Bird Flu Scare Expends Valuable Public Health Resources

Since 2003, when the first three cases of "bird flu" (the H5N1 influenza virus strain) were reported, a great deal of time, money, and other public resources have been utilized to detect this dangerous flu, to slow its spread, and to prevent it through new vaccine technologies. Worldwide attention has focused on the "worst case" scenario: what to do if the virus mutates sufficiently to cause a global pandemic through person-to-person transmission. H5N1 reaches humans through contact with infected birds, poultry being the most common carriers. The growing number of cases and high death rate among those infected is legitimate cause for concern, says G. Richard Olds, MD, Chairman and Professor of the Department of Medicine and Linda and John Mellowes Professor of Medicine. But we might better spend our time and money on preparing to deal with the more common influenzas that strike with deadly force every year, he notes.

"First of all, 'bird flu' is a misnomer," says Dr. Olds. "All flus are bird flus. That means that all the flus in the world, including the flu that we get every year, starts in birds. Regular flu goes from birds to pigs to human beings. The pig is the species that recombines the flu viruses, taking a virus that's in birds and recombining it with human flu viruses and giving new combinations.

"That happens all the time. The unique thing that happens with bird flu is the virus goes directly from birds into human beings. That has occurred several times since 1997, and it should be pointed out that it's not all with H5N1. There's been this assumption that the only bird flu is H5N1, and that's not true. We've had other combinations of influenza viruses that have come from birds directly into human beings."

Vaccine "Solution" Has Limitations
The fact that H5N1 is not the only bird flu should be taken into account as decisions are made on a vaccine "solution" that may itself have limitations and medical drawbacks, said Dr. Olds. "That's important, because one of the strategies is to make an H5N1 vaccine. Well, that would be okay if H5N1 is the one flu strain that ends up being the problem, but there's no guarantee that it is going to be the problem.

"Personally, I believe it's far more likely that we'll have an epidemic with regular old influenza, because we're overdue for it. Every 16 to 30 years we have a pandemic with a new strain. We haven't seen an H2N2 influenza virus for 30 years. Don't you think it's more likely that we're going to have an influenza epidemic with a strain that has already caused a pandemic within our lifetimes rather than that bird flu is going to have some strange mutation that will make it both highly lethal and person-to-person transmission? It seems so to me."

Dr. Olds said that a more general approach to tackling infectious disease could very well be more effective than investment in strain-specific vaccines. "One of the things to do is to make sure that we have better public health plans to deal with any highly infectious respiratory virus, whether it's bird flu, whether it's a pandemic with regular flu, or whether it's a bioterrorism agent like plague that would involve person-to-person transmission," he said.

"Maybe we should have a plan for how we would deal with that, a plan emphasizing public health measures, appropriate quarantine, masks, hand washing, restrictions on public gatherings and airplane travel, whatever it takes. But we ought to have some plan in place, because that plan would be helpful no matter what happens. It's far more likely that will be useful."

Impact in Affected Nations
According to the World Health Organization (WHO), there have been 240 laboratory-confirmed cases of H5N1 influenza in ten nations from 2003 through August 21, 2006, with 141 deaths attributed to the disease.