Forget SARS: WHO Expert Says He Fears the Flu More

CAL/AAEM News Service pottsbri@yahoo.com
Wed, 4 Jun 2003 10:07:43 -0700 (PDT)


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WSJ.com

Thursday, May 29, 2003

 

Forget SARS: WHO Expert Says He Fears the Flu More

By GAUTAM NAIK 
Staff Reporter of THE WALL STREET JOURNAL


As an expert on SARS, Klaus Stohr works 16-hour days, sometimes in virtually the same clothes as the day before, and often juggling three phone calls at once. But his chief worry isn't SARS. It's flu.

Not any old flu, but a long-awaited influenza pandemic that could spark a massive crisis in public health. This sort of virus could circle the globe in less than six months, long before a vaccine is ready. Though antiviral drugs exist, not a single country has stockpiled them in anticipation of an outbreak. And there are glaring cracks in the flu pandemic surveillance systems of many countries, especially those in the developing world.

"We're not prepared," says Dr. Stohr, the scientist who heads the World Health Organization's influenza program and is also leading the agency's fight against severe acute respiratory syndrome, or SARS. Compared with the devastation of a flu pandemic, he adds, "SARS will be something to smile about."

Influenza is one of the oldest and most common diseases known to man. But a flu pandemic would be a lot harsher than the flu bug that causes millions of Americans to call in sick each year. Annual flu outbreaks occur when the structure of the virus undergoes small changes, permitting it to evade the immunity that people have acquired from previous infections or from vaccinations. But sometimes the surface proteins of a flu virus known as influenza A change dramatically, and nobody has immunity against such a bug. If it also acquires the ability to spread from person to person, the stage is set for a pandemic.
BATTLING SARS


• For full coverage, see SARS: Containing the Outbreak.
 
• See the latest toll from the deadly SARS virus by country.
 
• See an interactive graphic of how the SARS epidemic spread.
 
• See a comparison of SARS and other recent health scares.
 

The damage can be catastrophic. The Spanish flu pandemic of 1918 killed more than 40 million people, while those of 1957 and 1968 together felled some four million. By comparison, SARS is a lot less infectious, and it has caused fewer than 750 deaths so far.

Global jet travel and urban overcrowding increase the risk. The WHO projects that in developed countries alone the next pandemic could cause up to 2.3 million hospitalizations and 650,000 deaths in less than two years. The toll in developing countries could be worse. Countries that belong to the WHO have recognized the danger only recently. Earlier this month, they passed a resolution underscoring the need to improve flu surveillance and response.

Influenza pandemics have occurred historically at 25-year intervals. Since the last one swept the world 35 years ago, the conclusion is hard to avoid: We're due. "It's not a matter of if, but when, this will happen," says Albert Osterhaus, a Dutch scientist involved in pandemic preparedness planning in Europe. "I'm far more scared of a flu pandemic than I am of SARS.
 
So is 44-year-old Dr. Stohr, who trained as a vet in East Germany and later became an expert in diseases that jump from animals to people. He joined the WHO in 1992 after impressing the agency with his work in rabies control. Two years ago, he was named head of the WHO influenza program and was asked to revamp it.

The program then was poorly regarded. Focusing on vaccine development and reacting slowly to global outbreaks, it largely responded to flu as if it were only a problem for developed countries. Dr. Stohr quickly discovered that he faced an uphill task when he tried to get appointments with some scientists, flu vaccine makers and governments, and was turned down.

But thanks to his strong scientific credentials and unflappable manner, Dr. Stohr was able to persuade potential partners to allow the WHO to take a bigger role in tackling flu. The key selling point was that although flu was a common problem, there wasn't enough coordination in fighting the disease, says Dr. Stohr. The WHO's flu-monitoring network today consists of 112 labs in 83 countries. One of its jobs is to organize the composition of each year's flu vaccine. Another is to look for the Big One -- Dr. Stohr's phrase for the expected flu pandemic.

Since 1976, there have been some half-dozen outbreaks of flu deemed to be unusual, and possibly marking the start of a pandemic. Authorities feared the worst in 1997, when a chicken flu virus, known as H5N1, sickened 18 people in Hong Kong and killed six, causing a panic. That year, when Dr. Stohr went to Hong Kong to advise health authorities, he was forced to stay in an out-of-the-way hostel to avoid dozens of news-hungry journalists. "I had to change cars three times" to throw them off the trail, he recalls. On the WHO's recommendation, Chinese authorities destroyed more than a million chickens, preventing the further spread of H5N1 to people.

Outbreaks of bird flu follow certain patterns. For example, such viruses tend to infect an intermediate mammal species -- such as pigs -- before mutating further and jumping to people. That's why, when the H7N7 strain of avian flu emerged two months ago in the Netherlands, the experts were puzzled.

For starters, the bug broke out in a west European country, not in impoverished, rural China, the suspected birthplace of SARS. (A likely reason: the use of modern animal farming methods in the Netherlands that pack millions of chickens and pigs in close quarters and make it easier for flu viruses to spread.)

