LAST month, a seven-year-old girl in British Columbia was sent home after vomiting at school on a Friday afternoon. By Sunday evening she was dead. The virus that killed her is so contagious that even quarantine will not stop it as it did SARS last year. But don鈥檛 panic. We have a vaccine. We even have drugs. So we can stop the killer.
Except we don鈥檛. Every year it kills some 700,000 people worldwide and infects billions of people and animals, each case a chance for the virus to mutate into something even deadlier. And once it does mutate, our existing vaccines won鈥檛 work. So why the complacency? Because the virus is ordinary old influenza. And who鈥檚 afraid of the flu?
Although nearly everyone gets flu sometime, most of those who die of it are over 70 or under 2 鈥� not types to set up vocal patients鈥� groups. So we stop worrying about it, even though we are overdue for the kind of pandemic that swept the planet in 1918, killing tens of millions. Maybe governments and doctors would take flu more seriously if scientists rebranded it 鈥渁cute myalgic fever鈥� and told everyone it was a new killer virus from animals 鈥� which every year, thanks to flu鈥檚 mastery of genetic juggling, it pretty much is.
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Despite years of warnings from scientists, we are not producing the defences we could. The US government spends twice as much on boll weevil research. Flu research is largely left to the private companies that make the drugs and vaccines. But there鈥檚 just no profit in it. While we have a fairly effective flu vaccine, even in the US and Canada, where authorities push flu shots harder than in Europe, fewer than half of those most at risk bother getting vaccinated. Last year drug companies had to throw unused vaccine away.
That鈥檚 not much of an incentive to improve flu vaccine technology. Every year, scientists observe which new mutant flu strains are circulating, and design next year鈥檚 vaccine. But this is produced, using technology half a century old, in chicken eggs. Sometimes, as happened this year, the circulating strains grow badly in eggs, so we use vaccine strains that do grow well even if they will not stimulate full immunity against the circulating virus. And it takes so long to make vaccine this way that sudden upswings in demand lead to shortages. Some of the really scary strains don鈥檛 grow in eggs at all.
Such problems pale beside those we would see in a pandemic. Nearly everyone has been exposed to flu viruses similar to the ones that normally circulate, so our immune systems merely need a boost to recognise them. But when a totally new virus starts to circulate, the vaccines we use now, made from killed virus, will not induce immunity in one shot. That will require more sophisticated vaccines, but where鈥檚 the incentive to develop them while there鈥檚 still time?
Then there are antiviral flu drugs. We have the neuraminidase inhibitors Relenza and Tamiflu. This year for the first time, Dutch doctors are routinely prescribing Tamiflu for patients in high-risk groups. But elsewhere few do. After all, it鈥檚 just flu. So several companies have cancelled research and clinical trials for promising new neuraminidase inhibitors.
The present market provides so few incentives for protecting the public in the long run that governments will have to step in. Astonishingly, it requires no headline-grabbing breakthroughs. We can already make novel vaccine strains and antigens by genetic engineering in the lab. And two companies, Solvay and Baxter, plan to manufacture vaccine in Europe using tissue culture rather than eggs.
But companies need more incentive than the market can supply to make enough standard vaccine for bad flu years like this one, and to test the vaccines we will need for pandemic strains. And vaccine companies need better protection from litigation when their products are used to protect public health in an emergency.
Meanwhile, even if we develop and test all the vaccines we may need, it will take around six months after the start of a pandemic to deploy them. During that time the only hope will be antiviral drugs. So we need stockpiles: not of the little capsules with limited shelf lives that pharmacists sell patients, but barrels of bulk agent that governments can dispense in an emergency. No country has such a stockpile.
Fortunately, we have a model for how governments can fill these gaps. This year the US will spend nearly a billion dollars providing incentives for companies to develop drugs and vaccines against agents such as anthrax and Venezuelan equine encephalitis (VEE). These germs don鈥檛 ordinarily cause enough disease to make the effort commercially worthwhile. The US government is paying out because it fears they might be used as bioweapons. Yet proposals to make more flu vaccine through the same 鈥渂ioshield鈥� programme were scrapped.
Some dispute the likelihood of an attack with VEE. But no disease expert doubts that sometime soon we will face a biological attack that has nothing to do with terrorists and everything to do with the flu viruses circulating and mutating in the crowded chicken farms of south-east Asia. It isn鈥檛 鈥渏ust the flu鈥�. It is perhaps our biggest bio-enemy, and it is at the gates.