By Richard Woodman
LONDON (Reuters
Health) - Better planning--including possible stockpiling of influenza
drugs--is needed to prepare for the possibility of a global flu
pandemic like the Spanish flu outbreak of 1918, which killed up
to 40 million people, experts said Monday.
"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 suggested 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 hospitalisations, 18 to 42 million outpatient visits
and 20 to 47 million additional cases. The economic cost would
be $71.3 to $166.5 billion, excluding disruption to commerce and
society.
"Once
the pandemic virus enters a particular community, it spreads within
a period of weeks. While vaccine would be the ideal method of
prevention in pandemics, the supply may be insufficient at the
point that outbreaks begin," warned Dr. Arnold Monto, professor
of epidemiology at the University of Michigan, Ann Arbor.
"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. In addition,
if the pandemic virus is totally new, two doses of vaccine would
be required for good (protection)," he added.
Monto said
existing antiviral drugs 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 (WHO) pandemic
plan still relies mainly on vaccines, and that talks between WHO
and manufacturers about including the drugs 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,
said, "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 was 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 appeared they could become a "realistic
and widely available therapeutic and possibly also a (preventive)
option."
According
to Haaheim, "The contingency manufacturing capacity of both
vaccines and antivirals should be estimated.... An acute international
health crisis of this kind calls for a well-planned concerted
global action."
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