Monitoring for epidemic outbreaks

In 1998, the US National Vaccine Program Office took charge of making a plan for dealing with the threat of a new influenza pandemic. A draft plan has been completed and may be approved and made public for consideration and comment by concerned agencies and people some time in February 2001. The planners' first concern is to recognize a novel virus that has the potential to cause a pandemic as quickly as possible after it appears.

The World Health Organization has a network of 110 laboratories worldwide that collect specimens in the search for new influenza strains. The intention is that they would give an early warning of the next pandemic strain.

If such a super-virus is detected, teams of experts from public health agencies in that nation or nations, from the WHO and perhaps from the Centres for Disease Control in the USA, would be mobilized to go to the site or sites, get specimens, analyze them and try to determine whether certain groups are more at risk than others. The next step after detection would be immediately to transmit all the information available to national, regional and local public health agencies. They would be advised to examine their own planning against the appearance of the disease in their areas, and to make certain that they were ready to act should it appear.

Culturing a vaccine would be started at once. The best countermeasure would be to produce and distribute a vaccine specifically targeted at the dangerous new strain, but that would take time. For the United States alone, 70 million to 80 million doses would be needed, and it would be five or six months, perhaps longer, before that many could be manufactured. It could take another month or two to distribute the vaccine and administer it.

It might be impossible to make a vaccine or to make that much vaccine so quickly. Influenza vaccine is cultured in fertilized hens' eggs, and there would probably be nowhere near enough available except during the spring and early summer, the time of year when vaccine manufacturers would have ordered them so they could start making a vaccine for the next flu season. In the meantime some things could be done to slow the spread of the disease. There are new antiviral drugs that may reduce the risk of infection for people who are most at risk, such as the aged and chronically ill. They might also protect nurses, doctors and other healthcare providers, who would not only be in danger of infection with the disease but also could carry it to patients in hospitals and nursing homes. There could also be a problem with large-scale use of the antiviral drugs. They could induce antiviral resistance -- wiping out some of the viruses but leaving those resistant to the drug used untouched, and creating a new strain that would be even more dangerous.

Widespread publicity campaigns would be mounted, directed both to the public and the medical community. They would stress the things that could be done during the interim before a vaccine was available, such as frequent hand washing to reduce the risk of infection. Probably an effort would be made to discourage people who are ill from going to work and spreading the disease, and to encourage employers to put generous sick-leave policies into effect.

A major problem, one to which no satisfactory solution has been offered, would be that much of the world would depend on vaccine manufactured in the United States, Canada, the United Kingdom and Western Europe. It would not be in the interest of world health, including that of their own citizens, for the United States and other developed countries to produce vaccine only for their own use. Like the United States, many developed countries now have plans in place for dealing with the next pandemic threat. Most developing or health organizations at present capable of mobilizing to meet a pandemic threat.