#217
It’s a nice dream, really.
Sometime within the first few months of a pandemic, scientists miraculously come up with a vaccine. It is both safe and effective, and our government spearheads a nationwide effort to inoculate every citizen against the dreaded H5N1 Avian Flu Virus. Within a matter of a few weeks, the scourge of the bird flu pandemic is vanquished. Life returns to normal, and we go back to our 120 cable channels, our Playstation 3’s, and our lives of conspicuous consumption.
The world is saved through the miracle of modern science. It is the perfect Hollywood ending, all neat and tidy. Cue the triumphant music and roll the credits.
But, it is only a dream.
The reality is considerably darker. Despite constant assurances that scientists are working around the clock to develop a vaccine, and our state and local government’s apparent reliance that one will be developed, there is little evidence to support that scenario.
Still, the dream is a popular one, and it is being heavily promoted.
Case in point, here is a story reported by KOAA TV in Colorado Springs, Colorado.
Pueblo prepares for flu pandemic
The Pueblo City-County Health department held a mass flu and pneumonia vaccination, Saturday. The lines were long, and they started an hour before the doors opened.
The department's goal was to vaccinate 10,000 people; it gave out just over 5,000 shots. But workers said the exercise was a success, and that it will be valuable in the event of a future pandemic.
The vaccinations were given with the urgency of a real crisis. Residents were screened several times and had to answer questions on their medical background before they were vaccinated. With hundreds of volunteers and dozens of nurses, 100 people can be vaccinated at a time.
The health department said 92 percent of the people it surveyed said the exercise ran well.
http://www.koaa.com/news/view.asp?ID=5967
Around the country, similar exercises have been conducted, and others are planned. They are not completely without value, as they do serve to promote pandemic awareness while at the same time providing vaccines for seasonal influenza. Both are good things. But at the same time they also promote the idea that our salvation from a pandemic is just a matter of time; that the guys in the white lab coats will save us.
Why, you might ask, couldn’t this work? After all, we are the most technologically advanced country on earth. What’s the big deal?
The big deal is a little thing called logistics.
Unless and until we manage to create a universal influenza vaccine (give us 10 years, and maybe . . .), we can’t begin to create an effective inoculation until we have the pandemic virus in our hot little hands. A vaccine must closely match the virus; else it loses its ability to confer immunity. That’s why we get a new flu shot every year. The old one is rendered useless by the virus’s continual mutations.
So we can’t begin actual production until a pandemic breaks out.
Vaccine production has changed little since the 1950’s. We use millions of eggs to culture the virus, and then extract the components for the vaccine from them.
Using the current egg-based technology, it takes about six months to generate a vaccine in any quantity. There are plans to convert to a new, cell replication method, but it has yet to be approved, and would take several years to convert the manufacturing facilities to use it. For now, we are pretty much stuck with the limitations of 50-year-old technology.
Worldwide, we have the manufacturing capability to produce between 400 million and 700 million doses of influenza vaccine per year. For a world with 6.5 billion people, that’s not much. Early indications are that any avian flu vaccine will likely require two shots, given a month apart, and so our actual number of people we can inoculate is cut in half.
There are additional problems inherent with the production of a vaccine for the H5N1 virus. The virus tends to kill the eggs used to culture the antigens, and so production delays are likely. Worse, the amount of antigen required to confer immunity is considerably higher for the avian flu shot than for seasonal flu, and we must come up with an adjuvant that will extend the vaccine.
But assuming that in the midst of a raging pandemic, the power stays on, vaccine manufacturing plant personnel continue to report to work, and the problems of egg destruction and finding a safe and effective adjuvant are solved, the best we can probably do is generate 400 million double doses of vaccine a year.
Enough to inoculate 6% of the world’s population.
Most of the world’s vaccines are manufactured in Europe, not in the United States. With 450 million people living in the European Union alone, and a production capacity of only 400 million doses, it is unrealistic to expect that much vaccine will be exported to the United States.
Americans will be standing in line, along with the peoples of nearly 200 other nations, and most will go wanting.
To this we have to add the nightmare of distribution of any vaccine. Even if we had it, how feasible is it to dispense it during a pandemic?
An effective vaccine would be worth more than gold, and it would require very tight security just to move it around the country. It would be perceived as life saving, and would be the target of hijackers and criminals at every turn.
One would have to assume that by the time a vaccine were made available; there would be serious degrading of our infrastructure. Gasoline and other fuels would be in short supply. Power and communications could well be disrupted. And the health care providers we have today will have suffered serious attrition from the virus.
If a pandemic is still raging, how many people will risk coming out and standing in line for hours with thousands of people, many of who may be infectious? Immunity takes several weeks after receiving the shot, and so by going out and getting a shot, they may be risking catching the virus. And remember, these people will have to return for a second shot a month later.
And how many of us believe that vaccination stations would operate like the well-oiled machine described in the article above? It’s one thing to practice with seasonal flu shots; it is quite another to deal with thousands of panicked and angry citizens, all of who believe they, or their kids, should get the shot first.
During the swine flu scare of 1976, we spent 10 weeks trying to inoculate a nation of 220 million people. We managed to get vaccines to only 40 million. And those vaccines only required one shot. All of this was done in advance of a pandemic, and under ideal conditions. Our experience there doesn’t bode well for attempting a mass inoculation of a nation during a pandemic.
If a vaccine does become available in the first year, I expect that it will be given to select groups. Those working on the front lines; the military, national guard, health care workers, and utility workers.
A vaccine for the masses, at least during the first year of a pandemic, is a slim hope indeed. But that doesn’t seem to dissuade the authorities from promoting the idea, even though they generally put up a disclaimer, that a vaccine wouldn’t be available until at least six months into a pandemic.
And technically, they are correct. One year, two years, or even three years. They all fall into that nebulous timeframe of at least six months.
But then, so does never.
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