- The Washington Times - Sunday, January 15, 2006

Special correspondent John Zarocostas interviewed Dr. Mike Ryan, 41, director of the Department of Epidemic and Pandemic Alert and Response at the World Health Organization (WHO) in Geneva, Friday on the latest outbreak of human infections with the H5N1 avian-influenza virus in Turkey and about preparations worldwide against an influenza pandemic. A two-day international pledging conference on avian and human influenza will be held in Beijing tomorrow and Wednesday and co-sponsored by the government of China and the European Commission. The World Bank, meanwhile, will examine the financing needs of countries and regions, and how these needs can be met.

Question: How are efforts to stem the spread of human infection by the H5N1 bird-flu virus? Where are we?

Answer: Well, currently, as the world knows, we’re dealing with a situation in Turkey where we’ve had 18 confirmed cases of the disease, and that has been the latest emergence of this virus after what happened in Asia. So, we’ve seen the emergence of this virus as a human disease in the edges of Europe; now, that’s clearly a significant development.

We’re currently still dealing with a virus that’s transmitted from birds to humans. We are not dealing with a pandemic virus transmitted from human to humans, and that is good news.

However, it is still tragic to see human beings exposed to the virus, and we’re still dealing with the problem of widespread poultry outbreaks and continuing human exposure. … We’ve been lucky thus far, in that no virus has emerged that has the potential to spread between humans.

Q: Is the breakout in Turkey a wake-up call for health ministers and public health officials worldwide? The WHO has been beating the drum and trying to get governments to get their act together for the last two years. Do you think this will help?

A: I think we’ve seen — certainly over the last six months — a much, much higher level of engagement from all governments on the issue of preparedness for a potential pandemic of flu. The situation in Turkey is a further demonstration of the dangers that this virus presents. And in some ways, I think it will confirm to people that investing, right now, for a potential pandemic is a good investment.

In fact, if we look at the political commitment over the last six months, … we’ve seen a rapid increase in the number of countries that have national preparedness plans. We’ve also seen an increase in the number of exercises, both national and international, to test those plans. We’ve seen stockpiling of equipment and antivirals; we’re seeing accelerating work now on pandemic vaccine development.

I would characterize it as “the world is moving.” I think the Turkey situation says that we need to move even quicker and more comprehensively. I hope the meeting in Beijing will bring together the nations, and a further endorsement of the things that need to be done.

Q: You mentioned it’s still a transmission from birds to humans, but at the same time, the public is being told that it’s not a matter of if, but when [human-to-human transmissions occur]. So how close is the world to another influenza pandemic?

A: It’s impossible to say. I think what can be said is that the virus is breaching the barrier between humans and animals, and every time we allow the virus to breach that barrier, it offers the virus the opportunity to adapt to the human biology. And every opportunity we allow the virus, in that sense, is another opportunity for a pandemic virus to emerge.

So, it’s impossible to say when. But if you look at the number of human cases, if you look at the intensity of the poultry outbreaks, we are providing multiple opportunities for this virus to test itself, and to evolve. These viruses are transmitting in poultry; if they transmit to humans, they try to adapt. It’s an issue of pure probability.

Q: Is there reason for concern, given the latest results [regarding H5N1 virus specimens] from your reference laboratory in the United Kingdom on the mutation of the protein, which shows the cells can mutate faster?

A: We’ve seen similar mutations like this in the past. The issue is whether such a mutation will establish itself in the virus population, and there is certainly no evidence of that.

There is no evidence whatsoever at this particular time that there’s any human-to-human transmission, or that the virus has changed its characteristics in any way within the human population.

We’ll be tracking further clinical specimens and further isolates to track further the evolution of the virus. But at this point, no, this suggestion does not change our current risk assessment.

Q: How long would it take to build up sufficient stocks of antivirals and to get prototype vaccine in the event there is that trigger and you get a pandemic influenza strain? … How long would it take?

A: We still face a major problem to develop a vaccine relatively quickly based on a pandemic strain. We can’t begin development of that vaccine until we have a pandemic strain.

We’re already working with vaccine manufacturers on candidate vaccine strains, on doing prototype strains, and getting through a lot of the regulatory process that will be needed.

But we still face a big problem — the production-capacity issue — and bringing online expanded production capacity for pandemic vaccines is a major challenge for us, and for the private sector, and we’re working with the private sector on that.

At the moment, it’s quite clear [that] if a pandemic strain were to emerge anytime soon, we would not have enough vaccine in the initial months to cover the world’s population. That is a real issue, and that’s why we have two potential ways to slow the spread of a pandemic virus and possibly stopping the emergence of that virus.

One is to respond extremely rapidly should a pandemic strain emerge, with measures at country level to treat people with antivirals and to restrict the movement of people and goods during a particular time in a particular area to try and slow down the emergence of the virus.

Every day we slow down that emergence, or every day we stop that virus from emerging, there’s a potential of 5 million new doses of vaccine … being produced.

So, it’s extremely important that:

1) We find the host immediately when a pandemic strain emerges.

2) We contain that virus as long as we can, and we have in place a rapid-response protocol aimed at doing that using stockpiles of antivirals and rapid response teams, etcetera.

If [youre asking whether] there are enough antivirals in the world today to treat everyone if they get influenza, the answer is no. And, in fact, only a very small proportion of the world’s population will be currently covered by antivirals. So, in that sense, antivirals do not represent a silver bullet to reduce the impact of this disease on the world’s population.

Therefore, we have to rely on the capacity, at this particular time, if a pandemic virus were to emerge, of the ability of health systems to treat people and care for people, and for governments to put in place measures that will reduce the impact during such a pandemic.

Q: What are the key points the public should be aware of to limit the spread?

A: I think the key thing is in areaswhere we see the current disease in poultry, it’s exceptionally important that we reduce the exposure of human beings to this virus. Exposure of human beings to sick or dying poultry is driving the problem right now. We have to find means to educate, compensate, communicate.

There’s a lot of ignorance out there about the risk factors, and people feel there needs to be adequate compensation mechanisms in place to compensate farmers who lose their flocks, so that people report disease early and don’t hide disease. …

For me right now, that’s the message from Turkey and other areas. There is a tremendous amount of avoidable exposure, and it’s particularly tragic to see children exposed to this virus and children dying from this virus.

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