Thursday, April 06, 2006

Bird Flu preparations

Bird flu is in the news and every time it is mentioned so is the fear of a pandemic (that is an epidemic that spreads “everywhere”). Do keep in mind, no one knows if a pandemic will occur or when it will occur, whether it will be as deadly as the (regular) flu pandemic of 1918, but do keep in mind that hygiene measures (hygiene in its broadest sense) and healthcare (to treat the lethal complication of the flu) have improved dramatically since 1918. No one knows when (or if) the antigen shift will occur so that “bird flu” can be transmitted from person to person or just how virulent that virus will be.

But these things are not the focus of this post. My point today is that the oseltamivir (Tamiflu) pills that are being stockpiled “everywhere” and at significant cost and the public distribution plans being written and tested (at significant cost) may not have a significant effect if an epidemic or pandemic occurs.

First, the distribution of the drug to the public to interrupt an epidemic is problematic. The drug must be taken within 48 hours of the onset of the flu for it to be effective (if it is going to be effective). One thing that has been demonstrated in testing planned distribution systems is that they take too long and that is if everything is going as planned. Throw in panic or a few sick “distributors” and/or some other glitch and the distribution fails to avert and/or interrupt the transmission of the virus. You end up with boxes of undistributed meds, at significant cost in monetary terms, as well as individual morbidity and mortality.

Second, the drug itself has not been proven effective in treating or preventing “bird flu”. Granted it hasn’t be used in a large trial in treating “bird flu” transmitted to humans (there have only been a little more than 100 cases to date), but its efficacy has not been that great. The other concern is that those taking the medication in case of an epidemic or pandemic may be less symptomatic (partially treated), although still capable of spreading the virus, and end up as Typhoid Marys spreading it.

I bring these points up for a couple of reasons. We should not complacently rely on stockpiling and distributing oseltamivir. We must take a real look at the cost/benefit ratio of the system we are putting in place. Will it be more effective than a concentration on hygiene measures and common sense? And very importantly, vaccine research and development is paramount.

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