First Glimpse of the Enemy
First Photos of Avian Flu Virus
The first high-resolution close-up photographs of the H5N1 avian flu virus to be taken by a scanning electro microscope appeared in the daily ”Dagens Nyeter” on Sunday, in what the newspaper said was a world exclusive.
The photos, taken by science photographer Lennart Nilsson, show the virus as a string of blue balls attacking and destroying healthy pink cells.
The newspaper says the 83-year-old photographer had initially approached US laboratories for a sample of the virus but was turned down. In the end he obtained samples from the World Health Organisation which were then cultivated at Stockholm’s Karolinska Institute.
Nilsson then photographed the virus using images from a powerful microscope. The H5N1 sample had come from a father and daughter who died from the virus in Hong Kong two years ago.
It was Nilsson who first photographed the moment of human conception, published in a book in 1965 called ”A Child is Born”.http://www.dn.se/DNet/jsp/polopoly.jsp?d=597&a=483764&previousRenderType=2
Extending the Tamilflu Supply
The following article from Australia caught my eye today - it focuses on the practical and prior tested method of extending similar drugs - and making the limited stockpiles of tamiflu. By combining the drug Probenecid with Tamiflu the potency of Tamiflu is enhanced by 2x or 2.5x - which could either (a) allow existing Tamiflu stocks to treat twice as many people as originally estimated, and/or (b) provide a buffer that would allow existing doses of Tamiflu to become twice as effective - something that might be needed if the virus proves to be more resileint than originally anticipated.
Certainly food for thought and more thorough analysis....US doctor comes up with solution to drug shortageThe World Today - Wednesday, 2 November , 2005 12:34:00
Reporter: Karen Percy
ELEANOR HALL: As health authorities around the world try to work out how to deal with a possible flu pandemic, an American doctor has come up with a potential solution to any drug shortage, and it's a solution that goes back more than six decades.The Oregon-based Dr Joseph Howton from the Adventist Medical Centre says using the antiviral treatment Tamiflu, together with a drug called Probenecid, makes the flu treatment last twice as long.
It's a technique similar to that used during World War II to preserve supplies of penicillin. Karen Percy has been talking to Dr Howton about how he made the connection.
JOSEPH HOWTON: Recently, I was reviewing the studies and also Tamiflu, and I found that they talk about being careful when you use Probenecid with also Tamiflu, because it raises the drug level. And I thought about it from the opposite perspective – well this is great, this a wonderful side effect, why don't we consider using Probenecid to, exactly for that reason, we have this tremendous shortage of the drug. And there was one study in 2002 that documented the profound effect of Probenecid on Tamiflu, it, actually it increased the level by two and a half times, and at that time it wasn't really being looked at as an issue of, you know, something to use during a shortage. But if you look at Tamiflu the same way we looked at penicillin during World War II, and penicillin was in very short supply, and as a result we gave Probenecid with penicillin to enhance the effect and extend the supplies, why not use that same idea for Tamiflu.
KAREN PERCY: As I understand it, Probenecid is used primarily to treat gout. Just explain, I guess, a little more to those of us who don't have a medical or science mind, about how it actually might work in cooperation with Tamiflu.
JOSEPH HOWTON: Tamiflu is a drug that's, it's a weak organic acid, and as such Probenecid, it blocks organic acid from being excreted by the kidneys, so other drugs like penicillin and cephalosporins or other antibiotics all by the same mechanism, the Probenecid blocks the enzymes that allows the excretion of the drug via the kidneys, and therefore you have much less of the intact drug excreted. It stays around and recirculates and you have better virus-killing effect.
KAREN PERCY: Tell us then the significance of this discovery of yours.
JOSEPH HOWTON: I don't want to let it get to my head too much. It just means that since the supplies are so limited, that we can use it one of two ways. We can give a half-dose of, or even less than half of a dose of Tamiflu, along with Probenecid, and we should get roughly the same levels as if we had just given a full dose, so therefore we can treat twice as many people with the same amount of drug.Another approach might be to use a standard dose of Tamiflu, along with Probenecid, and thereby getting a higher than usual tissue level of Tamiflu, which might actually be necessary, depending on how things turn out with this virus. There are some mouse studies that indicated that we will need higher levels of Tamiflu in the system to effectively combat the virus.
