Bird Flu is Back in a Stronger Avataar

New research shows that the H5N1 virus can become contagious. But is the government prepared for a pandemic?

Published: Jul 13, 2012
Image: Siu Chiu/ Reuters

This may not be the influenza season, but news about the virus that causes the pandemic has been infecting us in the last few weeks. First, two academic groups published their much-debated research about a lab-engineered strain of bird flu (H5N1) that shows how it can acquire the ability to rapidly spread among humans, even though now it only hops from bird to bird. For six months, various agencies, including the World Health Organization, had debated whether public knowledge of this research would help fend off pandemics or aid bioterrorism. It was then followed by a slew of recommendations on preventive measures and preparedness, urging the governments and regulators around the world to enhance surveillance and collaboration.

On June 27, the medical journal Lancet published an analysis of the 2009 swine flu (caused by H1N1 strain, which had jumped from pigs to humans) deaths across 13 countries, rich and poor, which shows 284,400 people died in the first year, eight times the officially reported figure. It hints that the forthcoming analyses could reveal even higher numbers.

In this context, the new research that shows how H5N1, which can become contagious without mixing with other animal and human viruses (as was the case with previous pandemic viruses, including the Spanish flu of 1918), paints a prospect that is scary. It could become a reality in days or decades. There isn’t enough understanding today to accurately predict such events.

Still, the scientific community is not surprised. Since the influenza virus mutates very fast and can acquire new traits easily, anything can happen, says VM Katoch, director general of the Indian Council of Medical Research. Now that the specific mutations are public knowledge, the surveillance programme can keep a vigil on the virus for these mutations, he says.

But there is no active surveillance in the country. It’s mostly event based, says AC Mishra, director of the National Institute of Virology in Pune which monitors bird flu outbreaks.

This year has seen a 10-15 percent rise in bird flu and mortality, including deaths of crows in West Bengal and Jharkhand.

As for H5N1, over the last decade, this highly pathogenic virus has emerged among chickens and has rarely jumped to humans. Since 2003, about 600 confirmed human cases have been reported from over a dozen countries, 60 percent of which have resulted in deaths. But it’s believed this virus will eventually become more transmissible to and from humans.

After the 2009 pandemic, says Katoch, “there’s been tremendous increase in the capability” to detect viruses. Three years ago there was no state-level lab; today 20 labs exist, 16 of which are functional. In five years, there will be 250 such labs, he says.

These labs improve the response time, no doubt, but there are other lessons from 2009 that apparently have not been heeded. Between March 2009, when the first case was detected in Mexico, and October 2009, when the vaccine was finally ready to be distributed in the developed world, Indian health authorities and vaccine manufacturers worked closely to develop doses in large quantities.

Three companies, Bharat Biotech, Serum Institute and Panacea Biotec got Rs 10 crore each to build technology platforms and ramp up manufacturing capacities. But once the pandemic fear subsided, the government refused to procure the vaccines. However, “indigenously developed H1N1 vaccines” did get a mention in Pratibha Patil’s presidential address.

“The supply time was shortened from six to two months. Naturally, we couldn’t comply, but all of us had already invested much more than Rs 10 crore that was given to us. Till today the stocks are lying. Serum [Institute] even filed a court injunction for that payment,” says Krishna M Ella, chairman and managing director, Bharat Biotech. The next time such events occur, the industry would be very wary, he says.

Preparing for a pandemic is no less than preparing for defence for a country. And vaccines, which are arguably weapons of mass protection, should be treated like defence stockpiles.

War or no war, armed forces keep their stocks. In the set of recent journal publications, experts recommend scaling up of vaccine manufacturing capabilities and technologies so that the vaccine development time is shortened from six months to one or two weeks.

Unlike 2009, where the Centers of Disease Control in Atlanta provided the H1N1 strain to India for vaccine development, if there’s an H5N1 outbreak, international agencies would be scared of shipping samples as it’d be highly risky, warns Ella. What’s more, unlike H1N1, which was treated initially by Tamiflu (a tablet), H5N1 will require a vaccine.

