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KOH You-Sang

Coping with the Spread of New Flu

KOH You-Sang

Nov. 27, 2009

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Since June, when the World Health Organization declared a global pandemic of the N1H1 influenza virus was under way, hundreds of thousands of people have been sickened and thousands have died, fanning fears worldwide. The pandemic declaration - the first since 1968, when an H3N2 flu strain was initially detected in Hong Kong - means the new virus has jumped across continents.

Flu originally occurs in birds, and bird flu virus is presumed to be transmitted to humans through pigs, whose organs are similar in size and structure to humans. Seasonal flu that occurs in winter can be prevented by vaccination, but pandemic flu can hardly be contained because development of a vaccine for the new virus is only made after the virus has spread substantially.

Flu virus strains are categorized according to two proteins found on the surface of a virus: Hemagglutinin (H) and Neuraminidase (N). Hemagglutinin is a glycoprotein that binds the virus to the cell being infected, while neuraminidase is an enzyme that helps the virus to breach cell walls. There are 16 subtypes of hemagglutinin and nine subtypes of neuraminidase. So theoretically, there can be 144 flu subtypes which are the combinations of H and N proteins. However, only H1, H2, H3, and N1, N2 subtypes are commonly reported among humans.

The current pandemic is the fourth since 1918, when the Spanish flu (N1N1) killed 20 million people, the 1957 Asian flu (H3N3) that resulted in approximately 2 million deaths, and 1968 Hong Hong flu that killed up to 1 million people. The 2009 H1N1 is a variation of an H1N1 seasonal flu virus that has been circulating since 1977. The most notable characteristic of the new flu is the speed in which it spreads; only six months transpired since the first warning to pandemic status. Still, the flu has killed less than 0.1% of its victims so far, much lower than the 2% in past pandemics.

It is difficult to contain a flu pandemic, and more frequent occurrences are expected going forward. A virus is the simplest living organism. Its structure is unstable, making for easy mutations. A flu virus is particularly more prone to mutations, which explains new variations that crop up annually. Many types of bird flu that have not been transmitted to humans are closely watched since it they may jump to humans at any time.

The fast spread of flu can be attributed to three factors. The first is urbanization and globalization. Second, the massive breeding of poultry that are the major infection source has led to the higher possibility of collective infection of these poultry and virus mutation. Third, vaccines take six months to develop, using the traditional method of cultivating the virus in chicken eggs. This makes it difficult to prevent the fast rate of infections in the early stages of a new flu virus, allowing for massive spread.

Since it is difficult to fundamentally prevent the occurrence of flu, it is necessary to contain infections and find more effective solutions. The government will need to store sufficient amount of vaccines and treatment drugs and prepare emergency countermeasures. Also crucial is to operate a crisis management system to calm public fear. Companies should prepare emergency contingencies to cope with decision-making paralysis caused by wholesale absence of managers and other personnel. Yet the utmost task to prevent the spread of flu is to prepare weapons for diagnoses, vaccines and cures.

The size of world vaccine market was US$111 trillion in 2008. Annual average growth of 9% is expected until 2013. Vaccines to conquer viruses such as pandemic flu and AIDS are likely to lead the future vaccine market.

Vaccines need to be produced every year, so global major pharmaceuticals firms that are struggling with falling sales due to expiration of patents for key products are aggressively entering into the market through mergers and acquisitions. Meanwhile companies in emerging economies such as China and India are growing quickly thanks to low labor costs and government policy.

The markets for molecular diagnosis and immunity diagnosis device systems for virus diagnosis reached US$23 trillion and US$62 trillion, respectively, in 2007. Flu symptoms are similar to those of many respiratory diseases, and thus the need is growing to develop diagnosis devices that can find and identify a virus promptly and accurately at its early stage. Mid-to-large systems suitable for specialized institutions like general hospitals are prevalent as of now, but in the future small "point-of-care" analysis systems that allow real time diagnosis are expected to grow.

The market for anti-viral drugs, which stood at US$219 trillion in 2008, is predicted to see 9.5% growth on annual average into 2013. The drug market for flu treatment is relatively small, currently standing at below US$10 trillion. The market is dominated by a Tamiflu of Swiss drug company Roche Holding and Relenza of UK-based GlaxoSmithKline. Yet, tolerance to anti-viral drugs steadily builds up and at some point, their effectiveness is lost. Hence, uninterrupted research and development for new anti-viral drugs is imperative. Most recently, a new kind of antibody-based flu drugs are being actively developed.

Since the death rate of the 2009 H1N1 flu is low than past pandemics, the current situation should be approached calmly, rather than with extreme fears. Industry-wide, vaccine-related bio technologies should be developed to prepare for the next new pandemic. There is time to cope with through pre-development of vaccines and anti-viral drugs for the possible outbreak of H5N1 bird flu that is considered next-generation flu. These viruses have yet to mutate into a form that is infectious to humans on a massive scale. Non-bio technologies that prevent the spread of disease itself such as sterilizing and purifying air should also be simultaneously developed. One example is to introduce home electronics that kill viral germs by applying ultraviolet rays or ozone.

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