Flu news: Canadian edition

If you're a regular reader at Just a Bump in the Beltway, you'll know that Melanie and Charles have been closely watching the avian flu story and the possibility that the bug responsible, H5N1, could mutate into a form that could pass from human to human and lead to a global pandemic with devastating consequences.

Yesterday Melanie pointed to a Denver Post story with the comment: "The US press finally wakes up."

Fearing an outbreak of a new flu strain capable of killing millions, the nation's public health agency is quietly preparing a plan that proposes quarantines, school closures and rationing vaccine to counteract an epidemic.
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Even as they plan, health officials worry those steps won't halt a deadly bird flu if it mutates and starts spreading among people. An outbreak of avian flu in humans - if it happens - would kill millions worldwide.

Scientists say it's not a question of if but rather when a flu that people lack immunity to emerges, triggering a pandemic. A mild form of avian flu has already spread among a small group of people in Europe.
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Avian flu, which plagues birds in Cambodia, China, Hong Kong, Indonesia, Japan, Laos, Pakistan, South Korea, Thailand and Vietnam, lacks the ability to spread from person to person. Of the 37 deaths that have occurred worldwide, most of those who died had direct contact with infected birds.

But influenza viruses mutate constantly, which is why people need vaccines each year to fend off the latest strain. The longer that avian flu persists in birds, the greater the likelihood it will mutate into a form that is contagious among people.

If that happens, "then you have a virus that essentially the vast majority of people have no protection against, but it transmits well in humans," said Lynette Brammer, an epidemiologist at the CDC in Atlanta. "That's when you get a pandemic."

As if on cue, there are a couple of stories in the Canadian media today on the same subject. At CTV, there's a Canadian Press story that reports on a debate among flu experts over the possibility of stopping a pandemic in its tracks.

With a rising death toll in Vietnam and almost daily warnings that an influenza pandemic is imminent, a number of flu experts are wondering whether a pandemic could be averted with swift and decisive action.

A stockpile of anti-viral drugs deployed in Southeast Asian countries battling outbreaks of the deadly avian flu might temporarily stall or even stop a pandemic, two experts hypothesize in this week's New England Journal of Medicine.

Their articles were released ahead of schedule Monday to coincide with a conference on pandemic influenza organized by the University of Michigan's Bioterrorism Preparedness Initiative.

The director of the World Health Organization's global influenza program mused that if the H5N1 virus experts fear is poised to trigger a pandemic only gradually acquires the genetic changes needed to easily spread from person to person, an unprecedented effort to stop a pandemic might bear fruit.

"Though it is an attractive option, no attempt has ever been made to interrupt the transmission of an influenza virus; the results of such an enormous and costly undertaking remain uncertain,'' Dr. Klaus Stohr acknowledged.

"The option deserves further investigation, however, particularly when viewed against the profound effect a delay in global spread and a flattening of the peak in disease prevalence could have during the initial phase of a pandemic.''

But a leading U.S. epidemiologist suggested the idea was unworkable. Dr. Michael Osterholm said there are neither enough anti-viral drugs available globally nor a way to quickly find all possible cases of human-to-human transmission and get drugs to their close contacts -- and there isn't time to find solutions to those problems.

Meanwhile the Toronto Star reports on a company that claims it can quadruple the production of flu vaccine.

A Canadian biotech company could be about to spark what the head of the WHO's influenza program says may be a mini-revolution in the manufacture of flu vaccine.

Microbix Biosystems Inc., a Toronto company, has developed a mysterious "process" it claims produces a four-fold increase in the yield of influenza virus incubated in eggs. It recently announced it's in negotiations with a major player in the flu vaccine world for an exclusive licence to the process.

It's not uncommon for the biotech field to make extravagant claims that never come to pass. Still, this one has some global flu experts watching closely.

They see the Microbix process ? if it pans out ? as a possible partial solution to what will be a massive global vaccine shortage when the next flu pandemic hits.

But there's a fly in the ointment and it raises an issue that needs looking at, especially in light of the potential consequences of something as deadly as avian flu.

But the proposed exclusive licensing deal with the potential buyer worries some experts concerned about the inadequacy of the global vaccine production in the face of a looming influenza pandemic.

"Exclusive licensing of a technology like this is simply not in keeping with the interests of global public health," says flu vaccine specialist Dr. David Fedson.

"Assuming that this is something that can either be synthesized simply or is naturally available in what are, in effect, limitless quantities ... then the needs of public health really demand that it be made available to every vaccine company that's interested," says Fedson, a retired executive of vaccine giant Aventis (now Sanofi) Pasteur.

"And for those vaccine companies that aren't interested, their national governments should come around in the middle of the night and persuade them ? make them an offer they can't refuse ? to get interested in this and test it."

As the article reports, there's still a great deal of mystery surrounding the "process". But with the media starting to pay attention to this, I suspect we'll be hearing more in the near future.