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The
Big Bad Flu, or Just the Usual?
By
For all the public concern over the rapid spread of the new Fujian strain
of influenza, health officials and doctors say there is still no way to
know whether this year's flu season is particularly severe or just off to
an early start. And for all the clamor for dwindling supplies of vaccine,
no one knows how effective the current vaccine will be against the But the flu season has already thrown some
realities about the public health system into sharp relief, these experts
say. It suggests that the country needs to be far better prepared to deal
with influenza — either the conventional strains that cause serious
illness each year, or a horrendous strain like the one that caused the
1918-19 pandemic, which killed at least 30 million people worldwide. Influenza is arguably the most unpredictable
of viruses, and protecting the public against it is a tricky balancing
act. It involves a number of factors: inadequate scientific knowledge of
the virus; educated guesswork in choosing what strains of influenza to
include in each year's vaccine; time-consuming, old-fashioned
manufacturing techniques; and skills in communicating with a skeptical
public. Such protection also depends on a strong
public health system. But years of underfinancing have weakened the
system. And confidence in it was scarred by the flawed emergency swine flu
immunization program in 1976, which was halted after a relatively few of
the 45 million people who had been vaccinated became temporarily paralyzed
from Guillain-Barré syndrome. More recently, gaffes and miscommunication
about events like the anthrax attacks of fall 2001 left Americans unsure
what to think about public pronouncements, and insecure about the nation's
capacity to deal with a severe epidemic of SARS or a new strain of
influenza. Communication has improved since then.
Still, the government had little to say about influenza this fall, while
the health and human services secretary, Tommy G. Thompson, and his top
aides visited African countries torn by AIDS. Only after their return did
news conferences about influenza resume. Government health officials have repeatedly
warned about the inevitability of another influenza pandemic. Yet the
government has to approve final plans to counter such a disaster. No one knows why influenza has hit the
western Dr. Anthony S. Fauci, the director of the
National Institute of Allergy and Infectious Diseases, put it bluntly:
"No way will the Dr. Julie L. Gerberding, director of the
Centers for Disease Control and Prevention, says the vast majority of
influenza cases are an annoyance, causing only a mild respiratory illness.
But Dr. Gerberding also noted that influenza is lethal for 36,000
Americans on average each year. The deaths are among the reasons health
officials have been urging Americans to take influenza vaccine. An
estimated 185 million Americans are eligible for it, but manufacturers
produced enough vaccine for only 83 million Americans. Each February and March, the World Health
Organization and the The three strains are turned into the
following season's vaccine, and W.H.O. provides the seed viruses free to
all vaccine manufacturers. The Because the manufacture of influenza vaccine
is entirely in the private sector in the One reason for the gap between supply and
demand this season is the perennial lack of response to pleas from health
officials for most Americans to get flu shots. That consumer response
forced manufacturers to discard 12 million of the 95 million doses
produced last season at a loss of millions of dollars. So manufacturers
produced 83 million doses for this season. The time when the three strains are chosen
is critical to vaccine production. One reason is that it takes tens of
millions of chicken eggs to produce each season's vaccine, and they must
be bought months in advance. Once production is complete, additional doses
cannot be made without reducing the amount that could be produced for the
next influenza season, Dr. Gerberding said. Because the process is complex and even the
best influenza vaccines are about 70 to 90 percent effective, a notch
below the standard childhood immunizations, health officials have long
urged researchers and industry to find new ways to produce influenza
vaccine. Scientists have come up with promising new methods. But major
problems, including those involving technology and intellectual property
rights, are unresolved. Dr. Barry R. Bloom, dean of the Harvard
School of Public Health, said that because of industry's limited capacity
to make vaccine, "we would be in terrible shape" if there was a
pandemic of a virulent strain. "That is unlikely to change without
government intervention," he said. Soon after the swine flu episode in 1976,
the government began drafting a plan for its response to a real pandemic.
Then in 1993, it created a panel to come up with the plan. Many drafts
have been prepared as the science has changed, but there is no final one,
said Dr. Bruce G. Gellin, the director of the government's National
Vaccine Program Office. Critics say an official plan is needed. But
even a draft, Dr. Gellin said, has been useful as a blueprint for
preparing against a bioterrorism attack and in dealing with SARS. "We need to diversify our manufacturing base and develop new techniques to improve our chances of success," Dr. Gellin said. "Ideally, that would produce a vaccine that would be given once and protect against all influenza viruses." Copyright
© 2002 Global Action on Aging |
