Doing What It Takes
Public health agencies had been preparing for this moment for years. The SARS epidemic in 2003 had woken officials to the way a spreading illness can wreak havoc on economies and people’s daily lives. And the flu had long ago proved its catastrophic power. The Spanish flu of 1918-1919, considered the worst pandemic in recorded history, killed an estimated 50 million people worldwide. So Dr. Cox’s flu team, along with other public health workers, had stockpiled antiviral drugs and updated outposts with superfast detection kits, including the one that flagged the first U.S. case in San Diego. They’d run drills for various what-if scenarios. Now it was all happening for real.
Soon it became apparent that swine flu was no more lethal than the typical seasonal flu. Yet no one is ready to say for sure that we’ve dodged the bullet — and no one is calling off the massive vaccination campaign. Why? Because scientists know it’s foolish to try to predict the direction of a flu pandemic. In fact, researchers have a saying, notes Michael Shaw, PhD, who heads the CDC flu lab under Dr. Cox: “If you’ve seen one pandemic … you’ve seen one pandemic.”
The most dire scenario involves not just swine flu but the H5N1 bird flu virus that’s been smoldering in Asia since 1997 — it’s fatal in nearly two thirds of cases. Its spread has been limited by the fact that it can’t leap easily from person to person. But an animal simultaneously infected with swine and bird flu could act as a living mixing bowl; the viruses could swap genes to create a superbug as deadly as bird flu and as easily spread as swine flu. Fortunately, that isn’t likely, but a flu virus needn’t trade genes to get more dangerous. The virus responsible for the 1918 pandemic caused only mild disease at first but evolved in ways that made it able to quickly kill previously healthy people.
So the government has committed to paying nearly $2 billion for vaccines. It’s an enormous investment, but the only alternative is to do nothing and hope for the best. Public health experts know that there are other good uses for those billions, but even if the virus remains no more dangerous than the typical seasonal flu, it will kill thousands of Americans. And privately, vaccine experts see another substantial benefit from the swine flu campaign: It will strengthen a vaccine pipeline that’s badly in need of help.
Vaccines have always been a stepchild of the pharmaceutical industry. They generally aren’t big money earners, because just one or two doses protect people, unlike medicine for problems like diabetes, which must be taken daily. And while people clamor for drugs that will cure their ailments, they often don’t bother with vaccines — until, that is, a serious epidemic approaches.
But the massive cash infusion will help convince drug companies that vaccines are a reasonable gamble. The complex logistical preparations will serve as a dry run for future efforts. And that’s good, because someday, experts know, we will face a truly calamitous virus. And when we do, we’ll be grateful for the ability to protect ourselves with a vaccine.