KAREN PERCY: There is some criticism that Probenecid won't be enough in and of itself, that the world still needs to be producing a lot more of the flu vaccines, and that this is only sort of one element to a broader plan. Do you agree with that?
JOSEPH HOWTON: Oh 100 per cent. Yeah, really the only hope to… the only way we're going to prevent just massive numbers of fatalities in the event or a major pandemic is by a vaccine. So the whole idea of a drug like Tamiflu is to buy us time, so that the vaccine can be developed. And if you kind of look at it in the analogy of a forest full of dry kindling and a spark gets set off, you want to stamp out that spark as quickly as possible before the whole forest goes up, and the same kind of thing with a pandemic, you know, it's possible, the virus is just mutating like crazy, so it's possible that it'll eventually mutate to a point that it can spread easily among humans, and when and if that happens you want to move in quickly and quarantine the area, give Tamiflu to everyone who's exposed and treat people with that, with Tamiflu, and but try to stamp out that spark and then hopefully buy time that you can take that strain of… virus that's causing the problem, and develop a vaccine that'll be effective.
KAREN PERCY: One of the issues with Tamiflu is that a) there are patents around the world, as well there's just not the ability to produce it quickly enough. Are there similar issues that might relate to Probenecid?
JOSEPH HOWTON: Fortunately, Probenecid is fairly easy to produce, and it's very widely available. So it's been around since 1951, and it's, I don't think there should be a short supply of that.
ELEANOR HALL: And that's Oregon doctor Joseph Howton speaking to Karen Percy.
Avian Infuenza reaches the UK
It's now confirmed that a parrot in quarrantine in the UK has died from H5N1 bird flu - the bird was imported form South America - although it is believed it contracted the disease from other birds imported from Taiwan that had also died but lab tests proved inconclusive as to cause of their death. The strain appears to be similar to those found in SE Asia a few months ago and not that found in Romania, Turkey and Greece the past week (later mutations).
Last week the UK government took over control of all UK stocks of Tamilflu - you can no longer buy it in this country even with a prescription - and all stock is being centrally controlled by the UK department of health. Additionally, supplies of the regular winter flu vaccine has now been depleted to the point of being virually unavailable.
Every UK newspaper and news report has a story on Avian Influenza and there are frequent broadcasts on the BBC World Service. Compared to 3-4 weeks ago when few people in Britain had even heard of the problem - only those effectively cutoff from any form of mass media have not heard of the Avian Influeza threat.
The question on everyone's mind now is what happens next? Will it strike large numbers of wild birds and require extensive controlled culls? When will the first human case occur? And what happens after that? With an cold winter ahead projected in the UK (particularly in the north) combined with rising energy costs there is growing concern that hospitals will have a very busy season particularly with the elderly - aside from any avian influenza outbreak. I was further concerned after US research this week confirmed that the 1918 Influenza epidemic was indeed a direct avian sourced strain and did not need to combine with a human strain before transmitting to the population. That explains how it managed to strike so many so quickly.
I wonder how the UK will fare compared with the US? With Retrovirals in short supply for now and no true vaccine available until 6 months after a human strain of H5N1 evolves - is there any safer part of the globe to be at this point in time? No-one really knows just yet...
During the past two weeks there has been a significant increase in media attention to the H5N1 Influenza threat here in Europe - practically every newspaper and now television news article has some mention of the problem. The media machine has stepped up a notch again today with the recent verification http://www.alertnet.org/thenews/newsdesk/L13234523.htm
that the strain has appeared in birds in both Romania &Turkey http://www.alertnet.org/thenews/newsdesk/L13600830.htm
. Greece also has tightened it's borders and is checking out a suspected outbreak onboard a ship anchored at Pireus the main Greek commercial port http://www.alertnet.org/thenews/newsdesk/L13613330.htm
German Environment Minister Juergen Trittin announced today that he was immediately instructing increased checks on the importation http://news.yahoo.com/s/nm/20051013/ts_nm/birdflu_germany_dc
of all animals, animal parts and meat being brought into the country.
