Air Date: Week of December 3, 2004

A virus common in birds could have widespread and fatal consequences for humans. That’s according to the World Health Organization which recently announced an avian flu pandemic would be “very, very likely” in the next few years. Recent reports have found that the virus has jumped from birds to humans. Scientists worry that if the virus takes on a form that can be communicated between humans, a pandemic on the order of the deadly 1918 outbreak could be close at hand. Host Steve Curwood talks with Dr. Anthony Fauci of the National Institutes of Health about how the U.S. might protect against an impending pandemic.

Transcript

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CURWOOD: From the Jennifer and Ted Stanley Studios in Somerville, Massachusetts, this is Living on Earth. I’m Steve Curwood.

The flu might have physicians and patients scrambling for shots here in the states, but there’s another, more deadly form of the disease that’s grabbing the attention of health officials here and overseas. Thirty-two people in Southeast Asia have so far died from a strain of avian flu called H5N1, and these recent cases are the first signs that the virus has crossed over from infected birds to humans.

Poultry farmers are particularly susceptible to the virus since they are in close contact with birds that could be flu carriers. In Asia, millions of birds have been infected with the H5N1 virus. And scientists worry that if the virus takes a form that could be easily transmitted among humans, it could set off a public health calamity like the influenza pandemic in 1918 that killed 20 million people worldwide.

Officials at the World Health Organization recently declared that a bird flu pandemic is, quote, “very, very likely,” and could kill two to seven million people or more and quickly infect up to one-third of the world’s population. Dick Thompson is a spokesman for WHO.

THOMPSON: This virus would travel by jet. It would likely break out and circle the globe within six months.

CURWOOD: Joining me now to talk about efforts underway in the U.S. to protect against the virus is Dr. Anthony Fauci. He directs the National Institutes of Allergy and infectious Disease in Bethesda, Maryland. Dr. Fauci, welcome to Living on Earth.

FAUCI: Thank you, it’s good to be here.

CURWOOD: We’ve just heard how the World Health Organization is estimating as many as two to seven million people around the world could die from this disease, and some of their folks are saying as many as 100 million. What’s your take on the accuracy of those numbers?

FAUCI: Well, I think they’re very soft. It’s very difficult to predict. I think it’s important rather than to get involved in the analysis of mathematical models for numbers, to know that when you get a pandemic flu, namely the emergence of an influenza, in this case, one that’s fundamentally a bird flu that jumps species into humans, that you’re gonna have a serious problem worldwide, because the level of immunity against a flu that civilization has not ever experienced before can be catastrophic. It can be millions and millions and millions; seven, ten, 15, 20, it’s difficult to predict, because all flus are difficult to predict. But the one thing you do know, that if it is a bird flu that gets into humans as opposed to the normal, cyclic, every seasonal flu, which in and of itself causes significant problems – 36,000 deaths per year in the United States and 200,000 hospitalizations – that’s on a regular year, if you get a situation with the bird flu, it can then go into a very large number of people worldwide.

CURWOOD: Okay, now how does the biology work here, Tony? How does an influenza that goes in birds, how does that get into people?

FAUCI: Well, it gets into people by the agricultural conditions of people and birds very closely together in farming agricultural communities, particularly in Asia. That there are flocks of chickens, people take care of the chickens, the chickens get sick, the workers are exposed to their respiratory secretions, they get infected, and then, ultimately, they can infect other humans. It’s that step from human to human which has not yet matured to be very efficient. But what we are seeing is that the people who are around the chickens, particularly in the flocks in the market, they are the ones from whom this virus and this ultimate epidemic will emerge.

CURWOOD: Yeah, and how does that work, that it can then shift to become something that transfers from one human to another?

FAUCI: It becomes just a genetic mutation where just some of the genes just normally mutate. Or one type of influenza that’s not amenable to spreading from human to human infects someone who also is infected simultaneously with a virus that can spread from human to human, and you have exchange of genes of those two viruses, and that’s called re-assortment. So you could re-assort genetically and then get a less efficient virulent virus to become a more efficient spreading virulent virus.

CURWOOD: And that’s the fear that you have in this case.

FAUCI: Exactly.

CURWOOD: If this disease comes to the United States, what are the ways it can get here?

FAUCI: Well, it’s very easy. It’s jet travel. What will happen is someone will be in Asia, in China, in Hong Kong, in Indonesia, or wherever, Vietnam, Thailand, they’ll get on a plane and start coughing and sneezing and someone will wind up getting infected and that’s how it’s spread. Particularly in the age of jet travel when you can be in Asia one day, and then 13-15, 18 hours later, you’re in New York City or Washington or Boston.

CURWOOD: Who’s mostly at risk from this?

