The long war against flu. Nature

[gsgs]

Re: _|NATURE, EDITORIAL: The long war against flu|_

Re: _|NATURE, EDITORIAL: The long war against flu|_

these vaccine-capacity estimates are presumably all old.

Some years ago we had been told that cell-based production
is needed, because it could be scaled up, if necessary.

Now we have it.

But still we hear the old capicity-calculations,
these "there will be only vaccine after 6-9 months
for ~10% of the population" like predictions.

 

[mixin]

Re: _|NATURE, EDITORIAL: The long war against flu|_

Re: _|NATURE, EDITORIAL: The long war against flu|_

Please. No conversions planned. Influenza is a virus with special growth requirements.

If millions of people were going to die in a pandemic, couldn't they accommodate special requirements?

 

[Sally Furniss]

Re: _|NATURE, EDITORIAL: The long war against flu|_

Re: _|NATURE, EDITORIAL: The long war against flu|_

Can influenza virus be grown using cell based technology?

 

[HenryN]

Re: _|NATURE, EDITORIAL: The long war against flu|_

Re: _|NATURE, EDITORIAL: The long war against flu|_

Can influenza virus be grown using cell based technology?

Yes, the latest data from Baxter were from patients vaccinated with infleunza grown in African green monkey kidney (VERO) cells.

 

[HenryN]

Re: _|NATURE, EDITORIAL: The long war against flu|_

Re: _|NATURE, EDITORIAL: The long war against flu|_

If millions of people were going to die in a pandemic, couldn't they accommodate special requirements?

No. Companies had a hard time switching from New Caledonia to Fujian H3N2 in 2002 leading to many unnecessary deaths, primarily in children. That switch involved swapping on version of H3N2 with another version of H3N2 by companies already making seasonal flu vaccines.

Getting companies that don't make flu vaccines to switch to flu AFTER a pandemic has begun is beyond hopes and dreams. It will NOT happen (or even be considered).

 

[HenryN]

Re: _|NATURE, EDITORIAL: The long war against flu|_

Re: _|NATURE, EDITORIAL: The long war against flu|_

these vaccine-capacity estimates are presumably all old.

Some years ago we had been told that cell-based production
is needed, because it could be scaled up, if necessary.

Now we have it.

But still we hear the old capicity-calculations,
these "there will be only vaccine after 6-9 months
for ~10% of the population" like predictions.

Vaccine companies that make seasonal flu are NOT very nimble. 6-9 months is a REALISTIC estimate for far less than the world's population.

You are posting "hopes and dreams".

 

[Oracle]

Re: _|NATURE, EDITORIAL: The long war against flu|_

Re: _|NATURE, EDITORIAL: The long war against flu|_

Tissue cell culture for large scale influenza (seasonal and pandemic) vaccine production has been a hot item since 2006. MDCK (canine kidney cells) and baculovirus-insect cell lines are two of many that have gone through testing and early production evaluation.

We here can be a vocal minority to push governments to pursue the concept of general immune conditioning, rather than aiming for specific strain vaccines (a moving target that is very expensive to chase).

Priming with previously produced vaccines is just one approach of several that could be employed NOW, immediately, rather than waiting to vaccinate the population in a matter of weeks.

The current logic of emergency pandemic vaccination is SERIOUSLY FLAWED.

 

[gsgs]

Re: _|NATURE, EDITORIAL: The long war against flu|_

Re: _|NATURE, EDITORIAL: The long war against flu|_

no need to involve other capacities. Just scale up cell-based
production.
Baxter has it, Novartis,Glaxo,... had it approved before but US-press
won't mention it. Anyway. It's available.

just a poker for the best matching vaccine and the best price, or not ?


I keep hearing 3-4 months as timeline.
(could be a bit more expensive, though ;-) )

 

[HenryN]

Re: _|NATURE, EDITORIAL: The long war against flu|_

Re: _|NATURE, EDITORIAL: The long war against flu|_

no need to involve other capacities. Just scale up cell-based
production.
Baxter has it, Novartis,Glaxo,... had it approved before but US-press
won't mention it. Anyway. It's available.

just a poker for the best matching vaccine and the best price, or not ?