Funding to assist some Asian countires impacted by the avian influenza outbreak was also announced that may assist http://www.alertnet.org/thenews/newsdesk/SP40333.htm
to some degree in helping contain the outbreak in the coming months.
The European Commission also issued a warning today that countries should prepare for a potential Pandemic. So the message is clearly getting out and the media (and therefore the politicians) are therefore taking notice. Despite alot of money and time being engaged key fundamental issues are still not yet addressed and international collaboration readiness is lower than it was with SARS in 2003.
The Time for Detection
Among the many practical challenges being faced by the Avian Influenza threat is the time it currently takes to obtain positive verification of an infected patient - a problem that is evidently quite severe in the South East Asian region today. Suspected cases in the sub-region currently need samples flown to the WHO affiliated laboratory in Hong Kong which results in a 10-14 day lag between sample point and lab result. Clearly time to action is critical for effective containment of any H5N1 outbreaks - unless improvements are made to speed up the detection and verification process containment will prove difficult.
The Presidents New Partnership to Fight Bird Flu
Today in Washington D.C. some 300 government officials representing 60 countries around the world met to discuss international collaboration in improving global readiness to the avian influenza threat. The initiative was announced by the president at the United Nations on 14th September and http://usinfo.state.gov/gi/Archive/2005/Sep/15-86476.html
Paula J. Dobriansky is the key State department official leading the international coordination efforts on behalf of the US. The D.C. meeting, being chaired by Bud Rock of the State Department, is a positive sign of movement in the right direction but many obstacles still need to be overcome for the initiative to become effective.
For starters even though more staff have been deployed to focus on the threat from WHO (up from 4 to 12 personnel) - it is still significantly understaffed compared to the manpower needed to coordinate an effective global campaign. They therefore need to heavily rely on US funded resources at CDC in Atlanta - and that of course triggers wariness by some of the member nations of the partnership.
Next up, Canada will host a ministerial meeting of approximately 30 nations next month to address the threat of a bird flu pandemic “working very closely with WHO,” David Malone Canadian assistant deputy minister for global affairs announced last month. Human and animal health issues, the ability of nations to respond to the disease, openness, improved surveillance and testing, and risk communication will be on the meeting’s agenda, he said.
Mobilizing the Philanthropists
I spent yesterday in Edinburgh at the Carnegie Medal of Philanthropy - the recipients this year were the Cadbury family, the Aga Khan, the Packard family, the Hewlett family, Agnes Gund and Sir Tom Farmer. They join previous recipients Bill Gates, the Rockefeller and Sainsbury families, media tycoon Ted Turner and financier George Soros http://carnegieinstitution.org/news_releases/news_0509_22.html
In addition to the medal ceremony at the new Scottish parliament building, there were workshops on various focus areas including poverty and health http://www.holyrood.tv/library.asp?title=Carnegie%20Awards%20Ceremony§ion=70
. There was some limited discussion on the Influenza threat - but less than I had expected. Although I did discuss the issue with some of the participants there is clearly a need to further raise the awareness of this topic with the Philanthropy community worldwide.
On a seperate topic I heard from RiSci that Ted Turner and Sam Nunn have agreed to help RiSci with increasing the awareness of the Influenza pandemic threat. They are collaborating thourgh their non profit NTI organization http://www.nti.org/b_aboutnti/b_index.html
NTI's mission is to strengthen global security by reducing the risk of use and preventing the spread of nuclear, biological and chemical weapons. NTI also seeks to raise public awareness, serve as a catalyst for new thinking and take direct action to reduce these threats.
The Call to Action
Ever since the SARS outbreak in Asia, I have been becoming increasingly concerned about the threat posed to the world by the next Pandemic - when the next cycle hits a population of almost 6.5 billion http://www.cia.gov/cia/publications/factbook/rankorder/2119rank.html
on our planet. In the age of an increasingly inter-dependant and inter-connected world (be it online or by airplane) the potential human and economic costs are simply staggering.
