What the President Should Have Said About Bird Flu

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Speaking Out

What the President Should Have Said About Bird Flu

Currently the U.S. can treat just over two million people. The World Health Organization won't even have a few million doses of antiviral drugs until the middle of 2006.

By Nick Schulz

From the January/February 2006 Issue

Stung by criticism over the unpreparedness of government at all levels to address Hurricane Katrina, President Bush has been taking steps to make sure another disaster doesn't embarrass his administration. When Hurricane Rita formed in the Gulf, the White House was noticeably more active prior to that storm's landfall. Recently, President Bush addressed in extensive detail at a press conference his thoughts about the threat of an avian flu pandemic.

"If we had an outbreak somewhere in the United States," Bush said, "do we not then quarantine that part of the country, and how do you then enforce a quarantine? . . . And who best to be able to affect a quarantine? One option is the use of a military that's able to plan and move."

So the President has given some thought to what could be a serious problem—the virus, H5N1, has already killed up to 100 people in Asia. Estimates vary, but a global outbreak could kill as many as 150 million people. Papers published recently in the journals Nature and Science from researchers at the Armed Forces Institute of Pathology, the Centers for Disease Control and Prevention, and Mount Sinai School of Medicine suggest the flu could be more catastrophic than previously thought.

While quarantines need to be considered, they are difficult to execute effectively in countries like the United States that are large and have a diverse and highly mobile population.

A better idea is to take steps to make sure a quarantine isn't necessary. One idea that health and government experts now seem to agree on is the need to stockpile the antiviral treatment Tamiflu. Jeffrey Levi of Trust for America's Health, a nongovernmental organization (NGO), told the AP, "It appears that this is the only effective intervention we have once someone has been infected." Doctors in Asia are already using it to combat bird flu.

There's one big problem, however—there's not a lot of Tamiflu to go around these days. It takes a long time to manufacture the drug, and as governments and health agencies seek to procure it, they're finding they have to wait.

President Bush hinted at this problem in his press conference. "One of the issues is how do we encourage the manufacturing capacity of the country," Bush said, ". . . to be prepared to deal with the outbreak of a pandemic? In other words, can we surge enough production to be able to help deal with the issue?"

Presently the answer is no.

The drug was invented by Gilead Sciences of California, and they licensed manufacturing and distribution rights to Roche, the Swiss drug giant. But even though Tamiflu has been known as an effective treatment against H5N1 for several years, Roche presently lacks the capacity to fill orders quickly.

According to a report in Business Week, the Secretary of the Department of Health and Human Services, Mike Leavitt, wants a stockpile capable of treating 20 million Americans. Currently the U.S. can treat just over 2 million people. But an order placed by American officials for another 3 million treatments will only be filled by Roche in 2006. Senator Bill Frist, who has taken a keen interest in the issue, recently called the supply for Americans "totally inadequate."

"Right now, our national stockpiles of antiviral drugs sit at dangerously low levels—about 2 percent of what we would need in a serious outbreak," Frist wrote recently in the Washington Times.

And it's not just the United States that's waiting. "It will take Roche two years to complete the United Kingdom's stockpile order to treat 14.6 million of its citizens," Business Week reports. The writer and blogger Randall Parker has created an invaluable overview of the stockpiling efforts of several nations. He illustrates the gravity of the situation by pointing out that the World Health Organization—the global body responsible for coordinating the counterattack on a flu pandemic—won't even have a few million doses until the middle of 2006. Today it only has 80,000.

Supply is so tight, ABC News reports, that Roche has had to institute a "first-come, first-serve" waiting list. Unfortunately for Americans, "the United States is nowhere near the top of that list."

The capacity situation is bad enough that Gilead sued to force Roche to relinquish manufacturing rights to the drug in the hopes that it will be able to massively ramp up production.

So here's one area where President Bush could take some proactive steps. According to the San Francisco Chronicle, Roche is planning to build a plant in the United States, but it would not be producing drugs until the end of 2006. To speed things up, President Bush could order the Food and Drug Administration to speed up approval of other, already established plants in the United States for manufacturing the ingredients of Tamiflu. The FDA has taken similar steps in response to infectious disease outbreaks, such as its efforts to fast-track available treatments for HIV/AIDS.

And President Bush could encourage Roche to initiate a technology transfer to manufacturers in the U.S. to ramp up development. This would respect the property and contract rights enjoyed by Roche while getting more product to the clinics, hospitals and programs that need it.

George Mason University economist Tyler Cowen, who established an avian flu website to track the disease, also suggests stockpiling "high-quality masks and antibiotics for secondary infections (often more dangerous than the flu itself) and, more important, have a good plan for distribution and dealing with extraordinary excess demand and possibly panic."

Lastly, Tamiflu is an important part in a first-line defense against a flu pandemic—Sen. Frist pointed out that if an outbreak occurs, "Tamiflu is what people would go after. It's what you're going to ask for, I'm going to ask for, immediately." But it is no cure-all. Work needs to proceed on vaccines, as well as procurement of other possible treatments, like an injectable form of the drug Relenza, made by GlaxoSmithKline, especially as there may be instances of resistance to Tamiflu if it is used widely.

President Bush shouldn't be focusing on a quarantine just yet. He should be taking steps to make sure a quarantine isn't necessary. He has outlined some steps to do that. But if he has learned anything from Katrina, he can demonstrate it by taking steps to make sure that, while the United States is presently "nowhere near the top of the list" for the treatments needed to fight an outbreak, that situation doesn't last long.

(As of presstime on November 18, 2005.)

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