Tuesday, November 21, 2006

Britain vulnerable to drug-resistant bird flu

Britain vulnerable to drug-resistant bird flu

By Roger Highfield, Science Editor
Last Updated: 2:07am GMT 21/11/2006

# The report: Pandemic influenza: science to policy
# Q&A: What is bird flu?

The nation has been left vulnerable to a global bird flu pandemic because the stockpile of anti virus drugs is deficient, leading doctors and scientists have warned.

Only a few days after MPs criticised the way politicians abused scientific research, a report warns that the Government is not making best and timely use of independent scientific advice in preparing for an influenza pandemic, when an avian strain of influenza develops the means to spread among people and kill millions worldwide.

The report by the Royal Society and the Academy of Medical Sciences, published today, recommends that the Department of Health urgently revisits its decision to stockpile only one antiviral drug – Tamiflu – in light of emerging scientific evidence that the avian flu virus known as H5N1, can develop resistance to this drug.

The Government has ordered 14.6 million courses of Tamiflu, which could cover one quarter of the population.

Leaving aside issues of how to use Tamiflu effectively, how much drug will be required to treat infections, and whether it should also be used to prevent infections, Prof Neil Ferguson, from Imperial College London, said that the emergence of a Tamiflu-resistant pandemic strain is a "nightmare scenario" for which the UK needs to be prepared.

Stocking the alternative - inhaled - antiviral Relenza, alongside Tamiflu, which is taken in tablet form, could provide an important second line of defence in the event of a pandemic, as in other countries, because "not all viruses that are resistant to Tamiflu are resistant to Relenza," said Sir John Skehel, chair of the report's working group.

"The Government was right to order Tamiflu in early 2005," he said. "However, we are concerned that it is not updating its plans as the landscape of what we know about influenza changes.

This shortcoming illustrates how "we are concerned that decisions are being made, as the UK prepares for a possible pandemic, that fail to take account of expert advice," he said.

The Department of Health ordered two pandemic vaccines on the basis of preliminary data and no human or animal trial data, according to the report, which calls on samples to be made available to scientists for testing as soon as possible and for more openness: "The working group found difficulty in penetrating the barrier of confidentiality that surrounds the industry and its relationship with the Department of Health."

The report recommends the appointment of a leading influenza specialist as a high-level independent adviser to government, a Flu Czar, to feed the latest scientific information from academic researchers, industry and government departments into the ministerial committee which is responsible for preparing for a pandemic.

The report also calls on the Department of Health to bring together academic researchers and those in pharmaceutical companies to develop and improve vaccines – which will be a fundamental tool to control the scale of an influenza pandemic.

The report highlights that it would not be possible to manufacture enough influenza vaccines globally in a pandemic. However, limited supplies can "go-further" if combined with compounds known as "adjuvants" which increase vaccine effectiveness.

Improving vaccine performance with these compounds will help overcome the challenges of producing sufficient H5N1 vaccine against the particular virus that may hit the UK. "Encouraging researchers and drug manufacturers to share information would speed up the development of adjuvants and vaccines to make the UK more responsive during a pandemic," the report says.

And it says that the Government should consider "population priming" where, even without an exact match in virus strain, it may be possible to provide broad immunity by vaccinating with a pre-pandemic influenza vaccine.

So far this year, there have been 75 deaths caused by the H5N1 virus, compared with 42 last year, and there are still widespread concerns that it could mutate or combine to make a superflu capable of causing a global pandemic.

Prof Lindsey Davies, the Department of Health's Director of Pandemic Influenza Preparedness, said: "We are already addressing many of the report's recommendations in our ongoing pandemic preparedness planning."

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