By Elizabeth M. Whelan, Sc.D., M.P.H.
Posted: Tuesday, November 8, 2005

ACSH IN THE NEWS
Publication Date: November 8, 2005

This article originally appeared in the November 8, 2005 New York Post:

Public awareness about the possibility of a pandemic of avian flu has soared, but so has misinformation.  Here are the top 10 things you need to know.

1. There are currently no known cases of avian flu traced to person-to-person transmission.  The only transmission is between birds and in a small number of people who have had close contact with birds.  A pandemic would occur only if the current virus mutated in such a way that it could be transmitted between and among humans.  There is no need to panic, only to prepare.

2. The media daily tout hypothetical threats -- claiming, for instance, that trace levels of pesticide residues in food pose hazards -- but bird flu is not a run-of-the-mill phantom risk.  There is sound scientific evidence suggesting a pandemic could evolve.

3. There are major differences between the deadly 1918 flu pandemic and one that might occur in modern times.  Today we have anti-viral drugs that can mitigate the effects of the infection, and we have antibiotics to treat secondary infections and complications.

4. There are, however, challenges that remain essentially the same as they were nearly 100 years ago.  Influenza is highly contagious.  Unlike SARS or smallpox, influenza can be spread one or two days before symptoms appear.  During the SARS epidemic, the disease was kept in check by keeping travelers with fevers from boarding planes.  Carriers of influenza may show no such signs of disease.

5. As President Bush stressed in a speech this week, the first step in preparedness is surveillance, tracking and documenting the frequency of infection in birds and in people working with birds -- and reporting immediately any person-to-person transmission.  This will involve a concerted, worldwide effort.

6. Vaccine production is complicated given that (a) we cannot develop an effective vaccine until human to human transmission has occurred and we have identified the new virus, and (b) there is currently little incentive for pharmaceutical companies to make vaccines given the liability risks they face and the uncertainty that sales revenue would justify the staggering production costs.  Some advocate stockpiling "pre-pandemic" vaccines designed to protect from the H5N1 strain currently infecting birds, recognizing that a new strain allowing person to person transmission would be different but arguing that a pre-pandemic vaccine might at least offer some protection.  Others say it is a misuse of limited resources to allocate over $1 billion to produce a vaccine of unknown efficacy.  Medical professionals agree, though, that we must develop quicker, more efficient means of making vaccines, while giving companies incentives to produce them -- including liability protection and guarantees of purchase.

7. Government stockpiling of medicines to treat influenza -- anti-virals and antibiotics -- is essential.  At the moment, Tamiflu is the number one choice in treating influenza, but the drug is in short supply and is licensed only to Roche.  With the right incentives, Roche would team up with other companies to dramatically increase production.  (Stocking up on Tamiflu now for personal use, though, is unwise and unnecessary.) 

8. State and local health departments should create an infrastructure that would allow for storage and distribution of both vaccines and treatments -- and the possible sudden increase in need for hospital beds and isolation/quarantine programs.

9. Advance preparation should avoid "quick fixes" that could backfire.  Proposals to allow governments to violate patents on drugs like Tamiflu -- ignoring laws that protect intellectual property -- would be disastrous, discouraging the pharmaceutical industry from developing desperately-needed new anti-virals.

10. As with any crisis, hucksters will try to make a quick buck.  Already, dozens of Internet sites sell what is almost certainly imposter "Tamiflu" and surgical masks that offer little or no protection against the flu virus.  Buyer beware.

Dr. Elizabeth M. Whelan is president of the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com).