detection and control programs has concealed the true spectrum of disease, preventing calculation of accurate mortality rates. So far, out of 88 laboratory-confirmed cases, 51 have died -- for an estimated mortality rate of about 60%.
But since total cases -- including milder ones -- remain unknown, the real death rate remains obscure.
Dr. Osterhaus called for a global task force to set research priorities and policy and control strategies that he said would cost just $1.5 million a year, a sum dwarfed by the $1.35 billion cost of animal outbreaks so far in the Netherlands, Thailand, Vietnam.
Write to Marilyn Chase at marilyn.chase@wsj.com8
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