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CHUNG Sangho

The Coming War against Pandemics

CHUNG Sangho

Nov. 17, 2005

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Since the mid-1990s, headlines have been warning against the potential global outbreaks of diseases such as the mad-cow disease, foot-and-mouth, avian flu, swine fever, and SARS. Yet, these warnings have not been sufficiently alarming for people to accept the prospects of mass-death or total paralysis of the global economic system. Furthermore, in the context of coordinating international responses and preparing for such disasters, the efforts have been marginal. On the contrary, these incidents produced a short-term mass-hysteria, followed by a collective euphoria that today's medical technology will alleviate the dangers.

Such complacency is shattered once we consider, for example, how many people die from garden-variety influenza every year. According to Korea's National Statistical Office, the number of people dying from respiratory diseases in Korea, including pneumonia and influenza, is around 15,000 a year. This is more than the number of traffic-related fatalities averaging 10,000. In the US, about 36,000 people are estimated to perish from flu each year.

The size of these deaths alone is disturbing enough. Nevertheless, once our thoughts turns to a global flu pandemic and its likely casualties, it's mind-boggling. According to the World Health Organization, a global bird-flu pandemic could kill an estimated 2 to 7.4 million people under a mild-case scenario. This estimate is much lower than 25 to 50 million deaths caused by the Spanish Flu of 1917-18.

Global Pandemic?

Is the world heading to another round of pandemic-scale influenza comparable to what broke out 90 years ago? The answer is maybe. Most medical experts and public health officials insist that the matter is not if, but how and when.

If that's the case, the key question is how to devise preemptive measures effectively. There are a number of things we can and should do, not to speak of what governments around the world must do. Sadly, however, many governments seem to think that all they need to do is to purchase and stockpile drugs that supposedly are cure-all.

But there are things only governments can do to fight the spread of catastrophic pandemics. They possess organizational power, massive resources, and global networking to minimize death tolls and societal disruptions. Governments can and must produce well-designed contingency plans. Yet we don't see much of this evidence at home in Korea . Nor do we see organized campaign in other countries replacing scaremongering in the media with calm preparations explaining the risks involved in fighting a potential pandemic like avian flu.

Currently, a strain of bird-flu virus called H5N1, found in Asia and parts of Europe, has been blamed for the deaths of domesticated fowls on a massive scale. Its lethal effect has been also proven by dozens of human fatalities in China and in Southeast Asia in recent years. What is alarming to health officials the world over is the possibility of this deadly virus to cross the species barrier to attack mammals, including humans through person-to-person contacts. Once that happens, there is no stopping it unless measures to prevent or cure the disease come on stream.

A drug to contain the bird flu has been developed and marketed by Roche. It is called oseltamivir, marketed by the Swiss company in the US as Tamiflu. The problem is that the company can't produce the drug fast enough to help the world's health authorities stockpile sufficient quantity in time for a sudden outbreak. Typically, it would take six months to produce the drug custom-tailored to the viral strain currently in circulation.

No Panacea

Tamiflu, as the only effective weapon against avian flu, has created a global scramble to hog this drug, either through imports or local production. India, for example, has a reputation for producing many generic medicaments. Other countries such as Korea and Taiwan are willing to mass-produce a generic version of Tamiflu under license for use in their own countries.

Korea should actively consider producing Tamiflu under co-production arrangement with Roche. Whether this kind of cooperative venture can materialize is an open question, but if so, it can set an important precedent for similar international cooperation to fight other pandemics in the future.

Korea has a Tamiflu inventory sufficient to cover 700,000 people (less than 2% of its population). Health officials say they will acquire more drugs to cover 300,000 more people over the next few months. As these figures show, Korea lacks any significant capability to cope with potential crises such as bird flu.

Unfortunately, even this drug provides only partial protection vis-a-vis the bird flu. It is effective only against a special type of H5N1 strain called Z+, the most virulent, species-crossing permutation which was first detected in Vietnam and Thailand in early 2004. The Z+ variety killed rodents, pigs, and humans, as well as chickens and ducks in its wake. The question we ought to ask now is: What would happen if this special virus undergoes another mutation, turning into a new strain no longer curable with Tamiflu or any other experimental drugs currently in the labs? Needless to say, that could spell a yet another kind of disaster.

What We Can Do

For several weeks since the news broke of bird-flu pandemic, the Korean government has done little except announcing plans to buy more Tamiflu tablets, and warning poultry farmers against exposing their flocks to migratory birds. This is no way to deal with the threat. Not only the government in Korea, but also other governments, must establish specific crisis management plans along with clear rules on how to ration medical supplies and services well before the arrival of an epidemic.

This question of prioritization is very important because the priority groups may change depending on the nature of the disease in question. When the Spanish Flu broke out, the age group that bore the brunt of the outbreak was those aged 20 to 35, not the young and old as it would have been popularly surmised. That means healthcare officials should be more careful in focusing their attention on those considered most vulnerable, and not waste their scarce resources.

The critical issue is what age groups should get the first medical attention in time of crisis. It's not simply a matter of forming a social consensus, but a cold-hearted calculation of setting medical priorities to minimize the casualty rate. Setting the right priority for effective fight against pandemics will raise ethical and moral questions, but in the end, it's the conquest of the disease that should overrule all other issues.

Ultimately, it's not the job of government alone to fight this type of pandemic that could cost lives of millions of people. It's a job that requires both the public and private sectors to work closely together. The job of saving lives is too great to be left to the government alone.

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