In Parts I-IV
I discussed the biology, morphology, etiology, genetics and ecology of
influenza, the various influenza pandemics that have occurred over the past
century and the current socioeconomic factors that increase the likelihood and
potential severity of another deadly flu pandemic. In Part V, I further examine
these socioeconomic factors and propose some solutions.
Over the past
several decades there has been a dramatic decline in public health funding and
infrastructure which could exacerbate any pandemic. Vaccine technology has
changed little since the 1950s, and is still done in eggs, a slow process that
is prone to contamination.3(139) Even with modern technology, however, we have
lost much ground in the last 30 years. In 1976, there were thirty-seven flu
vaccine manufacturers in the U.S. Today there are less than four.3(p140) Worldwide, there are only 12 flu
vaccine manufacturers and 95% of the stock goes to the wealthiest countries,
even though the majority of victims will likely be in the developing world.3(p159)
The war on
terror has taken funding that could be used for critical pandemic research and
redirected it toward research on rare or non-existent diseases such as
smallpox. Dr. Anthony Fauci, director of the National Institute of Allergy and
Infectious Disease, said that a flu pandemic was greater threat than a
bioterrorist attack.3(p171) 758
researchers, including 2 Nobel laureates, signed a petition claiming that the
war on terror, and it’s obsession with exotic pathogens had caused a 27%
decline in federal grants for research on immediate threats such as
tuberculosis, malaria and influenza, that kill millions of people each year.3(p170)
As a result
of HMO streamlining, many hospitals have been closing. Those remaining open
have reduced the number of unused beds to as close to 0 as possible, thus
leaving no space for new patients in a disaster, terrorist attack or pandemic
(but maximizing profits). Between 1990 and 1997, for example, Los Angeles lost
17% of their available hospital beds due to streamlining, while a 2003 survey
of hospitals found that 90% of U.S. emergency rooms were “seriously
understaffed and overcrowded.”3(p132) Additionally, millions of American remain
uninsured or lack paid sick leave, which results in sick people continuing to
work where they infect their coworkers.
Lastly, there
is a growing anti-vaccination hysteria that threatens us all by discouraging
people from getting vaccinated. Yet flu vaccines typically produce strong
immune responses in 70-90% of those who have been vaccinated.11 However,
there are several caveats to this. Flu vaccines take up to two weeks to
stimulate complete immunity.11 For
some patients, particularly young children, up to two doses may be required.11 In the time it takes to develop immunity, a
person can be infected and become sick. This might lead one to believe that the
vaccine made them sick. In reality, influenza made them sick before the vaccine
was able to protect them. Therefore, getting vaccinated early, before the
height of flu season, is critical to self-protection. Also, if a high enough percentage of the population is
vaccinated, there will be very little, if any, of the pathogen circulating in
the population, thus further reducing the chances of infection. This is called
herd immunity and occurs when 70% of population is immunized.13(p792)
One reason
people fear vaccines is that there have been several notable correlations
documented between vaccines and alarming side-effects. However, correlation
does not equate to cause, and in virtually every case, the correlations were
coincidental; not causative.
In 1976,
several people developed Guillain-Barre syndrome (GBS) after getting vaccinated
for swine flu. Many people assumed that the vaccine was responsible.
Guillain-Barre is a neurological autoimmune disease that sometimes follows infection
with Campylobacter jejuni and influenza.11 It is also very rare, occurring in
approximately 1 out of every 100,000 people. The number of people who
contracted GBS during the 1970s swine flu vaccination program was not
significantly higher than normal. The CDC believes that there may have been 1 additional GBS case per
100,000 during the 1976 vaccination program, yet no scientific evidence has confirmed
this.11 The most likely explanation is that the few
cases of GBS that did occur, would have occurred anyway.
Even when
vaccines are available and desired,
poor Americans have less access. Only 39% of African American seniors get
vaccinated annually, while 71% of white seniors get vaccinated. This is one
reason why seasonal flu is still so deadly in the U.S.3,(p35-6)
![]() |
From Wikipedia |
What Can Be Done?
While
another deadly pandemic is likely, there is much we can do now that was not
possible in 1918. Vaccine, antiviral and antibacterial technology is far more
advanced than it was then. With sufficient funding, we should be able to
develop vaccines against Highly Pathogenic Avian Influenza (HPAI) strains like
H5N1 and make them available to people throughout the world. We also need to
provide more funding for antibiotic development to fight the various bacteria
that cause deadly secondary infections associated with influenza and
governments should stockpile Tamiflu and provide it to people early, when it is
effective at stopping influenza.
Governments
also need to invest in the rebuilding of public health infrastructures,
including an increase in available beds and emergency room capacity. However,
they also need to do a better job of educating the public on the benefits and
safety of vaccines. Lastly, the rich countries need to provide support for
better veterinary surveillance in the developing world and all governments need
to be completely open and honest about HPAI outbreaks in their backyards.