I invited San Sharp, President of RiSci http://www.risci.org/
last week to join me on a HALO link from New York City to California - along with some other interested parties - his briefing shocked everyone in the meeting as to the sheer scale of the threat of the H5N1 Influenza. With cases now in the Russian Urals, and moving towards Europe at 20 miles per day, it is simply a matter of time as to when the disease will reach Europe, the US and shortly afterwards the rest of the world. There is no vaccination as yet - until the virus completes it's transition to the full blown human form this cannot even start; the retrovirals being produced today are limited in supply and even though they are considered a stopgap till the vaccine can be developed (typically 6-12 months after the disease stabilizes) there are signs that these may be less effective than originally thought. Even once we have a vaccine forumation developed - there is currently only global capacity to create doses for around 10% of the world's population.
Once the disease becomes established, it is estimated that between 5 million and 150 million people will die of the disease - depending on the level of effective response raised. To fight this threat - the world needs true global collaboration on a unparalled scale. This goes beyond politics, ideologies and national boundaries - it will ultimately be a grand test of humanity that future generations will judge us by.
Attached is an excerpt from the RiSci briefing I received - it should be our collective call to action..."While concerned with preparing for all potential pandemics, the Pandemic Preparedness Project is focusing primarily on the threat of avian influenza, which the World Health Organization calls “the most serious known health threat the world is facing today”. As of September 2005 outbreaks of avian flu in poultry have occurred in 15 nations. In five of these countries, people have been infected, sickened, and/or killed by the disease. The virus is widespread also in migratory wild birds and has spread from Southeast Asia, where it is endemic, to Russia, Tibet, Mongolia and Kazakhstan, inciting concern that it will continue toward Europe. There is extensive fear in the scientific community that the most prominent avian influenza virus, known as H5N1, will mutate to become as easily transmissible in humans as common flu. Unlike common flu, H5N1 is a new virus to which human beings have no immunity, rendering it lethal to people. If the warnings from the scientific community are correct, the resulting pandemic could kill millions of people worldwide, spread by jet travel at a rate well ahead of the ability of public health systems to respond. There is precedence for this: flu pandemics occur, on average, every 30 to 40 years, when the constantly mutating flu viruses produce a virus capable of infecting humans that spreads easily among people and against which we have no natural immunity. The so-called Spanish Influenza pandemic of 1918-1919 proved more deadly than the First World War, taking between 20 and 100 million lives. Half a million Americans died, in an age well before jet travel and with a world population less than one-third of today’s.. Even more frightening, the virus killed a disproportionate number of young, healthy adults. The H5N1 strain appears to affect people in a similar fashion.
More recently, SARS demonstrated, mostly in Canada and Southeast Asia, the impact of a global outbreak of a respiratory infection. SARS cost the Asia-Pacific region an estimated $40 billion, although there were fewer than 8,000 cases and only 775 deaths. Because influenza is far more contagious in people, the human, economic, and civic toll from pandemic flu would easily dwarf that of SARS. Despite efforts by WHO and others to alert and prepare the world for this potential health catastrophe, there are pronounced gaps in preparedness in all sectors. Infection surveillance and diagnosis techniques and communications on the ground are inadequate and hampered in some places by concerns regarding the economic toll paid by countries that report outbreaks of avian flu. Medical interventions—vaccines and anti-viral therapies—are not being produced rapidly enough, and there exists no global structure to stockpile and distribute them equitably, meaning that as of now, the great majority of countries have no medicines to counter a pandemic. There are few financial incentives for pharmaceutical companies to develop and manufacture vaccines. Perhaps most significantly, three-quarters of the countries in the world have not yet drawn up national preparedness plans, much less made significant domestic preparations for a potential influenza pandemic. The stakes are high: pandemics can immobilize normal civic activities, necessitate massive quarantine, and cause severe economic disruption, in addition to the tragedy of millions of deaths."