IN THE spring of 1918, North Americans were complaining about an unseasonable flu that was sweeping through several cities. They and the rest of the world were still blissfully unaware of what was in store for later that year: a pandemic that would kill 50 million people, or by some estimates many more – certainly more than the Great War that was still raging.
Some 90 years later, we’re in the same position: suffering a relatively mild outbreak of a novel flu virus of the same family, H1N1. The difference is we now know this virus could turn into a monster. We know, too, that “could” is the operative word. It is not inconceivable that the Mexican H1N1 virus will vanish from the northern hemisphere with the summer sunshine – but let’s not forget the southern hemisphere, and the fact that potential pandemic viruses are not always afraid of warm weather.
So what should we do? Anyone who cares for themselves or their families might say: everything we can to prepare, just in case. It should be obvious that now is the time to pull out all the stops to make as much vaccine as possible. If this virus doesn’t cause a pandemic of severe disease – if instead it disappears, or stays mild – nations should be prepared to pay for it as just one more cost of good government on a crowded planet.
Advertisement
This is arguably a wiser use of resources than bailing out bankrupt car makers, but there are less obvious costs, which involve hard decisions. Do we stop making ordinary flu vaccine to focus on pandemic vaccine? If we do, people may die if a pandemic doesn’t materialise and ordinary flu hits instead. Alternatively, we could finish the production run of ordinary vaccine – which is what the world appears to have decided this week – and then start making a vaccine against the new strain. If this virus mimics the 1918 H1N1, any delay could be fatal for millions; and however hard we try, we haven’t the factories to make anything like enough vaccine (see Swine flu: how can we prepare for a killer autumn wave?).
“Even if the Mexican virus doesn’t cause a murderous pandemic, another one inevitably will”
There has to be a better way to run a planet. What saved many people in 1918 was exposure to the first and less lethal wave of the virus, which spread through Europe that summer. Should we be organising “flu parties” now? As many of the cases of the Mexican H1N1 have been mild, it is tempting to believe it might be a good idea to get the virus now, and be less vulnerable if it comes roaring back. But what if this flu fizzles out? Then you’ve risked what has, for an unfortunate few, been a serious or even fatal infection, for nothing. That is not something health officials can recommend.
Or what about the approach long advocated by one of the biggest and most colourful names in flu, the Australian virologist Graeme Laver? Sadly Laver died last October, too soon to have witnessed the disarray that is greeting the putative pandemic he had long predicted. What we should do, he told anyone who would listen, is wait till people show signs of infection and then, once you are sure they have flu, treat them with one of the antiviral drugs. That way the patient recovers, the drugs are used in a way that minimises the development of resistance by the virus, and a growing number of individuals are exposed to the virus and become immune. Enough of those cases and you start getting herd immunity.
That idea is one for epidemiologists to debate, but not a practical proposition for public health officials to consider. Most countries don’t have a sufficient stock of antivirals or the diagnostic technologies to ensure these drugs are not wasted, and neither can be obtained at short notice, as required.
There are dip sticks that can diagnose flu in seconds, but many doctors haven’t even heard of them. And there is a gizmo that can instantly tell you what bug you have living in your lungs, which helped diagnose the first cases of H1N1 in California. It would be useful in doctors’ offices now, but there are only a few more like it anywhere in the world.
These are all things that flu scientists have for years been telling us we needed – and which you might have read about in Â鶹´«Ă˝. Even if the Mexican virus doesn’t cause a severe pandemic, it might finally convince the world that we need to adopt some of these measures for the day when, inevitably, some flu virus will take off – maybe even H5N1, which is still lurking out there.
The scoffers may claim the scare has been a cynical ploy to sell newspapers and magazines. Wiser heads will see that prevention is always better than cure.
