WELL, it鈥檚 happened. A pandemic is looming though it comes not from bird flu in Asia, as we thought it might, but swine flu in Mexico (see 鈥淪cientists have warned about swine flu for last decade鈥�). It may yet fizzle out 鈥� viruses like this have done before 鈥� but no researcher we have spoken to is hopeful.
So what now? Things look bad, but rather than panicking we should use the best science we have to assess the situation. And then we should scream and scream again at the people in charge 鈥� caution-merchants and commercial interests for the most part 鈥� until someone does something.
Because right now, we are not really in a position to defend ourselves, though it鈥檚 true we鈥檙e better off than we were. Since the wake-up call of the narrowly averted SARS catastrophe in 2003, and concerns about H5N1 bird flu since 2004, there has been a vast amount of research on vaccines, treatments and pandemic response.
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鈥淲e should scream and scream again at the people in charge until someone does something鈥�
Here is what we know. Measures such as washing a lot and cancelling public events can slow the spread of the virus, but they won鈥檛 stop it. There are a few antiviral drugs, which can be effective if taken early enough. But stocks are limited, and without quick and accurate diagnosis they could be wasted on the worried well at the height of a panic, or controlled too carefully and therefore administered too late. There鈥檚 also the spectre of virus resistance.
The best bet, as always, is vaccines. But there are problems. The extent of global vaccine R&D and manufacturing capacity has been largely dictated by companies鈥� commercial interests. No more or less can be expected of companies, of course, but with few exceptions we鈥檝e left everything to them. The best that they can do now is to divert all resources to tackling this virus instead of ordinary flu. Commercially, that means a huge leap of faith: if the pandemic doesn鈥檛 materialise, firms will be left with no ordinary vaccine and useless swine flu shots. They may only do it if governments pick up the tab.
But if they do, and if this swine flu is no harder to make a vaccine against than H5N1, which has been the focus of most research, then according to one recent study, we could have 340 million doses of vaccine in four months. If it turns out to be easier to make, we could have a billion. But let鈥檚 not forget there are nearly 7 billion people in the world.
Four months could be critical. Pandemics vary enormously, so history is a poor guide, but the last time this family of flu viruses went pandemic, in 1918, there was a four-month gap between the first, mild wave of illness and the big attack. The usual toll cited is 50 million.
What if we can鈥檛 make enough vaccine? The final edition in 1918 of the Journal of the American Medical Association carried a poignant message. Though the year saw the end of 鈥渢he most cruel war in the annals of the human race鈥� the journal concluded that science 鈥渕ust turn with its whole might to combating the greatest enemy of all 鈥� infectious disease鈥�.
That message still resonates. The 1918 pandemic death rate translates into 170 million victims today. A pandemic now could take fewer lives, but it could also take more. A policy of 鈥渋t may not happen鈥� will not do when a pandemic could cost the lives of millions and derail what鈥檚 left of the global economy. So we must make vaccine. But who鈥檚 鈥渨e鈥�? As New Scientist has warned for years, only a few countries have vaccine plants, mainly in Europe. They may be unwilling to export their product.
Distributing limited stocks of vaccine between countries bids fair to be a mess, never mind between people. Some countries have thought about who should get drugs and vaccines first, but plans could come unstuck if a pandemic tears the fabric of society.
The Manhattan Project is an overworked metaphor, but throwing your resources into one activity sometimes makes sense. We could also launch a crash programme of testing and developing new drugs and vaccines that are now only at the experimental stage. These include vaccines that focus on parts of the virus that do not mutate, meaning they will still work if the virus evolves; new DNA and protein vaccines; antibody therapies based on the serum of survivors; and anti-inflammatory treatments (see 鈥淗ow to survive pandemic flu鈥�).
We鈥檝e had five years to prepare for a pandemic. We aren鈥檛 ready. Either we use every tool at our disposal to shore up our defences or we keep telling people to wash their hands a lot, and watch the death toll rise.
