Poorer countries with no access to antivirals in pandemic could use
generic drugs to prevent deaths
29 June 2009
Almost 90% of the world’s population will not have timely access to
affordable supplies of vaccines and antiviral agents in the current
influenza pandemic, but it is possible that inexpensive generic drugs
that are readily available, even in developing countries, could save
millions of lives.
That’s the conclusion reached by an extensive review and analysis by
immunisation expert Dr David Fedson, published online by Influenza
and Other Respiratory Viruses within hours of the World Health
Organization declaring a pandemic.
Dr Fedson points out that seasonal flu resistance to antiviral drugs
like Tamiflu may make them ineffective in the pandemic and maintains
that without effective drugs some countries will have to rely on 19th
century public health measures to see them through the outbreak.
He is calling for urgent and sharply focused research to determine
whether drugs that reduce inflammation or modify the host response — the
way that the body responds to infection or injury — could be used to
manage the pandemic. And he believes that a lot could be learnt from the
work done on these commonly available generic drugs — which include
drugs to lower cholesterol and treat diabetes — by scientists not
involved in influenza research.
“Despite the best efforts of influenza scientists, pharmaceutical
companies and health officials, the stark reality is that although
studies of the molecular characteristics of influenza viruses have been
enormously informative, they have failed to explain the system-wide
effects that flu has on people who contract it.
“For example we still don’t understand why so many young adults died
in the 1918 pandemic, while the death rate for children was much lower.
I believe this is because researchers have focused on studying the
actual virus rather than how these particular hosts — the children and
young people — responded to the virus.
“Most of the world’s population lack realistic alternatives for
confronting the next pandemic and urgent research is vital. Otherwise
people everywhere might be faced with an unprecedented public health
Dr Fedson maintains that experiments by non-influenza scientists have
defined common cell signalling pathways for acute lung injury caused by
different agents, including the inactivated H5N1 influenza virus (bird
“Research suggests that giving patients anti-inflammatory and
immunomodulatory agents such as statins, fibrates and glitazones could
help to regulate the cell signalling pathways in patients who have
suffered acute lung injury, a common problem with influenza” he says.
“They can also help to reverse the cellular dysfunction and cell damage
that accompanies multi-organ failure.
“Cell signalling pathways play essential roles in the ability of
cells to perceive and correctly respond to their microenvironment. They
form the basis of development, tissue repair, immunity and normal tissue
“Statins are commonly used to lower cholesterol and prevent heart
disease — but have also been shown to be effective in reducing
hospitalisations and deaths from pneumonia. Fibrates modify fatty acid
metabolism and glitazones reduce blood glucose levels in type 2
diabetes. All of these drugs modify the cell signalling pathways
involved in acute lung injury and multi-organ failure. Moreover, they
are affordable generic drugs that are widely available even in
Dr Fedson points out that there is currently no logistical plan to
distribute supplies of pandemic vaccines to the non-vaccine producing
countries that contain 88% of the world’s population.
“In all likelihood, people in these countries won’t be able to obtain
supplies of pandemic vaccines or they will get them too late” he says.
“Many health officials have placed their hopes on stockpiles of
antiviral agents, but resistance to the most widely stockpiled agent,
Tamiflu, in seasonal flu outbreaks, has prompted concerns that similar
resistance could develop in any pandemic virus.
“It’s estimated that countries that do not produce influenza vaccines
will only have enough antivirals to treat one per cent of their combined
“At a scientific meeting in 2008 we heard that all of the people who
developed bird flu in Indonesia, and did not receive antiviral
treatment, died. This observation is terrifying. If this particular
virus were to develop efficient human-to-human transmission we could see
a global population collapse.
“Swine flu has only recently emerged so we have had less time to
study its effects. But any influenza pandemic is cause for great concern
regardless of what strain it is.”
International influenza expert and journal editor Dr Alan Hampson
says that it is essential that the focus on swine flu doesn’t distract
health professionals from the risk still posed by bird flu, which is
continuing to rise, particularly in Egypt.
“Wouldn’t it be a terrible irony if bird flu suddenly achieved the
ability to transmit readily in humans, possibly aided by widespread
infection of swine flu and that fact that most of our resources are
focussing on that” he says.
Dr Hampson, who has worked extensively with the World Health
Organization and is an influenza advisor to the Australian Government,
says that the WHO recommended that all countries should develop pandemic
“However, web-based evidence suggests that only 45 countries have
produced plans so far and these tend to be the more developed countries,
who may be less vulnerable” he says.
Influenza and Other Respiratory Viruses is the first journal
to specialise exclusively on influenza and other respiratory viruses. It
is the official journal of the International Society for Influenza and
Other Respiratory Virus Diseases (www.isirv.org), an independent
scientific professional society promoting the prevention, detection,
treatment, and control of influenza and other respiratory virus
The journal is providing all of its content free online at
www.influenzajournal.com and fast-tracking the publication of
articles to help clinicians stay up-to-date with the latest research and
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