I keep hearing 3-4 months as timeline.
(could be a bit more expensive, though ;-) )

3-4 months = hopes and dreams

 

[Treyfish]

Nature looks at the status of avian influenza three years after their Special Issue

Nature looks at the status of avian influenza three years after their Special Issue

Hat-tip to Resident Member revere from Effect Measure:

Nature looks at the status of avian influenza three years after their Special Issue
<!--tabueau réagissez à l'actu -->I always cringe when I see headlines that say, "Whatever happened to bird flu?" Usually what comes next is a recital of other "scares" that never materialized, the poster child being Y2K (although it has been strongly argued that the reason Y2K didn’t happen was precisely because the business world prevented it with a sustained and intense effort). The article in question, however, just appearing in Nature magazine, still the world’s pre-eminent science journal, is authored by one of Nature’s senior correspondents, Declan Butler, the same journalist writing in the same journal who helped put avian influenza on the public map as a top public health worry back in 2005 (see our post on that event, here). So it’s interesting to see his take on the problem better than three years after Nature’s special issue:

Q. Is bird flu affecting fewer people now?
Yes and no. The 88 cases and 59 deaths reported last year are lower than the 2006 peak of 115 cases and 79 deaths, when the virus first arrived in Turkey and Egypt and sparked a large number of cases there. Thirty four cases have been reported so far this year.
Vietnam, Thailand and China — the only countries to report cases from 2003-04 during the current epidemic — have made progress in controlling the spread of the virus in poultry. Once major hotspots, all three countries have consequently seen a significant drop in human cases.
But cases have since cropped up in 12 other countries, with Indonesia leading at 135 cases — more than one-third of the worldwide total of 385. A major worry is that Bangladesh, which reported its first human case in May, might go the way of Indonesia because the virus is firmly established in the country’s poultry. The apparent current downturn in cases could be short-lived. (Declan Butler, Nature)
​

Written in question and answer format, Butler surveys the current situation. I’m pretty much in agreement with his assessments, although perhaps not as sanguine as he is the situation is improved as much in southeast asia. The poultry situation, as he observes in his piece, remains dire, with little progress and lots of extension into new areas like the Indian sub-continent, where the disease threatens to become endemic in poultry. He believes the failure to reach the Americas is just a matter of luck and that time will run out, possibly with devastating effects on the North and South American poultry industries.
I’m also not so optimistic that the many national plans that represent the main product of government public health responses represent as much progress as he implies. Eisenhower’s famous dictum that it’s not the plan but the planning is certainly true, but too many government planners think that The Plan, often represented by hundreds or thousands of pages of details, is A Sufficient Answer. The Plan will be out the window in the first week of a pandemic. Like military battle plans they don’t survive the first engagement with the enemy. Too many of them have been produced mechanically, without the genuine planning function involving entire agencies that gives them their main value. Indeed, many of those agencies are in much worse shape than they were three years ago, as governments continue to disinvest or defer investment in critical public health and social service infrastructure. In my view, we haven’t made progress in preparedness but have back slid even more.
Vaccine technology continues to be an active and fruitful area of work, and given time we will see significant progress there. Given time. Then, of course, there will be the problem of productive capacity, distribution, access, etc. Vaccines have significant technical problems, but the real obstacles are political and economic. Flu scientist themselves are sometimes part of the ethical and political problem. In a Commentary on the failure of this year’s seasonal flu vaccine in the same issue of Nature, Steven Salzberg takes WHO and CDC to task on sharing flu sequences:

The WHO and the CDC have stated publicly that they support placing sequence data in the public domain. Unfortunately, the WHO’s own centres do not release all their influenza sequences, and when they do, they often use the Los Alamos National Laboratory influenza database. This database is, as reported on its own website, "a private database for collaborators" — access is restricted to a private group of subscribers. A closed database limits the free exchange that is so important to scientific research, and it sets the wrong example. (Steven Salzburg, Nature)​

Salzburg could have added some of the world’s most eminent flu scientists to this list. We’ve discussed this many times here, but we’ll say it again: these scientists are acting unethically when they do not immediately share their sequences via publicly accessible databases. Pandemic influenza isn’t just any field of scientific research. It is one of urgent interest to everyone on the planet. Nature could help by refusing to even submit a manuscript for review unless any sequence mentioned in the paper has already been deposited in a publicly accessible database like GenBank.
Butler notes that media interest in bird flu remains high, although it has moved off the front pages to positions deeper in the news. We noted the same thing in our post of yesterday, where avian influenza was the top reported disease in the HealthMap system that datamines newsreports from all over the world for disease outbreak information. Like the virus itself, the big headlines have diminished but the disease is endemic in the news.
The subtitle of Butler’s question-titled Nature News piece probably sums it up as well as anything:

Whatever happened to bird flu?
The media frenzy over bird flu has receded, but the threat of a global epidemic still looms large. :tiphat:​

 

[sharon sanders]

Re: Nature looks at the status of avian influenza three years after their Special Issue

Re: Nature looks at the status of avian influenza three years after their Special Issue

Hat tip to Resident Member DemFromCT from Flu Wiki:

<table class="mainTable"><tbody><tr><td> H5N1 And The Long War Against Flu

by: DemFromCT

Sun Jul 13, 2008 at 10:57:51 AM EDT

</td> </tr> <tr> <td> cross-posted at Daily Kos Here's this month's editorial in the prestigious international science journal Nature:

That the H5N1 strain of bird flu has not yet caused a pandemic is no cause for complacency. Preparations for the inevitable must be redoubled to mitigate the potential devastation. Five years after the deadly H5N1 avian influenza virus exploded into a global epidemic in birds, it has infected more than 300 people. Happily, it has not yet evolved into a strain that can transmit easily between humans - an event that would trigger a pandemic that could kill tens of millions. But as long as H5N1 continues to be present in animals, that risk persists. And with so many other flu strains out in the world, all constantly evolving, a flu pandemic is inevitable.