It’s time to start building roadmaps, even if theoretical, says Ella. “There should be strategies for both eventualities—what if it’s real, what if it remains a distant threat? All viruses, H1N1 or chikungunya, are spreading faster and becoming more virulent.”

Since some key protocols remain unpublished, maybe the government should start working on collaborating with global agencies. Audit of facilities, development of reagents, quality control assays and hunt for adjuvants—chemicals that enhance the immune system and help maximise doses—shouldn’t wait for the last minute.

Katoch agrees there “needs to be a strategic thinking” but doesn’t confirm if there’s one already. Understandably, the buck stops at the health ministry. One of the key organisers of the 2009 emergency vaccine development programme, Katoch says he “isn’t aware that the vaccines were not procured from the manufacturers.”

“The stockpile has to be maintained and we’d like to see the faith between the industry and the government is maintained,” he says.

(This story appears in the 20 July, 2012 issue of Forbes India. You can buy our tablet version from Magzter.com. To visit our Archives, click here.)

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  • Raj

    What a Joke....When Swine was in it's full glory they (health authorities) had given statement that eating Pig meat (Pork) is safe if it's cooked on a certain high temperature.....Chicken meat is soft and tender is there any such implications on chicken...to cook on high temperature....

    on Jul 18, 2012
  • Srinivasan R

    India is at the cusp of a pandemic and the conditions are ripe for such an outbreak. The poor sanitary conditions coupled with bad management of the essential requirements of water, clean air, medical facilities, organizations trained to handle a pandemic, vaccines etc are other reasons that can throw the country out of gear. India is a hotbed of all possible diseases ranging from HIV to the simple cold and the figures are staggering when we look at the number of cases of various diseases that the country is leading the world in. In short we are a sitting duck. Again there is rampant use of antibiotics that further reduces the sensitivity to these drugs.

    on Jul 15, 2012
  • Dr David Hill - World Innovation Foundation

    For many decades now we have known that due to the constant mutations of viruses, that what was good one year was not necessarily good for the next as last year\'s virus with a few tweaks had circumvented the antibodies that prevailed the year before. That is why when one studies the Spanish Flu and the 2009 Swine Flu some chilling facts come out with regard to fighting pandemics on the total reliance in many ways of providing antidotes (vaccines). Indeed when we study the Spanish Flu we determine that in the second wave where the virus had mutated into a deadly human mass killer, that unofficially killed up to 100 million worldwide, the greatest human loss of life was between week 16 and week 26. But when we study the recent Swine Flu we find that a vaccine was created successfully only after 7 months 1 week from the first reported death. Then the vaccine had to be manufactured for the world and then distributed (a logistics nightmare in itself). Therefore equating the two pandemics together we see that in an oncoming human killer pandemic (Margaret Chan and a host of others have said for many years that it is only a matter of time not when), a vaccine would come too late for the vast majority of people. Indeed with regard to the Swine Flu outbreak only after 13 months 3 weeks had 23% of the American people received the antidote (but taking on-board that many had refused it also but where this will happen every time and the dispensing will be the same). Consequently in my mind using common sense we are on a hiding to nowhere with this so-called drugs strategy that will save us. That is why our Foundation has been saying for several years now that we have to adopt a more proactive strategy and address the killer virus at its source. In this respect it was only due to the extraordinary efforts of Kennedy Shortridge in 1997 that a pandemic did not emerge out of Hong Kong – by simply addressing it at source. Therefore we have to take very seriously indeed the only strategy, if we our intelligence, that will work. That strategy for the readers is, http://avian-influenza.cirad.fr/content/download/1931/11789/file/Kennedy-F-Shortridge.pdf Indeed if we are an intelligent species we have to see that this is the only way forward. For if not eventually hundreds of millions will perish and where every family across the globe will be affected by the death of a loved one. And of course the damage to the world economy would put the 2008 financial meltdown into perspective and where it would look in comparison as a storm in a teacup. Dr David Hill Chief executive World Innovation Foundation

    on Jul 14, 2012
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