Ready or Not?
An avian flu virus is on the brink of becoming a global pandemic, killing tens of millions of people. The U.S. is readying itself with vaccine stockpiles. Why aren't we?
Terry ONeill - January 3, 2005
A light drizzle muffles the sound of passing cars as a procession of men and women, most of them elderly, walk up to the glass doors at the front of a modern, six-storey office building in Port Moody, B.C., a 40-minute drive east of downtown Vancouver. Once inside, they ride an elevator to the second-floor offices of the Fraser Health Authority, where handmade signs direct them to a large, corner meeting room that has been converted into a temporary vaccination station.
Flu season has arrived once again in Canada, and business is brisk in the makeshift clinic. "It's by appointment," the receptionist says. "But we don't refuse anyone. You can take a number." About a dozen-and-a-half people are seated in four loosely arranged rows of padded chairs, filling out forms as they await their turn to be vaccinated by one of the two nurses on duty. It doesn't take more than 10 minutes of sitting before their number is called. Five minutes after that, they're vaccinated.
In all, more than a million people in British Columbia alone received free flu shots by the end of November, a testament to the efficiency and proper organization of the plans made by the B.C. Centre for Disease Control to tackle another impending flu season. "Everything went very smoothly," reports a satisfied William Seymour, 80, a retired federal government food inspector, just minutes after receiving his annual shot.
Seymour, who holds a doctorate in veterinary medicine, says he's been around long enough to know that sometimes managing epidemics--be they the flu, or something else--don't usually go this smoothly; that governments at all levels are prone to fumble the ball when it comes to responding to major disease outbreaks, whether among animals or humans. "I just think that all the time, or almost every time anyway, it seems the government is not fully prepared," he says.
In 1951 it was the spread of foot-and-mouth disease in Saskatchewan that caught government agencies flat-footed, resulting in a misdiagnosis of the disease that was not corrected until three months after an initial case, costing the economy today's equivalent of $15 billion. The Ontario government found itself scrambling to contain the deadly SARS outbreak in Toronto last year, botching the diagnosis on the first carrier, who had picked up the virus on a recent visit to China, and then prematurely relaxing containment strategies, allowing the virus to re-emerge in a second epidemic phase. Last year's avian influenza outbreak in the Fraser Valley required three separate federally ordered mass slaughters, culminating in the killing of virtually every single one of the area's 19-million chickens, ducks and turkeys before the disease was wiped out. And in November, a report from the Canadian Food Inspection Agency concluded that the federal government's response to the mad cow crisis in Alberta had been marked by bad planning, poor information-sharing and inadequate staffing.
None of these epidemics has yet proven to be virulent enough or spread rapidly enough to inflict any significant human toll. But in the near future, experts warn, we may not be so lucky. The World Health Organization predicts that somewhere in the indeterminate future looms a worldwide pandemic that will inevitably strike the globe with deadly force. The unknown plague may not hit for another 50 years. Then again, there are indications that it may be a lot sooner: experts are closely monitoring a strain of avian flu in Southeast Asia that is showing signs of rapid mutation and particular deadliness. But whenever it is that the pandemic finally arrives, will we be ready?
Canadian health authorities have acknowledged the dire threat posed by a global flu pandemic, and say they are making elaborate and costly preparations to prevent its spread, treat its victims and even bury its dead. In fact, building on the lessons learned in the SARS outbreak, many believe Canada to be among the best-prepared countries in the world to combat the looming pandemic. But that may not be saying much. On December 7, the country's foremost immunologists gathered in Montreal to assess Canada's preparedness for a flu pandemic. "We are optimistic that we are more prepared than most," Dr. Theresa Tam, associate director of the immunization and respiratory infections division of the Public Health Agency of Canada, told reporters. "But I think the reality is that there won't be enough vaccines." Other countries are ordering stockpiles of vaccines that many experts anticipate will prove critical in staving off pandemics, but not here. Dr. Danuta Skowronski, a physician-epidemiologist with the B.C. Centre for Disease Control, told the conference, "There's going to be very little tolerance for delays that could have been prevented . . . It will be unforgivable."
A key national-preparations document reveals that the government is still far from being fully prepared in many other ways. "Unfortunately, the world is not very well prepared for an influenza pandemic," says Maria Cheng, the Geneva-based spokesperson for the WHO's communicable diseases control and prevention program. "Only one country, the U.S., is at an advanced stage in developing a potential vaccine. WHO encourages all countries to consider stockpiling potential pandemic vaccine. The more countries that are working on such vaccines, the better it is for the global public health community."
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