​

</td> </tr> <tr> <td>The title of the editorial (The long war against flu) seems apt. H5N1 emerged as a major problem for humans in 1997 (Hong Kong) and again in 2003, and since then has been closely followed by the World health Organization, CDC and others (a text timeline through 2005 can be found here). We started writing about flu pandemics here at Daily Kos in 2004, asking the question "Pandemic - what's that mean? And what's that got to do with politics?" (and the answer is still "plenty." See Barack Obama's NY Times op-ed in 2005.) These diaries (Flu Basics: Science And Threats and Flu Basics II: Politics and Players written in May, 2006 are still, alas, relevant. More on Obama from the American Academy for the Advancement of Science 2008 election page (McCain's page is here, with no pandemic mention):

Senator Obama has said that preventing an avian flu pandemic is one of his national security priorities. He refers to his work with other Senators to provide $4 billion to the Centers for Disease Control to combat avian flu and to build a stockpile of antiviral drugs that had been in short supply.​

See also question 6 of 14 Science Questions the Next President Should Answer:

Pandemics and Biosecurity. Some estimates suggest that if H5N1 Avian Flu becomes a pandemic it could kill more than 300 million people. In an era of constant and rapid international travel, what steps should the United States take to protect our population from global pandemics or deliberate biological attacks?​

So taking stock years after the President's National Response Plan was published (November, 2005), after the cable media hype died down and after billions of federal, state and local dollars and man-hours (and quite a few diaries here at Daily Kos), it's worth a re-assessment of where we are at (for comparison, see 2005's Council on Foreign Relations: Pandemic Flu And Where We Stand.) Declan Butler, Nature's senior science reporter has a terrific Q&A this week on the H5N1 topic, entitled whatever happened to bird flu?. Bottom line: we can't get rid of it in poultry in Southeast Asia (and Egypt and other places in Africa) so it sits there smoldering, waiting to infect humans, and waiting to potentially mutate to make it easier to catch. H5N1 remains a risk to humans.
And are we prepared? Not so much.
Like hurricanes, pandemics can't be predicted. We don't know when the next category 5 storm will hit and where, but the inevitability of severe weather is matched by the inevitability of flu pandemics. As we all now know, there were three in the last century (1918, 1957 and 1968) and the 1918 pandemic was truly devastating. Note the spike in mortality representing the 1918 pandemic.

Thjis is what would happen if the same severity pandemic happened today (modern medicine and all - click for bigger pic):


For that reason (mortality, and especially child mortality), the mitigating efforts of public health and national security agencies have taken place.
There are lots of holes in where we are. Not enough personal preparations have taken place (at least 2 weeks of food and a water supply for every American are advised), and not enough information has reached the public (it's there if you go and get it.)
Our vulnerabilities are not so obvious, but our inter-related world and Just-in-Time economy contribute to our lack of resilience. For example, last week, I wrote about the price of oil and natural gas contributing to the price of latex exam gloves as an example of the nail-shoe-horse-kingdom chain of events that impacts on the cost of health care (and why it is not easy to rein in - see Health Reform: An Integrated Problem In An Integrated World), but the critical supply chain for food and goods is just as relevant for pandemic discusssions, as is our fragile electrical grid. The following pics come from Michael Osterholm at CIDRAP, U of Minnesota, and outlines the regional dependence of electricity on coal.


Our coal inventories are dangerously low (in terms of potential interruptions) Imagine if the folks who run the coal trains (and the mines) become ill.

This is why posts like 2007's Flu Stories: Is the Internet At Risk In A Pandemic? are relevant. So are energy stories, particularly when placed against the backdrop of worldwide food price hikes and potential and actual food shortages.
In the end, the risk of H5N1 (or some other flu virus such as an H7 or H9 strain) mutating and becoming a pandemic virus remains. Inevitably, a pandemic will happen (H5N1 being on the more severe end of possibilities.) What we can do is prepare ourselves for the inevitable, and in the process take a long and hard look at what we are doing on the energy front as well as the effects a natural disaster would have on surge capacity (see 2008's Pandemic Challenges For Hospitals.)
Whether it's rebuilding public health infrastructure, or including public health in health reform, or understanding the integrated just-in-time way of life we lead and protecting that as well, preparing for a pandemic will help us cope with whatever comes next. It'd be nice to know just what that 'something' is, but we're not always that lucky. Ask the folks in New Orleans whether more preparation time should have been spent, and whether we are spending enough time worrying about natural disasters now.
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