Rapid Responses to:

NEWS: In brief BMJ 2004; 329: 816 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Bird Flu Action

Peter Dunnill   (12 October 2004)

Bird Flu Action 12 October 2004
Peter Dunnill, Professor University College London, WC1E 7JE Send response to journal: Re: Bird Flu Action	Bird Flu Action I write to your medical audience as one who is concerned with the making of advanced medicines to ask for action. Your columns have for some while carried warnings that we are approaching a real possibility of a flu pandemic and you noted on Oct 9th that a first case may have been recorded of a human to human transfer of the H5NI strain. I detect a sense of hopelessness in the medical community over events but yours is the only one that has the capacity to address the issue forcefully and in the process to protect your own lives as the front line group most at risk. You can act in three ways. Firstly, you have the power as an influential lobby to persuade government that it should do more to make available necessary vaccine. Secondly, you can influence it to commit research to better and faster methods of producing vaccine and underpinning commercial investment to make that available. The present use of fertile hen’s eggs is archaic and requires a six month cycle for supply. Thirdly you could press for a large pilot trial of the use of a neuraminidase inhibitor, probably oseltamivir. It is not yet clear whether this drug is effective against H5NI but evidence with current strains is that it must be used early, so late action will be useless. The unspoken position by Government is that to issue the drug on the off chance of its need would be financially unthinkable. However I believe, carefully explained, many people would consider a private prescription a sensible bi-annual insurance premium. Limiting prescriptions to one per family member per 2 years of drug shelf life would put the onus on the public not to misuse the drug. It could be argued that poorer people would be disadvantaged but in reality a reasonable uptake would help to create a fire wall, and one ready in the households rather than in central stores. It would also raise manufacturing capacity, which cannot be turned up quickly at will. I can imagine the distaste which GPs might have for yet another task but it would be as nothing to their burden if a pandemic occurs – the less infectious SARS impact on Toronto doctors is indicative. Plainly any population-wide use of a relatively new drug carries risk which is why a well rehearsed pilot trial would be valuable. The initial risk with H5NI vaccine will probably be higher. We may be lucky and see a phase of poor human to human transfer in the Far East before the virus finds an optimum form. We need to use that window. Governments do not listen to engineers though we end up with the challenge of making drugs or vaccines. They do listen to doctors so please lets have a debate and if you do not like the oseltamivir idea please suggest a better one. Thinking why nothing can be done is not a responsible response. Yours sincerely Peter Dunnill Competing interests: None declared