Tuesday, August 09, 2005

The Karl Rove bird flu strategy

The New York Times rarely issues retractions, but we can agree with Henry Niman (in the comments to a previous post) that today's article by Altman and Bradsher, "A Successful Vaccine Alone Is Not Enough to Prevent Avian Flu Epidemic" is almost the same thing. No, they didn't go and say, "Never mind" about their post on Saturday but they may as well have. Unfortunately the AP didn't get the message (see, for example, "Government To Order More Avian Flu Vaccine").
Health officials, who over the weekend announced success in an initial test of a human vaccine against avian influenza, cautioned Sunday that the existence of a vaccine in itself would not be enough to avert a worldwide pandemic.

They said countries need to quickly organize ways to give the shots when they become available, a task that will take coordination, money and more scientific work. But they also emphasized that additional steps must be taken to better prepare for a possible worldwide epidemic of the respiratory disease, whether it is caused by the strain of avian influenza that has been spreading though birds in Asia and Russia, known as A(H5N1), or by another strain.
Why didn't they say that on Saturday, instead of leading many people to breathe a sigh of relief that the threat had receded and they can go back to more important things? Because that is exactly what is going on out there and federal officials are much to blame. Tony Fauci used to be pretty much a straight shooter, but when you carry water for The Man in the Big House you wind up, well, carrying water for The Man in the Big House. Because the "Hope is on the Way" exclusive to the Times on Saturday can't be seen for much else. Especially when it is coupled with a policy that has conveniently forgotten to tell us in equally effective ways that The Threat is on the Way.

So what's the problem with the vaccine? First, there isn't a vaccine yet. There is just one effort in a small clinical trial with a particular strain of bird flu H5N1, the one that is flying around southeast asia now. If it stays genetically fixed the vaccine might be very effective. But if it mutates much, it might not be. And the version flying around Russia (ex-China) is fairly far removed from the one that is in the supposed miracle vaccine.

Moreover we don't know if the vaccine even works to prevent disease in the strain it uses. All we know is that relatively high doses are needed to get an antibody titer high enough that experts think it might work. But the doses needed are unusually high:
Currently the combined output of the world's flu vaccine manufacturers is about 900 million 15-mg doses of antigen.

If a pandemic flu vaccine regime required two doses of 90 mg apiece, the combined annual output of the globe's flu vaccine makers could be as low as 75 million doses - enough to protect a small portion of the world's people. (Helen Branswell, Canadian Press)
The nature of the antibody isn't given or perhaps isn't known. Not all immunologic responses are effective and some are even harmful. We are reminded of the recent attempt to make a more generic vaccine by raising antibodies against the M2e protein of the virus, which is less variable across strains. A good antibody response was obtained, but unfortunately the vaccinated pigs died more often and more quickly than the unvaccinated ones on challenge with influenza virus (see our post on another much hyped vaccine "story," now off the radar screen since it has served its purpose of boosting Acambis stock prices). However Branswell's story quotes one of the investigators, Dr. John Treanor, referred to the antibodies as neutralizing antibodies. No support for this was given, but if true, suggests they would be effective.

As Altman and Bradsher properly point out, even if this were the greatest vaccine going, your chances of getting any in the next six months are poor. Federal officials put in an order for 2 million doses and are talking about upping that order, perhaps enough for 4.5 million people. But one result of the trials was that it takes a much bigger dose (administered twice) to get what might be an effective response, so the 2 million doses is only enough for about 450,000 people. But maybe you are well connected. If so, maybe you'll get some.

Maybe. Whether they can actually obtain even that much is doubtful, because there is a potential shortage of eggs to grow the virus in. The whole process takes time.
Given that manufacturers can only make enough vaccine for a fraction of the world's population in normal times with regular dosing schedules, experts said the findings underscore the urgent need to find ways to produce the same response with smaller doses of vaccine.

"I think these results suggest the world is even less prepared than more prepared," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"And unfortunately many policy makers might take this announcement as being 'We've hit the gold mine' - when in fact I would suggest we are having a hard time even finding water." (
Helen Branswell, Canadian Press)
So if a pandemic occurs this flu season, in the immortal words of Dr. Osterholm, "We're screwed."

But there is some hopeful news. Judy Miller is reporting from prison that Karl Rove has mounted a campaign to cast doubt on the alleged virulence of the virus. If he is successful in convincing everyone the virus isn't what it obviously appears to be, no one will die from it.

Or at least if they do, there won't be any photographs of the coffins.