TCS Daily


Ready? Or Not?

By Glenn Harlan Reynolds - January 9, 2006 12:00 AM

Is avian flu a threat? Yes. Is it a big or immediate threat? It's hard to say.

Right now, there's no evidence of human-to-human transmission; people are dying, but they all seem to have gotten it from birds, though the fast-spreading Turkish outbreak -- worrisome enough because it represents considerable geographic spread (and Dr. Henry I. Miller will have more on it in these pages on Tuesday) -- featured this troubling development, according to the Times: "Professor John Oxford, an expert on flu at Queen Mary's medical school, London, said the most worrying aspect of the deaths in Turkey was the large number of human cases resulting from exposure to a small number of birds."

Avian flu will either mutate so that it can spread easily among humans, or it won't. If it does, it might possibly also mutate in a way that makes it less fatal, or it might not. The result could be a dreadful epidemic that will kill millions, or just a new strain of flu. At the moment, no one can really say which is more likely, and those claiming otherwise are likely, um, overenthusiastic about their state of knowledge.

This raises a lot of problems.

This NPR story illustrates the problem with the current vaccine-development strategy: The vaccine now under development, based on the flu strain that killed people in Vietnam, might not work against a mutated strain. And even if it does, the vaccine has a shelf-life of only about a year, making it hard to maintain a stockpile against the day that the flu goes global.

We can stockpile antiviral drugs like Tamiflu or Relenza, though their effectiveness against avian flu isn't certain either. There are some reports of avian flu resistance to Tamiflu, though others pooh-pooh them.

Avian flu could be a catastrophe, but it probably won't be. But that doesn't mean we can't learn some important lessons even now, before we know whether it will strike.

The first is that -- as the SARS outbreak illustrated, and the avian flu threat is making clear -- we're not ready, either globally or within the United States, to deal with a major epidemic disease. American hospitals are already overwhelmed in places by ordinary flu outbreaks -- how will they handle a major pandemic? Not very well, I suspect. And that's the least of it. As the vaccine experience mentioned above illustrates, we're time-limited in terms of defenses: It takes too long to develop a vaccine with current technology -- once the flu is spreading, the vaccine won't be available in time; but the vaccine we develop in advance may not work and won't keep.

Given that everyone agrees that whether or not avian flu becomes a menace, we're pretty sure to face some sort of major pandemic in the coming decades, it makes sense to get ready. Beefing up public health and sanitation infrastructure is a good idea, but we really need to boost our ability to respond quickly to new diseases by developing vaccines and antivirals on a custom-tailored, rapid-production basis.

As Ray Kurzweil noted in testimony to Congress:

"As we compare the success we have had in controlling engineered software viruses to the coming challenge of controlling engineered biological viruses, we are struck with one salient difference. As I noted above, the software industry is almost completely unregulated. The same is obviously not the case for biotechnology. A bioterrorist does not need to put his 'innovations' through the FDA. However, we do require the scientists developing the defensive technologies to follow the existing regulations, which slow down the innovation process at every step. Moreover, it is impossible, under existing regulations and ethical standards, to test defenses to bioterrorist agents. There is already extensive discussion to modify these regulations to allow for animal models and simulations to replace infeasible human trials. This will be necessary, but I believe we will need to go beyond these steps to accelerate the development of vitally needed defensive technologies. ...

"Hastening defensive technologies is absolutely vital to our security. We need to streamline regulatory procedures to achieve this. However, we also need to greatly increase our investment explicitly in the defensive technologies. In the biotechnology field, this means the rapid development of antiviral medications. We will not have time to develop specific countermeasures for each new challenge that comes along. We are close to developing more generalized antiviral technologies, and these need to be accelerated."

As Kurzweil also notes, the problem is only made starker when we take into account the threat of bioengineered pathogens, which are likely to pose a greater danger as time, and technology, advance.

The avian flu threat, regardless of whether it materializes in the end, is offering us some important lessons. Will we be smart enough to learn from them?
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