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back to archive index4th November 2005 Avian Flu Pandemic - Danger or Drug Marketing?Bird flu is big news, but we need to ask: Why? What has really changed from last year? Is it the risk of flu, or the availability of a treatment for bird flu virus?It seems that governments are being rated by how prepared they are. A big factor in this rating is by how many treatment courses of anti-viral medication they have bought and stockpiled. The logic seems to be that good governments buy lots of drug and bad governments don't. Is it possible that a drug marketing strategy lies somewhere behind all this? If you think this is far-fetched look at a parallel from a few years ago. When the Hepatitis B vaccine came out, there were few people in Australia were concerned about it. It was felt that only people using drugs, having multiple sex partners, or coming in contact with blood products were at risk, reducing the market for the vaccine. To provide a broader appeal and boost the image of getting a Hepatitis B vaccination, large numbers of people who were at relatively low risk were vaccinated, such as footballers or lifesavers. A service club was also recruited to help with a 'Hepatitis B Awareness' campaign. In essence, a fear campaign was used to improve sales of Hepatitis B vaccine at a time when the Hepatitis B vaccine was very expensive. One manufacturer was even criticised by the regulating body in Australia! It was an embarrassing situation for the self-regulating system because all they could do was expel the manufacturer, effectively putting them beyond regulation! Many in the Pharmaceutical Industry were embarrassed, but time passed, nothing happened, and no meaningful regulatory system was put in place for drug marketing. Are we about to do the same thing again? There is a lot of fear, with politicians running around, having meetings and stockpiling vaccine at vast cost, just in case. I would like to think that that is not what is driving the show, but I cannot ignore the history or the mounting evidence that there is no human pandemic. The avian influenza virus ( more commonly known as 'bird flu') has been known for about one hundred years, and has at times mutated to become highly pathogenic for birds. A more recent strain, known as H5N1, was identified about eight years ago. We have been hearing reports about the infections passed from birds to humans, and while the potential for a mutation that will allow it to spread from human to human exists, there does not appear to be any reason to think it will do that any time soon. The United Nations World Health Organisation (WHO) has this to say about the likelihood of a human pandemic: "Although reports of avian [bird]-to-human transmission have been received from a number of countries, at present there is no evidence that human-to-human transmission has occurred.1" When the WHO talk of a pandemic 2 (affecting large areas or populations), they are talking about large-scale infection in the bird population. The fact that it is endemic (regularly found) in parts of Asia means that the influenza is already there in a form that is not killing all the birds, with many birds having had infections and survived. The fact that humans have not been affected in significant numbers in these areas is also important. It means that even in an area where whole flocks of birds are passing the virus around, few humans are seriously infected. Under these circumstances, a pandemic amongst humans would take a new mutation. This is possible, but this has been the case for years. So, why is there such a hullaballoo right now? I believe that the reason that we are hearing so much about it now is that there is a drug company that is keen to sell us an anti-viral drug. A pharmaceutical company called Roche has promised 3 million treatment courses to the WHO by early 2006. You will also have noticed that the media has created a sort of 'top of the pops' for countries whose health ministers are supposed to prove their diligence by the amount of anti-viral drug they have stockpiled. One should probably ask who provides the sales figures to compile these 'top pops'? Don't get me wrong, even if avian influenza never makes the leap from a bird-to-human infection to a human-to-human infection, it will have an impact on our poultry farmers and native birds. One must agree that there is a risk, and the increase of avian H5N1 strain among the world's birds makes it more likely that the virus will mutate to a strain that is more virulent in the bird population. If the virus present in the more birds, more humans will be exposed, and if more humans are exposed it makes it more likely that there will be a human to human mutation. There are a lot of 'ifs' in all this. History tells a more sober story, in that viruses have been mutating for years, and influenza epidemics have come and gone for years. It is not clear that stockpiling anti-viral drugs is the best way for us spend our health dollars, but it is certainly the best way for the drug companies to get a profit in the short term. In the case of avian influenza, the drug is Tamiflu, the company is Roche and they are making the money although they did not invent it, merely licenced the patent from another company. Ironically, the original research for the drug was publicly funded, and its producers, Professor Drahos and Dr Buddi Lokuge, have commented in the Medical Journal of Australia that if there is a pandemic, the government should pass a law that the patent is overruled in the interests of saving lives. Given that millions in Africa have died of AIDS because they could not afford anti-viral medication, and that African governments eventually exerted pressure to force a realistic price regime on the patent holders, this seems reasonable and sensible suggestion. Where to find information about influenza A (H5N1) 1. WHO, Communicable Disease Surveillance & Response, Avian influenza http://www.who.int/csr/disease/avian_influenza/en/ 2. WHO, Communicable Disease Surveillance & Response, Avian influenza,frequently asked questions http://www.who.int/csr/disease/avian_influenza/avian_faqs/en/ 3. WPRO, Avian influenza, http://www.who.int/csr/disease/avian_influenza/avian_faqs/en/ 4. Centers for Disease Control and Prevention, Avian influenza, http://www.cdc.gov/flu/avian/index.htm Stay Healthy (and Sceptical), Arthur Chesterfield-Evans (ACE) 1.WHO Influenza A H5N1 Guidelines for Health Care Facilities March 2004, http://www.who.int/csr/disease/avian_influenza/guidelines/ Guidelines_for_health_care_facilities.pdf 2. WHO http://www.who.int/csr/disease/avian_influenza/ guidelines/firstoutbreak/en/index.html
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