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FAFfing about

BMJ 2007; 334 doi: (Published 28 June 2007) Cite this as: BMJ 2007;334:0
  1. Tony Delamothe, deputy editor
  1. tdelamothe{at}

    Somewhere, I imagine, there's a small group of people proud to be counted among the Friends of Avian Flu, or FAF for short. I suspect they have a catchy mission statement, such as “Keeping the nightmare alive,” and lapel badges of vaguely bird-like shape.

    Their challenge is to keep bird flu forever in the public eye. This should be getting harder, as influenza H5N1 is proving particularly resistant to undergoing the killer mutation that would allow efficient human to human transmission of the virus. Ten years after the strain first appeared in humans, it has killed just 191 people. This is despite the most propitious of circumstances: millions of people and poultry living in very close proximity in South East Asia. Although these deaths are a tragedy for the victims and their families, it's as well to remember that a similar number of people die on the roads world wide every 84 minutes.

    Traditionally, we've blamed the drug companies for talking up the risks of diseases, or even inventing diseases, but this is not the case with bird flu. The track record of oseltamivir (Tamiflu) as a treatment for H5N1 is decidedly mixed, and its use in seasonal flu has been linked to suicides and neuropsychiatric symptoms in Japanese teenagers. FAF has incorporated this pharmaceutical failure into its story for bird flu: The Drugs Don't Work. Be afraid. Be very afraid.

    FAF knows that the best way to generate column inches is high profile scientific conferences with well oiled media machines, and in this week's BMJ Richard Smith, our previous editor, reports on a session he chaired at a conference of Health Technology Assessment International (doi: 10.1136/bmj.39255.606713.DB). Some of the observations were familiar: the inevitability of the pandemic and the possibility of drug resistance. But others were relatively new: the terminological mutation from “avian flu” to “pandemic flu,” in recognition of H5N1's failure to mutate genetically.

    H5N1 had been groomed for stardom, but now it can be any influenza strain that becomes pandemic, further details unknown. As influenza pandemics occurred in 1918, 1957, and 1968, another one is likely. But why should we be any more worried in 2007 than in 1997 or 2017? Couldn't those responsible for planning for the next pandemic do their planning less publicly and put the frighteners on the rest of us at the appropriate time?

    For AIDS, however, it really is apocalypse now. Sceptics used to point out that there were more papers on AIDS than people with the condition, but that was a very long time ago. Sixty million people have now been infected with HIV and another 14 000 are acquiring the infection every day. A vaccine against HIV would seem the best way to halt the AIDS epidemic, but as Alison Tonks points out in her review, an effective vaccine is as far away as ever (doi: 10.1136/bmj.39240.416968.AD). The AIDS Vaccine Advocacy Coalition regards it as more challenging than landing a man on the moon. “When it came down to the space race, we knew where we were; we knew where the moon was; and we knew, roughly, how to get there. It was, essentially, an engineering problem. When it comes to an AIDS vaccine, we don't know where the moon is—yet.”