Tue, Aug 11, 2009 page8

• Timing critical for battling A(H1N1)

  • By Su Ih-jen 蘇益仁
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  Global data for infection and mortality rates associated with the A(H1N1) influenza, or swine flu, are becoming clearer as time goes on. Twelve people have already fallen seriously ill in Taiwan, and the nation’s first death from this new viral strain occurred on July 30.

  A(H1N1) has become pandemic in the southern hemisphere and tropical countries, so it is almost unavoidable that a pandemic will occur in the northern hemisphere this coming autumn and winter. The estimated fatality rates for the virus vary from a low of 0.4 percent to as high as 2 percent, as reported in New York. The death rate in Mexico in April was even worse.

  Most of the Americas and Europe, as well as Japan, Singapore and Hong Kong in Asia, have sufficient stocks of the antiviral drugs Tamiflu and Relenza to treat 50 percent of their population. I have on several occasions called on the administration of President Ma Ying-jeou (馬英九) to stockpile enough antiviral drugs for 30 percent of the population, based on a predicted infection rate of at least 20 percent, most of which would be symptomatic.

  However, the government has only enough stockpiles for 13 percent. If this remains the case, half or more of patients infected in the potential epidemic would not get the medication they need. Among those infected, pregnant women and people with chronic illnesses are the most likely to be seriously affected, so these categories of people should receive priority protection.

  Ten percent of the nation’s Tamiflu stocks was purchased in 2006 and is in the form of powder, not tablets or capsules, so it is not suitable for prescription by clinics or general hospitals. That is why the local Centers for Disease Control wants to distribute Tamiflu through the National Health Insurance system, releasing stocks of capsules currently held by hospitals.

  I don’t know why the government has been so conservative about buying Tamiflu this time. Its shelf life has been extended from the original two years to five or six years. If there were sufficient stocks of the drug for one in every two people, everyone’s safety could be assured for a cost of NT$200 per person. It should be done for the same reason that people make annual insurance payments.

  I urge the government to seriously consider buying sufficient supplies of antiviral drugs immediately. If this does not happen, the nation may face a replay of the 2003 SARS crisis, when there was an outbreak of the illness in Taipei’s Heping Hospital and hundreds of patients and medical staff were quarantined. In Taiwan, 664 people were infected with SARS and 73 of them died.

  If the administration proceeds with tendering along the lines of the Government Procurement Act (政府採購法), the nation will probably not be able to buy vaccines until autumn or winter, when Europe and the Americas have finished vaccinating their populations and have vaccines left over. Local manufacturer Adimmune Corp (國光生技公司) had won the tender to produce 5 million doses of vaccine, and I hope the company can fulfill this onerous task.

  During a meeting of experts called by the Center for Drug Evaluation in May to discuss vaccines for the A(H1N1) strain, the participants advised the Department of Health to place orders with major overseas manufacturers as its main source for vaccines, while assisting Adimmune to produce vaccines as a backup for emergency needs or in case not enough vaccines could be bought from other countries. As things stand, however, we just have to hope that Adimmune will succeed in producing the required quantity of vaccines to meet the needs of disease prevention workers and high-risk groups.

  The optimum preparation period of three months starting from April has already passed, but the nation’s preparations in terms of antiviral drugs and vaccines are very conservative. I would like to believe that the confidence of former minister of health Yeh Ching-chuan’s (葉金川) is well-founded and not just wishful thinking. Otherwise, if stockpiling of drugs and vaccines does not go according to plan, we had better start thinking about how local health services are going to deal with a flood of seriously sick patients and deaths.

  As many as 50,000 people may get critically ill with swine flu during the coming autumn and winter. Even if every bed in every intensive care unit were made available, it would still not be enough for even one-tenth of these patients.

  And the implications do not stop there. Taiwan is just beginning to show signs of recovery from the recession, but an influenza epidemic could do serious damage to the economy, just as SARS did in 2003. If the government wants to retain public confidence, not just adequate preparation, but transparency and communication are essential.

  I call on the Ma administration to face up to the potential impact of an A(H1N1) flu epidemic and call a national security meeting as soon as possible to plan a strategy, stockpile materials and mobilize the necessary personnel to deal with it. Let us hope the SARS experience and the lessons learned from it can help Taiwan prevent or control an A(H1N1) epidemic.

  Su Ih-jen is a professor of pathology in the Department of Medicine at National Cheng Kung University.

  TRANSLATED BY JULIAN CLEGG
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