Table of Contents:

Foreword

Introduction

I. Storm Gathering

1. 1918

2. Master of Metamorphosis

3. H5N1

4. Playing Chicken

5. Worse Than 1918?

6. When, Not If

II. When Animal Viruses Attack

1. The Third Age

2. Man Made

3. Livestock Revolution

4. Tracing the Flight Path

5. One Flu Over the Chicken's Nest

6. Coming Home to Roost

7. Guarding the Henhouse

III. Pandemic Preparedness

1. Cooping Up Bird Flu

2. Race Against Time

3. Tamiflu

IV. Surviving the Pandemic

1. Don't Wing It

2. Our Health in Our Hands

3. Be Prepared

V. Preventing Future Pandemics

1. Tinderbox

2. Reining in the Pale Horse

Topics

References 1-3,199

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Outdated egg-based vaccine production

Experts fear a modern pandemic could “eclipse 1918,”489 but how could that be? We live in the age of modern medicine. We have vaccines and ventilators, antibiotics and antivirals, and the latest in medical technology. In 1918, they essentially didn’t even know what a virus was. One former president of the American Medical Association pointed out that the doctors of 1918 “knew no more about the flu than 14th-century Florentines had known about Black Death.”490 Doctors could do little more than advise people to get on waiting lists for caskets.491 Sadly, though, we’re not in much better shape today.

Osterholm explains why 21st century medical advances are not expected to make a significant dent in the next pandemic:
We really have no armamentarium today that is any different on a whole than what we had 100 years ago, at least in terms of what’s available to the world’s population. We have vaccines, we have some antivirals, but they will be in such insufficient quantities as to be what we like to say filling Lake Superior with a garden hose in overall impact.492
Vaccines are the cornerstone in our fight against viral disease. By introducing a killed or weakened version of the target virus, we can prime our adaptive immune systems to recognize the attacker in the future and mobilize a more rapid response. Unfortunately, influenza viruses in general, and H5N1 in particular, mutate so rapidly that it is impossible to present the body with a perfect match. We can try making vaccines out of the current Z+ type, but any strain that eventually “goes human” and triggers a pandemic may appear so differently to the body as to render the vaccine ineffective. Therefore “adequate supplies of vaccine will not be available at the start of a pandemic in any country,” concludes the World Health Organization.493 From the moment the pandemic strain is recognized, mass production of a workable vaccine is expected to take six to eight months. In other words, please wait six to eight months for delivery. Webster asks: “How many people are going to die in the meantime?”494

It may take a full year to produce enough for the United States,495 and, by then, the pandemic may be over. With today’s limited production capacity, we would not expect to be able to vaccinate more than about 14% of the world’s population within a year of the pandemic striking.496 The greatest problem then, according to the WHO, is production capacity.497

The tenuousness of modern vaccine manufacture—even for seasonal influenza498 —became clear in 2004, when half of the expected flu vaccine for the United States had to be tossed due to sterility concerns.499 The director of the Center for Bioethics at the University of Pennsylvania suggests this precedent should cast doubt upon reassurances from politicians that vaccines could be distributed effectively during a pandemic. “Rhetoric about the orderly and carefully thought-out rationing of a scarce life-saving resource—flu vaccine—turned [in 2004] into a cacophony of cheating, hoarding, lying and selfishness.”500 A similar crisis occurred in 2000. As one member of the California Medical Association put it back then, “Right now in San Francisco, it’s easier to buy heroin off the street than to get a flu shot from your doctor.”501

One of the main problems is the outdated method of vaccine production. According to the National Academy of Science’s Institute of Medicine, the basic technology for the production of influenza vaccine hasn’t changed in more than 50 years,502 dating back to when slide rules were the state of the art for mathematical calculation.503 This archaic method involves growing the virus for vaccine production in live fertile chicken eggs, a problem if you’re trying to grow a bird flu virus that may be 100% lethal to chickens—and their eggs. Researchers have since surmounted this hurdle, but there is no guarantee that an emerging pandemic strain could be cultivated fast enough.504

Development of a vaccine for current H5N1 strains is underway in hopes that there will be some cross-reactivity to the pandemic strain once it emerges, but we shouldn’t hold our breath. “We are really talking about years before Joe Smith in New York can go to his health clinic and get a shot for avian flu,” said a WHO spokesperson.505 Experts feel we may not have the luxury of that much time. “We have to get the message out loud and clear that vaccine will not save us,” emphasizes Osterholm. “We will have very little of it, and it will get here too late.”506