The other mystery was that H7N7 apparently skipped the "intermediate mammal" step and went straight from birds to people, something scientists didn't think was possible before. "It's an explosive mix," says Dr. Osterhaus, a virologist at Erasmus University in Rotterdam. "If avian flu is present in people at the same time as human influenza virus, we could have the start of the pandemic."

With rapid speed, H7N7 spread from the Netherlands to Belgium and Germany, infecting more than 80 people and killing one. Dr. Osterhaus had already alerted Dr. Stohr of the WHO, and he pointed out that the virus had even jumped from person to person -- an early sign of a potential pandemic. In response, the Netherlands raised its "pandemic preparedness plan" from level zero to level one, a first in Dutch history. But eventually H7N7 was brought under control, mainly through the slaughter of more than 30 million chickens in affected countries.

Nonetheless, the string of unusual infections in recent years -- H5N1, H7N7 and SARS -- suggests that the Big One may not be far off. Says Dr. Stohr: "These are signals from Mother Nature. If we don't prepare for the pandemic now, complacency will be paid for in human lives."

Write to Gautam Naik at gautam.naik@wsj.com

Updated May 29, 2003



Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC-Irvine

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<P class=articleTitle style="MARGIN: 0px">WSJ.com</P>
<P class=articleTitle style="MARGIN: 0px">Thursday,&nbsp;May&nbsp;29,&nbsp;2003</P>
<P class=articleTitle style="MARGIN: 0px">&nbsp;</P>
<P class=articleTitle style="MARGIN: 0px">Forget SARS: WHO Expert Says He Fears the Flu More</P><SPAN style="FONT: bold 12px times new roman, times, serif">
<P style="FONT: bold 12px times new roman, times, serif">By <B>GAUTAM NAIK</B> <BR><SPAN style="FONT: bold 10px times new roman, times, serif"><B>Staff Reporter of THE WALL STREET JOURNAL</B></SPAN><BR></P></SPAN>
<P class=times>As an expert on SARS, Klaus Stohr works 16-hour days, sometimes in virtually the same clothes as the day before, and often juggling three phone calls at once. But his chief worry isn't SARS. It's flu.</P>
<P class=times>Not any old flu, but a long-awaited influenza pandemic that could spark a massive crisis in public health. This sort of virus could circle the globe in less than six months, long before a vaccine is ready. Though antiviral drugs exist, not a single country has stockpiled them in anticipation of an outbreak. And there are glaring cracks in the flu pandemic surveillance systems of many countries, especially those in the developing world.</P>
<P class=times>"We're not prepared," says Dr. Stohr, the scientist who heads the World Health Organization's influenza program and is also leading the agency's fight against severe acute respiratory syndrome, or SARS. Compared with the devastation of a flu pandemic, he adds, "SARS will be something to smile about."</P>
<P class=times><B><FONT color=#660000>Influenza</FONT></B> is one of the oldest and most common diseases known to man. But a flu pandemic would be a lot harsher than the flu bug that causes millions of Americans to call in sick each year. Annual flu outbreaks occur when the structure of the virus undergoes small changes, permitting it to evade the immunity that people have acquired from previous infections or from vaccinations. But sometimes the surface proteins of a flu virus known as influenza A change dramatically, and nobody has immunity against such a bug. If it also acquires the ability to spread from person to person, the stage is set for a pandemic.</P>
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<TD class=plnEleven style="PADDING-BOTTOM: 5px; PADDING-TOP: 5px"><SPAN class=boldThirteen>BATTLING SARS</SPAN><BR>
<DIV width="100%"><IMG height=1 alt="" src="http://online.wsj.com/img/g.gif" width="100%"></DIV>
<DIV width="100%"><IMG height=5 alt="" src="http://online.wsj.com/img/b.gif" width="100%"></DIV><SPAN class=plnEleven>•</SPAN>&nbsp;For full coverage, see <A class=plnEleven href="http://online.wsj.com/page/0,,2_1011,00.html">SARS: Containing the Outbreak</A>.<SPAN style="FONT-SIZE: 5px"><BR>&nbsp;<BR></SPAN><SPAN class=plnEleven>•</SPAN>&nbsp;<A class=plnEleven href="http://online.wsj.com/article/0,,SB104922980154110400,00.html?mod=article-outset-box">See the latest toll</A> from the deadly SARS virus by country.<SPAN style="FONT-SIZE: 5px"><BR>&nbsp;<BR></SPAN><SPAN class=plnEleven>•</SPAN>&nbsp;<A class=plnEleven href="javascript:%20window.open('http://online.wsj.com/documents/info-sarsspread03-fset.html','sarsspread03','toolbar=no,scrollbars=no,location=no,width=710,height=510,left=70,top=30'); void('');">See an interactive graphic</A> of how the SARS epidemic spread.<SPAN style="FONT-SIZE: 5px"><BR>&nbsp;<BR></SPAN><SPAN class=plnEleven>•</SPAN>&nbsp;<A class=plnEleven !
 href="javascript: window.open('http://online.wsj.com/documents/info-sars03-frameset.html','sars03','toolbar=no,scrollbars=no,location=no,width=600,height=510,left=20,top=30'); void('');">See a comparison</A> of SARS and other recent health scares.<SPAN style="FONT-SIZE: 5px"><BR>&nbsp;<BR></SPAN></TD>
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<P class=times>The damage can be catastrophic. The Spanish flu pandemic of 1918 killed more than 40 million people, while those of 1957 and 1968 together felled some four million. By comparison, SARS is a lot less infectious, and it has caused fewer than 750 deaths so far.</P>
