Pyres: 2001 UK FMD Outbreak - Photo: Murdo Macleod.  Slides L-R: Smallpox, SARS Coronavirus , Foot and Mouth Disease, West Nile Virus.

In November 2003, Dr. David Halvorson
former President, American Association of Avian Pathologists (1993–94) , Diplomate, ACPV, College Of Veterinary Medicine, University of Minnesota participated in a discussion (Pandemic Influenza and Vaccine Production) regarding the challenge of  an international public health emergency and the availability of 160 million chicks hatched weekly (embryos available weekly) that could be used for emergency vaccine production in the United States.

Once again Dr. Halvorson has been kind enough to provide insight regarding the following questions associated with contingency planning for pandemic influenza (26 October 2004):

S.M.Apatow. What do you think our potential is for the production of human vaccine in the U.S.? International?

D.Halvorson:  From what little I know, our current potential for producing influenza vaccine in the US on an emergency basis is very, very small.  I understand that there is no longer a company making influenza vaccine in the US, so there is little infrastructure available to tool up.  Europe at least has the advantage of having viable companies involved in influenza vaccine production, but it would appear that there would be fierce global competition for the few hundred million doses that might luckily be produced. 

S.M.Apatow: Timelines?

D.Halvorson:  For ordinary pandemic influenza (based on Asiatic and Hong Kong experience) standard practices (6 months to a year) might be acceptable to planners.  We might lose a few hundred thousand people.  That would cause huge political fall out, but life as we know it would go on.

For emergency pandemic strains like the 1918 H1N1 or worse and with modern travel, emergency measures would be needed.  Millions could die.  The development of vaccines would have to occur within two to three months, maybe less.  We seem to have many people who know that it is impossible to produce vaccine in a couple months.  It probably requires people who know nothing about why it is impossible to produce a vaccine in such a short time.  Some organization like the US Forest Service that knows how to respond to an emergency forest fire.  That's the kind of thinking that is required to respond to an emergency, not thinking about research on underbrush, wind speed, fire retardant, etc.  (BTW, I am told the USFS provided excellent help in the Exotic Newcastle Disease eradication effort in California last year.)

S.M.Apatow: What contingency plans would you like to see developed and supported on the OIE/FAO/WHO level?

D.Halvorson:  Let's say we get a virus with a mortality rate approaching H5N1 in East Asia plus the ability to spread efficiently from human to human. Now we're talking about tens or hundreds of millions of lives world wide. Plus, in the US if people stayed home too long the economy would collapse.

In an emergency, some niceties will need to be abandoned.  Intellectual property rights would get temporarily suspended. Probably several stock viruses would be needed, so that clinical assessment could be done "on the fly."  Safety standards would need to be relaxed. "Conditional licenses" would be needed.  Martial law would be needed.  Fertile eggs, egg inoculating machines, maybe even whole hatcheries would be taken.  People with virus propagation experience would be conscripted. The National Guard would be needed to guard vaccine supplies. On and on.

Obviously, wherever possible, preplanning would be helpful.  Pre-approved protocols are needed, but they probably need to be developed again by those who do not understand the impossibilities.  Certainly it would be helpful to have a legal basis to do everything that is needed.  Finally, someone needs to be thinking about emergency live vaccines, possibly very crude ones.

And again, if the USDA can have the foresight to stockpile enough antigen for emergency vaccination of POULTRY, then we should certainly expect more from FDA and WHO for an emergency response to a pandemic virus.

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