![]() |
Image from Wikipedia |
Tamiflu is
only known drug that can fight H5N1 influenza. Rapid stockpiling of Tamiflu
(enough for 25% of the population of each country) is essential for averting
catastrophic losses of human life. 3(p145) Japan has purchased enough Tamiflu for 20% of
their population, while Australia only has enough for 5% of their population,
and the U.S. only has enough for only 1% of their population.3(p144) Poor
countries have asked permission to produce their own generic versions of
Tamiflu, but the U.S. and France vetoed the proposal because it would eat into
Roche’s profits.3
Rebuilding
public health infrastructures necessarily involves providing affordable and
accessible health care to all and the ability to stay home when ill. Short of
this lofty goal, hospitals could be required to maintain sufficient unused beds
for disasters or pandemics. Effective public health media campaigns, along the
lines of anti-smoking advertisements, could be used to educate the public specifically
about the safety and benefits of vaccinations and how to protect oneself against influenza
(e.g., frequent hand washing, staying home when sick, coughing into elbow).
Much more funding needs to go into influenza research, as well as the
development of new antibacterial drugs.
![]() |
Asian Bird Cull (from Wikipedia) |
While the
U.S. monitors its own flocks for HPAI, many developing countries do not. Most sub-Saharan countries have closed their
flu monitoring systems due to lack of financial resources (only South Africa and
Senegal still monitor).3(p24) Monitoring
must be dramatically improved in areas with histories of HPAI outbreaks, such
as Vietnam, Thailand and China. When there is any indication of an HPAI
outbreak, the WHO must be notified immediately. Samples must be provided to
experts for identification and, if it is a HPAI strain, the birds should be
culled immediately to prevent the spread.
In the
developing world, poverty, corruption and poor infrastructure all hamper such
efforts. Developing countries also have valid reasons for not cooperating with
the international community, even when they have detected an outbreak. For
example, they are less able to deal with the financial and nutritional losses
caused by a large chicken cull than developing countries. There are also cultural
challenges, such as the value of chickens as pets, future dowries, hedges
against famine, or, in the case of prize fighting cocks, as ongoing sources of
income.
Lastly, the
wealthy nations need to move away from the lifeboat ethic that currently
dominates their public health planning and recognize that the front line of any
deadly influenza pandemic will be the poorest and most socially isolated
communities in the world. It will be impossible to contain influenza in these
communities and it will spread throughout the world. Providing free or low-cost
vaccines and Tamiflu to developing countries will help protect us all.
References
- AVERT, 2009, AVERTing AIDS website, October 28, 2009: http://www.avert.org/worldstats.htm
- Bartlett, Donald L., and James B. Steele, 2004, “The Health of Nations,” New York Times, Oct 24,
- Davis, Mike, 2005, The Monster at Our Door, The New Press, New York
- Enserink, Martin, 2004, Science, 306, Dec ember 17, 2004
- Kash, John C., Tumpey, Terrence M., Proll, Sean C., Carter, Victoria, Perwitasari, Olivia, Thomas, Matthew J., Basler, Christopher F., Palese, Peter, Taubenberger, Jeffery K., GarcĂa-Sastre, Adolfo, Swayne, David E., and Katze, Michael G., 2006, “Genomic analysis of increased host immune and cell death responses induced by 1918 influenza virus,” Nature. October 5; 2006, 443(7111): 578–581.
- Soares, Christine, 2009, “Pandemic Payoff,” Scientific American, November, 2009, p19-20
- Various Authors, 2009, “Influenza:,” from Wikipedia, accessed November 7, 2009, http://en.wikipedia.org/wiki/Influenza
- Various Authors, 2009, “Cytokine Storm,” from Wikipedia, accessed November 7, 2009: http://en.wikipedia.org/wiki/Cytokine_storm
- Various Authors, 2009, “Black Death,” from Wikipedia, accessed November 8, 2009: http://en.wikipedia.org/wiki/Black_Death
- Various Authors, 2009, “1918 flu pandemic,” from Wikipedia, accessed November 8, 2009: http://en.wikipedia.org/wiki/1918_flu_pandemic
- Various Authors, 2009, “Seasonal Influenza: the Disease,” Centers For Disease Control and Prevention website, accessed November 14, 2009: http://www.cdc.gov/flu/about/disease/
- Wallace, Amy, 2009, “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All,” Wired, October 19, 2009: http://www.wired.com/magazine/2009/10/ff_waronscience/
- Willey, Joanne M., Sherwood, Linda M., and Woolverton, Christopher J., 2009, Prescott’s Principles of Microbiology, New York, NY, McGraw Hill
- Various Authors, 2009, “Pearl River Delta” from Wikipedia, accessed November 14, 2009: http://en.wikipedia.org/wiki/Pearl_River_Delta
- Various Authors, 2009, “Cortisol,” from Wikipedia, accessed November 16, 2009: http://en.wikipedia.org/wiki/Cortisol
- California Newsreel, 2008, “Unnatural Causes,” video. Transcript accessed November 16, 2009: http://www.unnaturalcauses.org/assets/uploads/file/UC_Transcript_1.pdf
- President’s Council of Advisors on Science and Technology, 2009, “Report to the President on U.S. Preparations for 2009-H1N1 Influenza,” August 7, 2009: http://www.whitehouse.gov/assets/documents/PCAST_H1N1_Report.pdf
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