Saturday, April 08, 2017

.The big one is coming

Experts say we are "due" a highly lethal flu pandemic. And when it comes, it will affect every human alive today. Geographical boundaries will be meaningless. Unlike seasonal flu, pandemics occur when a completely new or novel virus emerges. The result is a pathogen that can spread easily from person to defenseless person, our immune systems never primed to launch any sort of defense. We cannot solely rely on our bodies' ability to fight. A vaccine is our only real hope. The first time an ill patient shows up at a hospital anywhere on the planet with a novel virus, the clock starts ticking.

The Spanish Flu of 1918 was an unprecedented catastrophe. Experts' best estimates were that 20% to 40% of the world became ill and more than 50 million people died. In the United States alone, approximately 675,000 people died in just the eight months between September 1918 and April 1919. Some people died the same day they became ill, and others died within a few days from complications of the flu, such as pneumonia or meningitis. Forty years later, the Asian flu of 1958 and 1959 had a global death toll as high as 2 million and an estimated 70,000 of those in the US. Early in 1968 the Hong Kong flu began. By September, it made its way around the world, including the United States, and became widespread by December. Still, as many as a million people died, 34,000 in the US alone between September 1968 and March 1969.

Not all is gloom and doom.  In the developed world, at least, we have the ability to ease suffering with antivirals, breathing machines and antibiotics for secondary bacterial infections. Experts can also more quickly characterize pathogens causing outbreaks. Although it took several years to identify the virus causing AIDS, for example, it took only a few weeks to identify the SARS virus. We are also much faster at developing vaccines. A typhoid vaccine was first tested in 1896 but only developed into a safe and effective vaccine nearly a hundred years later, in 1994. It took just 12 years, however, to develop a safe and effective Ebola vaccine (2003 to 2015). And, last week, the National Institute of Allergy and Infectious Diseases announced initiation of a phase II trial for a Zika vaccine that started in August with the hope it may be ready for emergency use by 2018.  Our production capabilities have increased tremendously around the world. In 2006, according to the World Health Organization, we had the ability to make only 350 million doses of flu vaccine, but now, in theory, we could make 5.4 billion doses of flu vaccine if we harnessed and aligned manufacturing facilities all over the world.

However, the way we typically make flu vaccine is still pretty antiquated and hasn't changed much in nearly 70 years. We rely largely on hens' eggs to incubate and replicate the virus, which is too slow of a process to respond rapidly to pandemic flu. Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations, nevertheless, explained that recent scientific advances are fully transforming the speed at which vaccines can be developed and approved. Genomic techniques can be used to map the DNA or RNA of a new pathogen, genetically to engineer and mass-produce the same DNA or RNA and then inject it into the human body, leading to the production of antibodies to fight the virus. This method results in a new type of vaccine, a DNA vaccine.


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