Vaccine against avian flu is just the beginning

A major drug company reported today that a new vaccine against the H5N1 type of avian flu is showing a lot of promise. According to manufacturer GlaxoSmithKline, the vaccine created a protective response in 80 percent of people it was tested on, which is an impressive result. News reports say the vaccine could be for sale in the United States as soon as the end of the year.

The reported success of the vaccine seems like good news. However, the vaccine is most effective against the H5N1 strain used to make the vaccine. Flu strains mutate as they pass from bird-to-bird or bird-to-human. If the strain mutates to one that easily passes from human-to-human, this vaccine may not be as effective. And even if we end up with a vaccine for this strain, a completely independent strain could crop up. So it's important that we not declare this the "be-all, end-all" cure for pandemic flu.

If this new vaccine works as well as the drug company says, there may be calls to start vaccinating people, especially if the bird threat increases. (Whether or not we're going to need mass vaccinations against H5N1 is another story.) If we decide to start vaccinations here in the United States, there a few things that would need to be done first: The Food and Drug Administration would need to confirm that the vaccine works and is safe. And health insurers will need to agree to cover the cost of the vaccination, which sometimes will not happen unless the government recommends the vaccine in its immunization guidelines.

Once an avian flu vaccine becomes available, the U.S. government plans to stockpile it, to the tune of 20 million courses, to protect health care workers, emergency personnel, government officials and other "first responders." That means that our parents, children, friends and families may not be the first ones to receive the vaccine. (Unless of course, they are health care workers, first responders, etc.)

We also need to remember that it's not just the United States that needs the vaccine, and that it's not just for the rich. Most of the human cases of H5N1 avian flu we've seen so far have been in countries where individuals may not be able to afford the cost of the vaccine, and where there may not be strong health systems in place.

If this vaccine holds true on its promise, we need to make sure that those who most need it are the ones who are able to get it, both here in the United States and around the world.

Pandemic flu: Why should you care?

To many people, the possibility of a flu pandemic seems like just another one of those far-off, scary "what-ifs" that we hear about every so often. But at the beginning of the last century, it was a reality. From 1918 to 1919, avian flu swept across the globe, killing 20 million people, including 675,000 in the United States.

The disease was fast-spreading and frighteningly lethal, 25 times more deadly than the regular flu. Across the country, schools and churches were closed. Young victims lay gasping for air in their hospital beds as their lungs filled up with fluid. In many cases, doctors were unable to do much except helplessly watch their patients die. On a single day in Philadelphia in 1918, almost 800 people died. Cities had trouble keeping up with the burials of the dead.

Because of that pandemic, history has taught us to be wary of avian flu. Right now, a strain of avian flu called H5N1 has health officials around the globe worried. Since December, 2003, about 230 cases of H5N1 have been reported in humans, with 131 deaths. Right now, the disease is mostly infecting chickens and other poultry. Scientists are concerned, however, that the strain could soon turn into one that could quickly spread from person to person, much the way the common cold is passed along. If that happens, more than 1.9 million Americans could die, according to estimates.

Almost 2 million deaths, that's a lot of people. It's equivalent to more than 13,000 plane crashes, half of all the babies born in the United States in 2004 or the entire population of Houston, Texas. The chances are good that at least a few of those people would be someone you know or love. It could be your co-worker, your teacher, your child.

The reality is that if a pandemic hits the United States, all of us will be affected. And unfortunately, we are not ready yet. If a pandemic occurred tomorrow, our government, hospitals and health departments would be overwhelmed. And most people just aren't prepared.

That's why it's important that you should get ready now, and why we need to work to prepare our communities. The question we are faced with now is not "why should I care?" It's "how can I get ready?"

Photo: Demonstration at the Red Cross Emergency Ambulance Station in Washington, D.C., during the influenza pandemic of 1918. From the National Photo Company Collection (Library of Congress).

So what is a flu pandemic, anyway?

It is getting pretty confusing. On TV, in newspapers and online, we keep hearing about how a flu pandemic is likely. Then, the conversation turns to bird flu. The other day, one of our staff members talked to her mom, who asked "What is the difference between a flu pandemic and the flu that I get a shot for every year?" Even though her mother was pretty up on the news, she was confused and wanted to know more. So what is the difference between regular flu and avian flu, and why are people making a flu pandemic seem so scary?

An influenza pandemic occurs when a new type of flu virus that our bodies are not protected against spreads around the world, causing serious illness and possibly even death.

The flu shot that people are encouraged to get every year for seasonal flu will offer little or no protection against pandemic flu, as this new virus won't be included in the shot ingredients.

Because our bodies have not come across the flu virus that causes a pandemic before, people can easily catch it from one another. Anyone who gets the new virus can become much sicker than they would for seasonal flu, and can possibly die as a result.

