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):
do you think our potential is for the production of human vaccine in
the U.S.? International?
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.
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.
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.