Waiting for the Pandemic

The world has some new antiviral medicines that offer significant protection against influenza viruses if taken within forty-eight hours of the onset of illness, but the current supply is not enough to cover even 5 percent of the population. Vaccines are the long-term answer but they must be matched to the particular strain of flu that is causing the problem, so you cannot start manufacturing them until that strain actually shows up. It then takes at least two months to identify the strain and devise and test the vaccine, plus further months to manufacture adequate supplies. Even if they had had today’s technologies in 1918 and had produced a vaccine against the Spanish influenza, at least half the victims would have died before the vaccine became widely available. In other words, despite all of our medical progress, we are not in a vastly better position to deal with an outbreak today than they were in 1918.

For many months there would be no vaccine, and panic would spread as people fell ill literally from one hour to the next. Schools, theatres, even churches would be closed, and most public transport as well — anything to reduce the virus’s opportunities to infect new victims. Absenteeism at work would soar, with many people staying in their homes and avoiding even their neighbours. The few people on the streets would be wearing surgical masks. Ordinary retail business would practically cease. All of these things happened in Canada in 1918.

If the pattern of 1918 held true, up to 40 percent of the population would get the flu, but the vast majority of them would suffer only the usual aches and pains and be back on their feet in four or five days. For the unfortunate minority, it would be a different story. They would be critically ill, in agonizing pain and struggling to breathe, some of them turning blue from lack of oxygen, and many would die. Morgues and funeral homes would fill up and overflow, and quite soon normal medical services would cease.

Dr. Huiming Yang, deputy chief medical health officer for Saskatchewan and a member of the province’s Pandemic Influenza Steering Committee, is quite clear about what would have to happen. “Now we aim at optimum care, but during a pandemic I would call it adequate care. For example, people can be sent home when they are recovering, if they are stable, just to have acute-care beds available. There would be triage centres and non-traditional care centres.”

The economic impact would be equally big. In August 2005, a bmo-Nesbitt Burns report by Sherry Cooper and Donald Coxe entitled “An Investor’s Guide to Avian Flu” concluded that the damage caused by “a pandemic, even one meaningfully less virulent than the 1918 influenza outbreak . . . could be comparable, at least for a short time, to the Great Depression” and “would trigger foreclosures and bankruptcies, credit restrictions, and financial panic.”

Life insurance companies would be decimated as their reserves failed to cover the huge wave of claims. Manufacturing industries would soon be hit by breakdowns in their just-in-time delivery systems, which often cross international borders and other boundaries that would likely be closed, and car production in Canada might actually cease. Food deliveries would be heavily disrupted, especially in winter when Canada depends heavily on American food imports, and that, combined with panic buying, would soon lead to empty shelves in shops.

Over the longer term, large numbers of deaths would lead to a surplus of houses and apartments and a collapse in real-estate prices. China and India would be especially hard-hit, and as their economies slowed, worldwide demand for metals and commodities, including oil, would face a similar collapse.

Though pandemics are a global threat, so far the responses have been mostly at the national level. The US National Institute of Allergy and Infectious Diseases recently field-tested a vaccine against an existing variant of the h5n1 virus in the hope that it might give some protection against a “humanized” version of the virus and plans over the next few years to develop similar generic vaccines for other “H” types of the influenza virus that currently exist only in animals, including (in keeping with who priorities) H5, H7, and H9. Researchers at the Atlanta-based Centers for Disease Control and Prevention are trying to combine avian and human influenza viruses in their laboratories in an attempt to see how lethal and how infectious various combinations are. The Bush administration put forth a plan to spend $7.1 billion (US) to stockpile antiviral drugs, encourage the development of vaccines using cell cultures to allow for faster production than the current technology (which uses chicken eggs) and help other countries to train their medical personnel to detect and contain any outbreak of pandemic influenza. But the initiative stalled in Congress and it is not clear whether it will be revived.

Britain, after a slow start, has gone into high gear, ordering 14.6 million treatments of Tamiflu, with each representing a course of ten pills. (The United States, with nearly five times the population, has ordered only twentythree million treatments.) Britain has also signed “sleeping contracts” with drug companies under which the state will pay the corporations to build vaccine- production facilities, enough to adequately cover the entire British population. Researchers at the National Institute for Biological Standards and Control in London are using a technique called reverse genetics, which involves merging genetic information from laboratory viruses and active avian viruses in order to create prototype viruses. These could be “grown” very quickly to produce a possible avian vaccine. But neither Tamiflu, nor the hugely expanded vaccine-production facilities, nor the experimental high-speed production technique will be available outside of Britain in the immediate future — it’s all about protecting the British population, with barely a nod to the global dimension of the problem.

China is struggling to overcome the mistrust that other countries have felt ever since it concealed the sars outbreak from the world — a mistrust that returned when it concealed its first human case of avian flu (in Hunan province in October 2005) for three weeks before consulting experts at the World Health Organization. Huang Jiefu, one of China’s vice-ministers of health, promised to close China’s borders if a single case of human-to-human transmission of bird flu is detected in the country. In mid-November the government declared that it would vaccinate its entire domestic stock of fourteen billion chickens, ducks, and geese (20 percent of the global total) against bird flu in order to make that contingency less likely. The vaccine is cheap and it works fine, but it must be administered one bird at a time. Since three-fifths of the domestic fowl in China are family- owned birds that are free to wander around the home, the yard, and the entire neighbourhood, one doubts that the job will be done quickly or comprehensively. As for antivirals and human vaccines, China says not a word.