12.10.2005

Avian flu demands global response

Drug companies should be put under workers' control, argues Mary Godwin

Every few weeks reports about the advance of avian influenza towards Europe crop up in the news. In August there was alarm when the virus spread from the far east to Russia, despite efforts to contain it by the culling of tens of millions of birds in south-east Asia. After the outbreak in Russia, the EU increased monitoring of wild and domestic fowl and the governments of Germany and the Netherlands ordered farmers to keep poultry indoors to avoid contact with wild birds. Last week nearly 2,000 birds died from flu in Turkey, and the European commission responded by banning the import of live poultry from Turkey, as it had from Russia and regions in Asia where the disease occurs in birds. Carried by migrating wildfowl, avian flu spreads quickly, especially among birds living in confined conditions such as poultry flocks, and has killed people who have handled infected birds. Scientists fear the avian flu virus will evolve into a form which could be easily transmitted from human to human, with disastrous consequences. Influenza is normally a relatively mild disease in our species, although the elderly and those with chest problems or a weakened immune system are at risk from it. These vulnerable groups are already offered vaccination against expected strains of flu, and many large companies also provide such vaccination to their employees, calculating that the cost will be more than recouped by the reduction in time off sick. However, in a normal winter at least 10,000 deaths result from ordinary influenza in Britain, and flu epidemics with many times that number dying tend to happen every 20 to 30 years, although it has been 40 years since the last one. These epidemics can cause millions of deaths - the flu pandemic in 1918 notoriously killed more people than World War I: around 40 million. Now the World Health Organisation and other bodies are warning that a new pandemic is imminent, and predictions of anything between seven million and 200 million deaths globally have been made. A department of health contingency plan anticipates between 21,500 and 709,000 deaths in Britain in such an eventuality. Viruses such as those causing flu in animals, birds and humans are intermediate between living and non-living biological systems. They cannot reproduce except by subverting the protein-synthesizing machinery of host cells. Outside these cells they have no metabolism. Influenza viruses are spherical particles about a tenth of a thousandth of a millimetre in diameter, composed of a protein coat containing a circular molecule of RNA - material similar to the DNA that makes up the genetic blueprint of living cells. Biochemical reactions between the virus proteins and the host cell membranes enable the RNA to penetrate the cell and its nucleus, where it is copied thousands of times - along with codes for the synthesis and assembly of the protein molecules forming the coating and the enzymes needed to assemble the RNA and protein coat into new viruses. When assembly of virus progeny within the infected cell is complete, the cell dies and releases more viruses which can go on to infect other cells. How virulent a disease is, and how easily a given species can be infected by the virus causing it, is determined by the structure of the sub-units of the protein shell. Changes to the sequence of amino acids in the proteins of the shell produce a new strain of flu. Viral RNA can undergo mutations just as can DNA, but more usually when two related viruses infect the same cell simultaneously they exchange lengths of RNA, producing hybrid progeny in a natural biochemical process. Avian flu does not readily infect human beings, most cases being caused by close contact with sick birds. But it kills about three in four people who do become infected. The fear is that avian flu and human flu viruses simultaneously present in a human being or a pig may exchange genetic material and produce a strain that combines the contagiousness of ordinary human flu with the deadliness of the avian variety, leading to a pandemic. H5N1, the flu sub-type found in birds during the current outbreak, may be involved in this hybridisation and has been shown to be transmissible between humans. Like all viral diseases, flu is untreatable with antibiotics. However, antiviral drugs such as oseltamivir, marketed by Roche as Tamiflu, can make the symptoms of flu milder and help to prevent infection. As part of its preparation for the expected epidemic, the British government announced in March that it was spending £200 million on Tamiflu tablets for 14.6 million people. It claims that in the event of a pandemic these would be used to treat those with chronic disease, the over-65s and the very young. The best treatment option is vaccination, but it is difficult to know what vaccine to produce until an outbreak occurs and then to manufacture treatments in sufficient quantities. However, these problems could be overcome to a degree if governments invested sufficient money in vaccine production. Vaccines against flu are prepared from the protein coats of viruses from which the genetic material has been removed. These stimulate the immune system to produce antibodies against the virus and fight future infection much more effectively. Vaccines against H5N1 are being manufactured, and in July the UK government said it would buy two million doses of vaccine for key workers, identified in the press as doctors, nurses, transport staff, police and, if things get really bad, mortuary workers. However, this vaccine will provide only partial protection against a different strain of the flu. A better vaccine can only be prepared when the pandemic is underway and the exact structure of the causative virus is established - as things stand, it would take four to six months to prepare, according to some sources. What is more, research by the US National Institute of Allergy and Infectious Diseases found that effective vaccination against H5N1 requires very high doses of vaccine. Even working at maximum capacity, manufacturing plants could not currently produce more than 75 million doses of the high-strength H5N1 vaccine - not enough to protect everyone even in the developed world. So what do the authorities intend to do about it? The impact a natural disaster has depends on the organisation of society and the balance of class power. Huge numbers of lives could be saved if the working class acts on a global scale. Not only must we demand that the UK government spends more on antiviral drugs. Transnational drug companies like Roche must be brought under democratic control and run according to the principle of need, not profit. Without that bold step being taken untold suffering and death threatens. To meet the challenge of avian flu it is clear that there must be at least a tenfold increase in facilities for the production of H5N1 vaccine. Far from just protecting vital servants of the state and the rich and powerful, we demand that anti-flu drugs and vaccines be made generally available and distributed free of charge throughout the world. We refuse to sit idly by while the populations of Africa, Asia and Latin America are decimated. As a matter of urgency new factories must be built and existing plant and machinery quickly converted. Instead of a measly 75 million doses of H5NI vaccine, it is clear that 750 million doses would be nearer to what is needed. Whatever it takes, whatever is required - that is what should be done. In Britain the infrastructural facilities and emergency plans must be put in place now in preparation for the expected pandemic. There must, however, be transparency and there must be democracy. Instead of the whole operation being put into the dictatorial hands of unaccountable bureaucrats, the police and the army, we look to trade unions and popular involvement and control.