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General Medicine™
Webcast Video Editorials
Pandemic Flu: We Are Not Prepared
Posted 4/15/2005
Marc Lipsitch, D. Phil
The world faces a new influenza pandemic about 3 times each century.[1]
The 1918 pandemic killed at least 20 million people.[2] We don't
know when the next one will hit, but flu experts agree that we are now at
high risk for a serious pandemic.[3] H5N1 flu has become endemic
in Asian birds, and at least 74 human cases, including 49 deaths and probable
human-to-human transmission, have occurred since the beginning of 2004.[1,4,5]
We are unprepared for a new pandemic. International health officials lack
the resources to monitor avian flu in a human population of hundreds of millions
in affected parts of Asia, including some countries with almost no public
health systems.[1,6] Asia needs a significant stockpile of the
anti-influenza drug oseltamavir, on-site, to treat and stop transmission of
the early cases that could give rise to a pandemic.
If a pandemic reached the United States today, we could manufacture only
enough vaccine for perhaps a quarter of our population.[7] Our
planned domestic stockpile of oseltamavir would leave over 99% of the country
unprotected.[8] Proportionally, Great Britain's stockpile will
be 25 times greater,[9] and some authorities suggest that even
that isn't enough.[10] To make a dent in a pandemic, vaccines and
antivirals will be needed in much greater quantities than current plans allow.[11]
Pandemic flu is an enemy that we know will return. Indeed, of the 12 disaster
scenarios recently assessed by the US Department of Homeland Security, it
is the most likely and perhaps the most deadly.[12] Our surveillance
and countermeasures abroad are inadequate, and current response plans won't
do much to slow a pandemic once it is under way. The United States, and the
world, must meet this enemy with the seriousness, the investment, and the
urgency that it demands.
That's my opinion. I'm Dr. Marc Lipsitch of the Harvard School
of Public Health. To contact the author: mlipsitc@hsph.harvard.edu
Readers are encouraged to respond to George Lundberg, MD, Editor
of MedGenMed for the editor's eye only or for possible
publication via email: glundberg@medscape.net
.
References
-
World Health Organization. Avian influenza: assessing the pandemic
threat. January 2005. Available at: http://www.who.int/csr/disease/influenza/WHO_CDS_2005_29/en/
Accessed April 11, 2005.
-
Patterson KD, Pyle GF. The geography and mortality of the 1918 influenza
pandemic. Bull Hist Med. 1991;65:4-21. Abstract
-
Li KS, Guan Y, Wang J, et al. Genesis of a highly pathogenic and potentially
pandemic H5N1 influenza virus in eastern Asia. Nature. 2004;430:209-213.
Abstract
-
Ungchusak K, Auewarakul P, Dowell SF, et al. Probable person-to-person
transmission of avian influenza A (H5N1). N Engl J Med. 2005;352:333-340.
Abstract
-
World Health Organization. Cumulative Number of Confirmed Human Cases
of Avian Influenza A/(H5N1) since 28 January 2004. Available at:
http://www.who.int/csr/disease/avian_influenza/country/cases_table_2005_03_31/en/
Accessed April 11, 2005.
-
Aldhous P. Vietnam's war on flu [news feature]. Nature. 2005;433:102-104.
Abstract
- Fedson
D. Pandemic influenza vaccines: obstacles and opportunities. In: Knobler
SL, Mack A, Mahmoud A, Lemon SL, eds. The Threat of Pandemic Influenza: Are
We Ready? Workshop Summary Prepared for the Forum on Microbial Threats, Board
on Global Health, Washington, DC: National Academies Press; 2005:184-196.
-
United States Department of Health and Human Services. Testimony of
Dr. Julie L. Gerberding before the Committee on Energy and Commerce United
States House of Representatives, Nov. 18, 2004. Available at:
http://www.hhs.gov/asl/testify/t041118c.html
Accessed April 11, 2005.
- Naughton
P. UK to stockpile drugs against bird flu pandemic. Times (London). March
1, 2005. Available at: http://www.timesonline.co.uk/article/0,,2-1506055,00.html
Accessed April 11, 2005.
-
Infectious Diseases Society of America (IDSA). Flu pandemic coming,
U.S. not prepared [press release]. March 22, 2005. Available at:
http://www.idsociety.org/ID=12436
Accessed April 11, 2005.
-
Longini IM Jr, Halloran ME, Nizam A, Yang Y. Containing pandemic influenza
with antiviral agents. Am J Epidemiol. 2004;159:623-633. Abstract
- Lipton
E. U.S. lists possible terror attacks and likely toll. New York Times. March
16, 2005:A1.
Marc Lipsitch, D. Phil , Associate Professor of Epidemiology, Department of
Epidemiology and Department of Immunology and Infectious Diseases, Harvard
School of Public Health, Boston, Massachusetts.
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