FAUCI: Well, anyone’s at risk from getting infected. But the people who are at risk for the complications are young infants from the age of six months to 23 months, elderly individuals greater than 65 years of age, people with chronic diseases like asthma, heart disease, lung disease, people who are taking drugs that suppress their immune system, as well as people like myself who are healthcare people, people who are physicians who take care of patients ‘cause you continually get exposed.

CURWOOD: That’s right, and in the big 1918 pandemic, one of the problems was all the healthcare workers were sick, right?

FAUCI: Well, not only healthcare workers. The problem with 1918 is that young people died very rapidly from that also because it was a very virulent form of the infection. So when you get a pandemic flu, there’s certainly no guarantee that just the people at high risk for complications will get complications. We lost a lot of young, healthy people during the 1918 pandemic.

CURWOOD: Okay, so what are the measures that we should take? You run the National Institutes of Allergy and Infectious Disease. What are you saying that we should do as a society in your role in government, to protect the public, assuming that this flu will be coming at us sometime in the next year?

FAUCI: Well, there are a couple of major general categories. There’s general public health measures like keen surveillance both in Asia and here so that you can detect it early and implement the public health measures. And that might be, for example, keeping people from crowded places, taking a look at the possibility of school closures, restrictions of activities, quarantines, isolations and things like that. Hopefully, it would never come to that. That’s a public health measure.

If you look at the research measure, the things that we do at the NIH, what we’ve done several months ago was to isolate the H5N1 and start to develop what we call a seed or a reference virus for a vaccine. That vaccine is now being made in pilot lots that will be ready…one group will be ready at the end of December and the other group will be ready at the end of March or early April, at which point we’ll do a clinical trial to determine the safety and what kind of dosage you would use. And we also are already jumping ahead in contracting with a company to make at least two million doses of vaccine against the H5N1 flu. So that, in fact, if it does emerge to the point of spreading from person to person, we’ll have a very big head start on the development of a vaccine that will give us that immunity that will ultimately reduce our vulnerability.

CURWOOD: Now, what about quantity? You say the government is planning to have, perhaps, a couple million doses of this available. We’re close to three hundred million people in this country.

FAUCI: Right. There are two types of vaccine doses that you make. There are the pilot lots that I mentioned early on which are about 8,000 to 10,000 per lot to use in a clinical trial, and then when you commercially scale up the ability to make the virus vaccine. And in this case, if you go to two million, the mechanics that go into allowing you to make two million doses automatically scales you up so that you can surge that to tens of millions of doses much more readily than if you just were aiming at a few thousand doses.

CURWOOD: Who’s going to do this? I mean, we’ve just looked at a flu vaccine disaster this fall, really. What, it got outsourced to a company to Britain and much of the batch was contaminated, and now…

FAUCI: Right, the company that is making the two million doses is Aventis Pasteur, the company that is now successfully getting us the vaccine that we’re using this year, the company that did not have a problem.

CURWOOD: What about the government doing this? As I understand it, there’s not much money in vaccine production. This is a public health service.

FAUCI: Well, the government needs to partner with industry, but we know from a number of experiences that you really don’t want to disassociate yourself completely from industry. The expertise is there, the capabilites is there. We need to incentivize the industry to get involved seriously in vaccine development and vaccine production. Because the government just is not good at making these kinds of quantities of countermeasures for viruses. It’s a marriage between and a partnership between government, industry and academia that will get us there in a very effective way.

CURWOOD: Now, how does this situation compare with the way past pandemics have spread?

FAUCI: Well, again, in the twentieth century, there have been three major pandemics. One totally catastrophic in 1918 in which 20 to 40 million people worldwide died and a half a million people died in the United States. The next one was in 1957 which was much less dramatic in its effect; and then there was another one in 1968. So, every few decades, you can get a pandemic flu in which there’s no immunity in the community, be it in the United States or worldwide. When experts say that it is inevitable that sooner or later we’re gonna get another one, that, I believe, is true.

CURWOOD: And this year is your highest level of concern?

FAUCI: Well, I’m not saying that anything’s going to happen this year. I think we’re getting closer to what we all consider the inevitability of having a pandemic flu. You know, the chances of it happening this year are small. But the fact that there are so many flocks of birds infected in Asia, whereas a couple of years ago there wasn’t that widespread exposure that we’re seeing, we’re getting closer to it. It’s impossible to predict. The one thing about influenza, you know, you just can’t predict.

CURWOOD: Uh-huh…

FAUCI: But given the number of birds, and given the fact that each year the virus learns, as it were, how to be more efficient, we’re not going in the right direction with the bird flu.

CURWOOD: And if you win with this, the public will never know, right?

FAUCI: Exactly, if you don’t get it and we do the right things, they’ll never know. That’s the nature of the job.

CURWOOD: Dr. Anthony Fauci is director of the National Institutes of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda. Dr. Fauci, thanks for taking this time with me today.

FAUCI: You’re quite welcome. It’s good to be here.