Fri, Sep 23, 2005 - Page 8 News List

We need to stockpile more bird

By Huang Yu-cheng, Lin Tzou-yien 黃玉成、林奏延

Will avian influenza (H5N1) become a pandemic? The answer is yes, given the following facts.

First, some strains are known to be highly pathogenic (usually fatal to animals) and it has already become endemic among animals in various areas in Asia. Second, in the past two years, the disease has affected a greater number of animal species. Third, transmission to humans has already occurred in Vietnam and Thailand, with a high fatality rate. The only element lacking at present is an increased capacity for human-to-human transmission. Once the H5N1 virus becomes a flu infecting humans, it has the potential to become a global pandemic. Many experts predict an avian-flu pandemic is inevitable, and only a matter of time.

The best way to prevent avian flu is by means of vaccination. But to develop and mass produce an effective vaccine in the near term is virtually impossible. Among the new generation of medications currently available are the orally administered Tamiflu capsule and the Relenza inhaler, which have both proved effective in preventing and treating influenza in clinical trials. They seem to have few side effects and the virus has not shown any significant increase in resistance to the drug.

Most importantly, laboratory sensitivity tests have determined that these medications are effective against the H5N1 viral strain. Although currently there are not enough cases of avian flu infection to carry out meaningful clinical trials of the two drugs on humans, Tamiflu or Relenza have been effective against the virus in Vietnam and Thailand, and if early diagnosis and treatment also produce an encouraging result, the World Health Organization (WHO) will suggest that each country stockpile a sufficient supply of these anti-viral drugs. But these drugs are expensive and their production is also limited.

Tamiflu and Relenza play different roles in different phases of a flu pandemic. Their effects have been shown in a recent study conducted by the Israeli government based on epidemiological modeling. They are also considered cost-effective. As for their effects, first, they serve as preventive medication. During a flu pandemic, healthcare providers and other high-risk groups can be required to take preventive medication to safeguard the health of first-line personnel, and remove the fear that national security and the national healthcare system could be compromised as a result.

Second, when a country's disease monitoring system detects a cluster of human cases, these drugs can be used by everyone living in the region of the outbreak. It also reduces the chance of viral mutation within the human body. Even if intervention fails, it will at least retard the global spread of the virus, giving more time for communication and preparation.

Third, if a pandemic has been declared, the necessity for early diagnosis and treatment with drugs goes without question.

Taiwan's pharmaceutical companies should have the ability to produce anti-viral drugs such as Tamiflu, and be encouraged to negotiate with Swiss drug maker Roche and British drug maker GlaxoSmithKline to import cheaper drugs. Another option would be for Taiwan to become licensed to produce these drugs when any country shows signs of an imminent outbreak.

The WHO strongly recommends every country stockpile a sufficient amount of anti-viral drugs. Some northern European countries and Japan already have plans to store at least 25 percent of their population's total requirement. Taiwan's stockpile will be just 4 percent next year. The government, the Legislative Yuan and the medical community should cooperate to achieve better results.

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