As someone so aptly said, “Nothing like a planned pandemic!”

 

LONDON (Reuters Health) Feb 12 - Better planning, including possible stockpiling of influenza drugs, was called for today in preparation for a possible flu pandemic like the Spanish flu outbreak of 1918, which killed 40 million people.

“The natural history of influenza suggests it is only a matter of time before another influenza pandemic occurs,” Dr. Martin Meltzer, of the US Centers for Disease Control and Prevention, told delegates at the Retroscreen Second International Scientific Conference in London.

He said study findings suggest that in the United States alone, a pandemic would kill 89,000 to 207,000 people. There would also be 314,000 to 734,000 hospitalizations, 18 million to 42 million outpatient visits and 20 million to 47 million additional illnesses. The economic cost would be $71.3 billion to $166.5 billion, excluding disruption to commerce and society.

Dr. Arnold Monto, professor of epidemiology at the University of Michigan in Ann Arbor, warned, “Once the pandemic virus enters a particular community, it spreads within a period of weeks. While a vaccine would be the ideal method of prevention in pandemics, the supply may be insufficient at the point that outbreaks begin.”

“This would be especially the case if global spread of virus is accelerated from that previously seen because of massive increases in air travel, leaving little time for vaccine production,” Dr. Monto continued. “In addition, if the pandemic virus is totally new, two doses of vaccine would be required for good immunogenicity.”

Dr. Monto said that neuraminidase inhibitors would almost certainly be effective against a pandemic virus, and unlike vaccines could be stockpiled well in advance.

However, the meeting heard that the World Health Organisation’s pandemic plan still relies mainly on vaccines, and that talks between WHO and manufacturers about including neuraminidase inhibitors, such as GlaxoSmithKline’s Relenza (zanamivir) and Roche’s Tamiflu (oseltamivir), are still at an early, informal stage.

Dr. Penelope Ward, medical director for Roche’s worldwide Tamiflu programme, warned: “Supply logistics would be absolutely critical in a pandemic. I would urge you to urge WHO to work with manufacturers because we can respond and find out the best way to adapt procedures in an emergency.”

Professor Lars Haaheim, Director of the WHO National Influenza Centre for Western Norway, agreed that current vaccine technology would be likely to deliver “too little vaccine too late, at least for the first pandemic wave.”

He said the new drugs were still in clinical trials when WHO drew up its pandemic plan. However, it now appears, he said, that they could become a “realistic and widely available therapeutic and possibly also a prophylactic option.”

Anticipating supply disputes between countries in the event of a pandemic, he said that “the contingency manufacturing capacity of both vaccines and antivirals should be estimated, and the global equity problem should be resolved in advance while there is still good time....An acute international health crisis of this kind calls for a well-planned concerted global action.”

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