So, what is the link to birds? The flu that is causing concern around the world right now is a strain that occurs primarily in poultry, such as chickens. It's also sickened other animals, including cats that have eaten birds. More troubling, though, is that this new type of bird flu has sickened people that are in close contact with birds, such as those that work and live on farms.
Right now, people can not easily catch this bird flu from another person. But that could change if the virus mutates. If it does, it could cause the next flu pandemic.

Although people are used to flu season occurring at a certain time of year, a flu pandemic can happen anytime. It does not have to be winter or the normal flu season. The scary fact is that a flu pandemic will occur sometime in the future; we just do not know when.

Every year, more than 200,000 people in the United States are hospitalized because of seasonal flu, and 36,000 people die from it. In the event of a flu pandemic, we are talking about something that can be hundreds of times worse than that. Past flu pandemics have sent millions to the hospital and killed hundreds of thousands in this country. It is definitely something that everybody needs to get ready for. The first step though is for everyone, including our friends, families, and our mothers, to learn more about pandemic flu.

Welcome to the APHA "Get Ready For Flu" blog

You may have noticed the increase in Web sites, government plans and information in recent months responding to the threat of pandemic influenza. The threat is a real one, and it's great that the U.S. government has made the issue a priority. But most of the federal information out there is too wordy and not written for average Americans.

To test the influenza planning materials that are available now, we asked our friends and families to check out some of the government sites. The findings weren't surprising: our testers couldn't understand most of it, nor figure out how to apply it to themselves. For example, materials on the government sites contain checklists and lists of items to stockpile in case of a flu pandemic, but no specifics. How much bottled water and canned food should a family of four stockpile? Should diabetics and those with heart conditions hesitate to eat stockpiled food if they have high salt content? Should they take nutritional supplements instead? None of these answers are available.

Additionally, government sites are so over-packed with information that it can become overwhelming. Web users have to download large PDF files and wade through miles of documents. And what about those who don't have access to the Web?

Government plans for pandemic flu preparedness also have a flaw in that they rely on individuals, families and communities to have their own flu plans in place, and expect them to have a full stockpile of goods for the foreseeable future. Good idea, but the major question is: HOW?

To help address some of those questions, APHA is launching the "Get Ready For Flu" blog. The blog will be a discussion forum on pandemic influenza, where the public can come and learn about pandemic flu and share their comments on the issue. Most importantly, we want this to be a venue for people who are looking for real advice on how to prepare for flu.

In coming posts, the APHA "Get Ready For Flu" blog will feature discussions on how to prepare your home, business and community for a flu pandemic or other emerging infectious disease threat. We will also include discussions on how to understand and apply recommendations from global, federal, state and local government sources. Upcoming topics will include egg and chicken safety, cats and avian flu and the availability of vaccines.

The APHA "Get Ready For Flu" blog is being written by APHA in consultation with experts and using the best science available. (Click here and here for more information on the APHA Flu Team.) It is being published in conjunction with APHA's new "Get Ready" campaign that will help Americans prepare for a pandemic of influenza or other emerging infectious diseases.

We will be posting information and commentary on the blog as things develop on influenza, so check back weekly. We look forward to hearing your thoughts and concerns and starting a public discussion on preparing for pandemic flu. This is your chance to get involved and make a difference on this emerging public health issue. Let's get ready!

About this blog

About this blog: The "Get Ready For Flu" blog is published by the American Public Health Association as a resource for the public on pandemic influenza. The blog was created in conjunction with APHA's new "Get Ready" campaign that will help Americans prepare for a pandemic of flu or other emerging infectious diseases.

About APHA: The American Public Health Association is the oldest, largest and most diverse organization of public health professionals in the world, dedicated to protecting all Americans and their communities from preventable, serious health threats and assuring community-based health promotion and disease prevention activities and preventive health services are universally accessible in the United States. Since 1872, APHA has led national movements for all Americans to be able to protect themselves, their families, and their communities from preventable, serious health threats. APHA accomplishes this by serving as the only association for public health professionals from every sector of society and health-related discipline.

About the authors of this blog: APHA staff, who include policy analysts, public health workers, global health advocates, journalists and grassroots advocacy staff, are the authors of the entries posted on the blog. Collectively, we are the "APHA Flu Team." The blog is being written in consultation with experts who include APHA members and using the best science available.

Comment Policy: Comments on this blog are screened, so there may be a delay before your comment is posted. Comments that include profanity, personal attacks, spam, inappropriate text or are irrelevant to the discussion topic will not be posted. By posting a comment, you are agreeing to abide by these rules. APHA reserves the right to block users who violate these posting standards and/or remove their comments.

Have a question about something discussed? Or a news item? Or a suggestion for us? Please contact us at pandemicflu@apha.org.