Intended for healthcare professionals


Calibrated response to emerging infections

BMJ 2009; 339 doi: (Published 03 September 2009) Cite this as: BMJ 2009;339:b3471

In the information society, nobody thinks!

Dear Editor,

Nobody thinks in information society was the firm opinion of Michael
Chrichton, a US trained physician!

There is a novel way of testing new vaccines in an emergency
pandemic, we are told, by bypassing the regular mandatory human testing. I
wonder if the WHO has permitted this to be done by the drug companies!
The new European procedure, which was established by the Commission and
implemented by the EMEA, allows manufacturers to gain an authorisation for
a ‘mock-up’ vaccine before a pandemic has occurred. EMEA explains, in a
question answer document, thus: (

“A mock-up pandemic influenza vaccine is a vaccine that mimics the
future pandemic influenza vaccine in terms of its composition and
manufacturing method. However, because the virus strain causing the
pandemic is not known, the mock-up vaccine contains another flu strain
instead. This is a strain that is not circulating in humans, and to which
humans have not been exposed in the past. This enables the company to test
its vaccine in preparation for any flu pandemic that may occur in the
future, by carrying out studies with the mock-up vaccine that predict how
people will react to the vaccine when the strain causing a pandemic is

I am a bit concerned, may be the wiser ones amongst us would allay my
fears, about a couple of things here. The “mock-up” uses a new strain of
‘Flu vaccine. Does this mean that we have stockpiled many unknown but,
potentially dangerous, ‘Flu strains in our laboratories? Is this a normal
practice? If the virus has not been exposed to humans thus far, how are we
sure that the few individuals that we expose to this new strain are not
being made guinea pigs?

Even assuming that all the above are fine, when the pandemic hits in
future the virus strain would again be a new one like the mock up virus
and its reactions could be as unpredictable as that of the mock up virus.
Each virus would produce its own individual way of attacking humans. How
then are we sure that the mock up bypass is of any guidance? Reminds me of
bypassing the coronary epicardial arteries in chronic angina where the
culprit is the reduced coronary reserve in the millions of perforating
muscular vessels inside the myocardium. Are all bypasses in medicine
basically money spinners? This bypassing will give permission to
manufacturers to get new vaccines as and when they think fit using
whichever strain they think is needed. To me it looks as if we have put
the cart before the horse. Long before the pandemic has arrived efforts to
make vaccines have begun; rather vaccine manufacturing seems to be our
primary concern in a pandemic.

I strongly feel the whole science of vaccination needs a re-look in
view of the fact that only one viral disease, small-pox, has been
successfully eradicated so far by human effort. Every other vaccine could
be explained as only a partial success in so far as the virus has only to
mutate to bounce back with greater vigour. The vaccine will, of course, be
useless in that scenario. Edward Jenner used cow pox virus on James
Phipps. Cow pox virus is genetically different from small pox virus. It
was T. Z. Holwell, FRCP (London), FRS, who studied the protective power of
the Indian Ayurvedic vaccination system prospectively for twenty years in
"The Bengall" in the eighteenth century to suggest universal vaccination
that has eradicated small pox for ever. (1) Hopefully, all laboratories
will have destroyed their stock of that deadly small pox virus.
Holwell in his paper to the President and Fellows of the London Royal
College in 1767 AD did write that the Indian vaccination was not only
effective but done with great care and sophistication. Holwell even noted
that the vaccination system existed for “times out of mind” in India, and
has been effective for hundreds of years, which he strongly recommended
for universal use! I think that his original papers are preserved in the
library archives in Regents Park. Recently Douglas C Wallace, a noted US
geneticist, who has discovered some extra nuclear mitochondrial DNAs
(mtDNA) that are more useful for drug testing and disease prevention in
contrast to our conventional Mendalian genetics where only nuclear DNAs
are taken into consideration. (2)

Using his MITCHIP he has been able to find that Asian herbal
medicines are not only effective against many diseases including some
infections like malaria that he had tested, but has also shown that the
western pharmacology of chemical compounds for a target might even damage
the cell in the bargain. Could this be the bane of all our problems with
the deadly adverse drug reactions? We might have to take a leaf out of
Wallace’s work to think of a new science of vaccination.

Another point that worries me is the possibility of multiple
vaccinations confusing the human immune system. Children get nearly 20
vaccinations in infancy and many more after that. To cap it, now we have
the “mock-up” vaccines also getting ready! Real immunity comes from real
disease only. Vaccines create a mild form of the disease and we do not
know how effective that mild (forme frustae) disease would be in producing
anti-bodies. Lately frequent tetanus toxoid injections have been shown to
be useless if not dangerous. One could easily understand the anxiety and
enthusiasm to produce vaccines. The latter is the best business as the
whole world becomes vaccine customers for the business. My worry is: could
the recent spurt in auto-immune diseases have anything to do with this
preventive strategy of modern medicine? I could be wrong but, just in case
someone has an answer!!

One lead here seems apt. African Americans have the highest incidence
of autoimmune diseases compared the Caucasians, while Africans in Africa
have very low incidence of autoimmunity. While there could be many
imponderables, but one that might connect the two is that Africans have
many kinds of germs that their immune system has to fight against for
survival. Their nearly 150 odd genes that oversee the immune system are
busily engaged. While African Americans live in a relatively germ free
sterile environment in the US compared to Africa. May be the genes have no
work to do. Could they become naughty and produce anti-bodies against
their own body cells? (Horror auto-toxicus of Paul Ehrlich?)

Yours ever,


1) Hegde BM. Vaccination system in India. 1998; 46: 472-473.

2) Wallace DC. Mitochondrial Chi. Genetics 2008; 179: 727-735.

Competing interests:
None declared

Competing interests: No competing interests

07 September 2009
BM Hegde
Editor-in-Chief, Journal of the Science of Healing Outcomes
Mangalore-575004, India