The world has moved swiftly to contain the spread of swine flu, largely drawing on lessons learnt during severe acute respiratory syndrome (SARS) and bird flu outbreaks in the last six years. So far, it looks like an epidemic with only a glimmer of a pandemic, but governments, researchers and global health authorities should seize this opportunity to iron out issues that arise during every such threat and then get brushed aside. This is particularly true with regard to development of vaccines and a new line of combination treatment to avoid development of resistance to the drug.
India, which has been lucky in the recent past in not having any real case of human infection of SARS and bird flu, particularly needs to have well-rehearsed emergency plans in place. For instance, the call that it will hand over a “proforma” to the airlines in the next 48 hours is a delayed response, as is the fact that many state authorities have pleaded lack of instructions from the Union government.
On the treatment front, stockpiling of Tamiflu, the most effective drug against the virus as of now, is one line of action, but health authorities, locally as well as globally, need to remember that the virus has shown signs of resistance to this drug. The European Centre for Disease Prevention and Control in Stockholm reported 660 cases of influenza viruses showing signs of resistance to Tamiflu last year. Researchers studying this phenomenon recommend a combination therapy, of buttressing Tamiflu with other antivirals, just as we do in HIV-AIDS treatment today.
That sure adds to the cost of the treatment as well as to the logistics of stockpiling, as one combination drug, Relenza, is inhaler-based, but it’s a call countries will have to take in their own social and economic interest. As far as vaccines are concerned, while they are difficult to develop because influenza viruses are like chameleons, rapidly changing patterns on their outer surface to avoid attack from antibodies, there are scientific advances which, if aggressively pursued, can handle some of these bottlenecks.
We hope Indian authorities are vigilant now, having let the public sector vaccine manufacturing programme languish with poor quality control for most of last year.
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