On
a wing and a prayer
Editorial
Nature 435, 385-386
(26
May 2005)
| doi: 10.1038/435385a
Abstract
This issue's focus on avian flu
highlights progress and incoherence in the world's response to a potential human
pandemic.
But the threat is
enormous, and some priorities are clear enough.
Millions
of people killed in highly developed countries within months. Tens of millions worldwide. The global
economy in tatters. A Hollywood
fantasy? No — it's now a
plausible scenario. The first
act, the spread of avian flu to, and probably between, humans, has already
started across Asia. Unless
the international community now moves decisively to mitigate this pandemic
threat, we will in all probability pay heavily within a few years. Then, hard
questions will be asked as to why we were not prepared.
Sceptics
abound, convinced that talk of a pandemic must be
scare-mongering, or scientists crying wolf. Surely with
support care, drugs and vaccines, at least the rich world can easily stand up to
a flu virus? After all, this is 2005, not 1918, when a flu pandemic killed up to
50 million people worldwide.
But while the science and medicine of flu have
advanced substantially, our ability
to mount an effective public-health response has made remarkably little progress
over the decades, and the potential for panic is, if
anything, greater given the impact of television and the
Internet.
In the 1918 pandemic, no one had immunity to a
new subtype of the influenza virus. The maths of epidemiology says that
pandemics are like fault lines: they inevitably give. But unlike
earthquakes, pandemics tend to give warning signs, and all the alerts from
Asia
are now flashing red.
Will
it be the 'big one'? No one can say with certainty, but the H5N1 flu
strain now circulating widely in Asia, and several of its cousins, are ones to
which we humans have no immunity. Accordingly, the world now
needs to develop defences for the worst-case scenario. How prepared are
we?
Extinguishing
avian flu in poultry and pigs, the melting-pot from which a pandemic strain
would probably emerge, is the job of national agriculture and veterinary
departments, the United Nations' Food and Agriculture Organization, and the
World Organisation for Animal Health (OIE). The
public-health aspects are the responsibility of health departments and the World
Health Organization (WHO).
This
international coalition is shaky and far from united or sure in its purpose. Its
efforts are grossly underfunded, and undermined at
every turn by conflicts between global public health, sovereignty and the stakes
of trade and economics.
If the next pandemic were to arise
five years from now, there would have been breathing space to stimulate our drug
and vaccine industries to limit the damage it would cause. But that requires
urgent action now.
As matters stand, a vaccine against a pandemic flu would
not be ready until at least six months after a pandemic starts. Too late: by
then the worst of the pandemic would already have happened.
A vaccine that
can be produced more quickly demands a research effort akin to that for a
strategic military weapon, not business as usual. We also need to be able to
produce enough of such a vaccine to cope with the surge in demand during a
pandemic. At present, the entire world production capacity can produce only
enough doses for 450 million people. To stimulate
an increase in capacity, we need health policies that boost demand for existing
flu vaccines in ordinary years. The same goes for antiviral
drugs.
But the worst-case scenario is that a pandemic
starts within two years. We would have no vaccine and few drugs, and we would be
dependent on governments and the WHO to try to extinguish the first outbreaks at
source. That's why the first
priority must be to prevent a pandemic emerging in the first place, by
extinguishing the disease in
animals.
Time for
action
Unfortunately,
the current situation does not bode well for the abilities of governments and
international agencies to cope with this challenge. We should be monitoring
in almost real time the genetic changes in the avian and human viruses that
could herald the emergence of a pandemic strain, for example. But there is
no international funding to help affected countries build decent and sustained
surveillance programmes. And while outside researchers want data from affected
countries, they aren't engaging enough in the meaningful collaboration needed to
build trust and open sharing. The international community is
not offering incentives, such as drugs for the Asian countries that would be in
the front line of a pandemic. Combine this
with the fact that countries are reluctant to share the few data they have
because their analysis could affect their trade and economies, and the current
mess in surveillance is hardly
surprising.
Each
human case that occurs in Asia
is potentially a global threat. The
international virology community needs to be permanently there, on the ground.
We need to diagnose cases swiftly, and treat the patients and all their contacts
immediately with antiviral drugs to try to kill the pandemic at source. To
understand the genetics, and link this to the epidemiology and pathology of the
virus, we need immediate sharing of all virus samples and data.
None of this
is happening adequately.
National
governments' performance is half-hearted, incomplete and far too slow.
International organizations are working with their hands tied behind their
backs, for bureaucratic and diplomatic reasons. In short, the level of current
efforts is not commensurate with the threat we
face.
This week,
we focus on the issues in depth (see pages
390 and
399), and are
providing a freely available, comprehensive collection of previous articles on
the topic, not only from Nature
but also from all other relevant Nature publications (see http://www.nature.com/nature/focus/avianflu/index.html).
Nature
is also engaged in a collaboration with two other
organizations.
The journal Foreign
Affairs will be publishing a survey of the policy aspects of
avian flu and other pandemics in its next issue, to be published in late June.
And, with both journals' involvement, the Royal Institution World Science
Assembly is organizing a high-level international meeting chaired by Rita
Colwell, former director of the US National Science Foundation, that is intended to bridge the gaps
between science and policy.
Above all, greater top-level political
oversight of the campaign is needed.
The time for diplomacy
and denial is over. It is time for advocacy and
action.