US wonders 'what if'
2009-11-02 15:03
Special Report
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Washington - Mothers with young children and pregnant women are being turned away from H1N1 flu vaccination clinics in the United States, some in tears, many utterly frustrated by the shortage of vaccine.
But it could have been much worse. The new strain of H1N1 flu could have been much more virulent, and it could even have been bird flu, which, because of the way the United States produces flu vaccine, could wreak havoc.
Months back, when an H1N1 flu vaccine was still just a glimmer in scientists' eyes, US health officials were driving home the message that children, and especially those with underlying health conditions like asthma, and pregnant women were at great risk of dying from H1N1 influenza and should be first in line for innoculation.
But after rolling out the vaccine early last month, the authorities ran into a problem: there wasn't enough to go around.
"The National Institutes of Health and Centres for Disease Control and Prevention have done a very good job of emphasising the importance of getting vaccinated. But then there's no vaccine," said Steven Salzberg, director of the Centre for Bioinformatics and Computational Biology at the University of Maryland.
Salzberg's wife and younger daughters were among thousands who queued last week in Rockville, a suburb of Washington, for vaccinations.
"They left when they saw the line was about 1km before the place was even open. There were many, many hundreds of people and more were arriving by the second," Salzberg told AFP.
'It could be worse because we mix so much more. We travel faster'
Last week, as child deaths spiked well above the annual toll for kids from seasonal flu, vaccination clinics in the county that includes Rockville were abruptly cancelled.
The county's supply of vaccine had run dry. On Friday, Montgomery had 250 injectable vaccine doses left, and only 8 800 people out of a population of one million who live in Montgomery County had been innoculated.
So what if this had been the next "big one", a flu on the scale of the pandemic that killed tens of millions around the globe in 1918? After all, the strain of flu that caused the 1918 pandemic was also H1N1, the grandfather of today's swine flu pandemic.
"If we had a really virulent highly infectious influenza strain today, it could easily be as bad as 1918," said Salzberg.
"It could be worse because we mix so much more. We travel faster," he said.
But David Beshai, associate professor at the Johns Hopkins Bloomberg School of Public Health, said progress in health care and nutrition mean "a replica of 1918 is not in the cards.
"The 1918 pandemic that killed so many people happened in a different world. Nutrition was so poor, our hospitals were so useless, you couldn't get on a ventilator in an intensive care unit," Beshai said.
The death toll from pandemic flu could also have been higher if it had been bird flu rather than swine flu making the rounds because vaccine is produced using chicken eggs.
"Bird flu might have been a double whammy because the chickens might all be dead," said Salzberg.
"Avian flu sweeps through poultry farms and can be very deadly so those chicken farms would not be available to grow those eggs."
Most approved flu-vaccine producers "grow" the vaccine in eggs, a method which has been described as outdated by the head of the Centres for Disease Control and Prevention, Thomas Frieden.
Salzberg agreed, calling the process antiquated.
"When you really need vaccine quickly, we just can't do it, and this has now been demonstrated," he said.
"Here in the US we have some 23 million shots available six months after it was detected.
"If we had cell-based vaccine production, we could have had 200 million doses by now," Salzberg said.
Salzberg said changing the way the United States makes flu vaccine was too costly for companies to put in place and would have to come from the highest political levels.
"Congress or the president or both together would have to say: 'You know what? We're going to create the process ourselves and then either have the government make the vaccine or let private companies make it as they do now.
"But it's clearly not worth it to private companies ... It's very expensive and time-consuming and flu vaccine is actually not that profitable for companies. So why would they do it?"
If the US government does not take action before the next flu pandemic - which might not hit for decades - "We could still be growing flu vaccine in eggs again," and facing a shortage of vaccine, said Salzberg.
- AFP