<P class=times>Global jet travel and urban overcrowding increase the risk. The WHO projects that in developed countries alone the next pandemic could cause up to 2.3 million hospitalizations and 650,000 deaths in less than two years. The toll in developing countries could be worse. Countries that belong to the WHO have recognized the danger only recently. Earlier this month, they passed a resolution underscoring the need to improve flu surveillance and response.</P>
<P class=times><B><FONT color=#660000>Influenza</FONT></B> pandemics have occurred historically at 25-year intervals. Since the last one swept the world 35 years ago, the conclusion is hard to avoid: We're due. "It's not a matter of if, but when, this will happen," says Albert Osterhaus, a Dutch scientist involved in pandemic preparedness planning in Europe. "I'm far more scared of a flu pandemic than I am of SARS.</P><IMG height=231 alt="[Image of Klaus Stohr]" src="http://online.wsj.com/public/resources/images/Stohr_Klaus-GC52904202003213733.gif" width=136 align=right border=0> 
<P class=times>So is 44-year-old Dr. Stohr, who trained as a vet in East Germany and later became an expert in diseases that jump from animals to people. He joined the WHO in 1992 after impressing the agency with his work in rabies control. Two years ago, he was named head of the WHO influenza program and was asked to revamp it.</P>
<P class=times>The program then was poorly regarded. Focusing on vaccine development and reacting slowly to global outbreaks, it largely responded to flu as if it were only a problem for developed countries. Dr. Stohr quickly discovered that he faced an uphill task when he tried to get appointments with some scientists, flu vaccine makers and governments, and was turned down.</P>
<P class=times>But thanks to his strong scientific credentials and unflappable manner, Dr. Stohr was able to persuade potential partners to allow the WHO to take a bigger role in tackling flu. The key selling point was that although flu was a common problem, there wasn't enough coordination in fighting the disease, says Dr. Stohr. The WHO's flu-monitoring network today consists of 112 labs in 83 countries. One of its jobs is to organize the composition of each year's flu vaccine. Another is to look for the Big One -- Dr. Stohr's phrase for the expected flu pandemic.</P>
<P class=times>Since 1976, there have been some half-dozen outbreaks of flu deemed to be unusual, and possibly marking the start of a pandemic. Authorities feared the worst in 1997, when a chicken flu virus, known as H5N1, sickened 18 people in Hong Kong and killed six, causing a panic. That year, when Dr. Stohr went to Hong Kong to advise health authorities, he was forced to stay in an out-of-the-way hostel to avoid dozens of news-hungry journalists. "I had to change cars three times" to throw them off the trail, he recalls. On the WHO's recommendation, Chinese authorities destroyed more than a million chickens, preventing the further spread of H5N1 to people.</P>
<P class=times>Outbreaks of bird flu follow certain patterns. For example, such viruses tend to infect an intermediate mammal species -- such as pigs -- before mutating further and jumping to people. That's why, when the H7N7 strain of avian flu emerged two months ago in the Netherlands, the experts were puzzled.</P>
<P class=times>For starters, the bug broke out in a west European country, not in impoverished, rural China, the suspected birthplace of SARS. (A likely reason: the use of modern animal farming methods in the Netherlands that pack millions of chickens and pigs in close quarters and make it easier for flu viruses to spread.)</P>
<P class=times>The other mystery was that H7N7 apparently skipped the "intermediate mammal" step and went straight from birds to people, something scientists didn't think was possible before. "It's an explosive mix," says Dr. Osterhaus, a virologist at Erasmus University in Rotterdam. "If avian flu is present in people at the same time as human influenza virus, we could have the start of the pandemic."</P>
<P class=times>With rapid speed, H7N7 spread from the Netherlands to Belgium and Germany, infecting more than 80 people and killing one. Dr. Osterhaus had already alerted Dr. Stohr of the WHO, and he pointed out that the virus had even jumped from person to person -- an early sign of a potential pandemic. In response, the Netherlands raised its "pandemic preparedness plan" from level zero to level one, a first in Dutch history. But eventually H7N7 was brought under control, mainly through the slaughter of more than 30 million chickens in affected countries.</P>
<P class=times>Nonetheless, the string of unusual infections in recent years -- H5N1, H7N7 and SARS -- suggests that the Big One may not be far off. Says Dr. Stohr: "These are signals from Mother Nature. If we don't prepare for the pandemic now, complacency will be paid for in human lives."</P>
<P class=times><B>Write to</B> Gautam Naik at <A class=times href="mailto:gautam.naik@wsj.com">gautam.naik@wsj.com</A></P><!-- article end -->
<P class=article><I>Updated May 29, 2003</I></P></DIV><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC-Irvine<p><hr SIZE=1>
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