Bioscope ‘05

by Dr. Barbara Price

Vaccines and Antivirals: The Future Pandemic

           “Current global manufacturing capacity... is inadequate to meet the expected global needs during a pandemic [of H5N1 flu] and cannot be rapidly augmented," the WHO Aug 19, 2005. This statement is distressing, but a reflection of our current health systems, including the pharmaceutical industries. We humans think we are closer to being able to relieve suffering from many diseases, including many of the diseases that currently affect developing countries, but we face very large impediments scientifically, economically and politically.
           A virus attack on an organism is complicated. The various components of viruses, membranes, replication mechanisms, etc., do not interfere with life functions by a single attack, say on alveoli in the lungs (which leads to the inability to get oxygen), but they elicit a complicated response). Our immune systems wage war on virus infections that are started by the virus itself, or components of the virus. A vaccine may help by showing our immune systems characteristics of the virus that may be useful for later defense, but our bodies may take several days to several weeks to make use of the information on and in quantities large enough to overwhelm a real virus attack. Since a virus attack is also an attack on the immune system, viruses may also subvert normal immune systems, either by attacking essentials of the immune system or by subtle attacks that cause the immune system to malfunction. Vaccines are part science, part art and some measure of good luck. Antivirals for influenza A, such as the nuraminidase inhibitors (zonamirvir and oseltamivir) or adamantane derivatives, may help by limiting the replication and spread of viruses, but drug resistant strains of influenza have already been seen. Neither vaccines nor antivirals are complete answers.
           The NY Times (Augu. 21, 2005) had a very interesting article on NYC’s plans to cope with an influenza-based pandemic. “The weakest link is the hospital capacity,” according to the Director of Columbia University’s National Center for Disaster Preparedness. Even with redesigned emergency rooms, air handling systems, and quarantine procedures, preparedness for contagious influenza is a big concern. With inadequate supplies of vaccine and antivirals, the public will be almost back to 1918, relying on such measures as asking the public to wash their hands and limit contact.
           Even if we had the science in hand, globally we lack the political and economic will to provide the vaccine and antivirals for the world. (Really, that is not too much different than the world’s difficulties with supplying enough food to everyone.) Unless we plan now, politics and economics will limit what will be done for global public health. We, in each country, will close our borders and order our citizens to refrain from public assemblies before we help to provide vaccines, antivirals and medical assistance to other countries. As we develop and manufacture vaccines and drugs, we should also be safeguarding our political systems, so that we do not become paranoid isolationists, and developing the foreign relationships that will help all of us be stewards for the globe.