COMMENTARY

Pandemic Flu: We Are Not Prepared

Marc Lipsitch, D. Phil

Disclosures

April 15, 2005

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The world faces a new influenza pandemic about 3 times each century.[1] The 1918 pandemic killed at least 20 million people.[2] We don't know when the next one will hit, but flu experts agree that we are now at high risk for a serious pandemic.[3] H5N1 flu has become endemic in Asian birds, and at least 74 human cases, including 49 deaths and probable human-to-human transmission, have occurred since the beginning of 2004.[1,4,5]

We are unprepared for a new pandemic. International health officials lack the resources to monitor avian flu in a human population of hundreds of millions in affected parts of Asia, including some countries with almost no public health systems.[1,6] Asia needs a significant stockpile of the anti-influenza drug oseltamavir, on-site, to treat and stop transmission of the early cases that could give rise to a pandemic.

If a pandemic reached the United States today, we could manufacture only enough vaccine for perhaps a quarter of our population.[7] Our planned domestic stockpile of oseltamavir would leave over 99% of the country unprotected.[8] Proportionally, Great Britain's stockpile will be 25 times greater,[9] and some authorities suggest that even that isn't enough.[10] To make a dent in a pandemic, vaccines and antivirals will be needed in much greater quantities than current plans allow.[11]

Pandemic flu is an enemy that we know will return. Indeed, of the 12 disaster scenarios recently assessed by the US Department of Homeland Security, it is the most likely and perhaps the most deadly.[12] Our surveillance and countermeasures abroad are inadequate, and current response plans won't do much to slow a pandemic once it is under way. The United States, and the world, must meet this enemy with the seriousness, the investment, and the urgency that it demands.

         That's my opinion. I'm Dr. Marc Lipsitch of the Harvard School of Public Health. To contact the author:          mlipsitc@hsph.harvard.edu

         Readers are encouraged to respond to George Lundberg, MD, Editor of          MedGenMed          for the editor's eye only or for possible publication via email:          glundberg@medscape.net          .        

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