Taking avian flu seriously

Posted: Oct 28, 2005 12:05 AM

The media makes a lot of money trying to scare people. Reports of shark attacks, global warming and other impending disasters are frequently blown out of proportion.  Even coverage of real threats like SARS is hyped to nearly unbelievable levels. So when the news stories about “bird flu” started flooding in, most Americans probably tuned them out and assumed there was nothing to worry about.

But when the experts grow concerned, Americans start to take notice. Take the work of the team at Tech Central Station on the avian flu, for example. Those who usually spend their days debunking “junk science” are not scoffing this time; they are calling for action. Noting the cycles of deadly flu in world history, TCS columnist James Pinkerton acknowledges that “it could be that the bird flu is the Next Big Nothing. But since we know that history has a way of repeating itself, it’s a cinch that we have calamitous epidemics in our future, as we did in our past.”

TCS editor Nick Schulz is using the momentum created by President Bush’s recent comments about bird flu to press forward for long-term solutions.  “Stung by criticism over the unpreparedness of government at all levels to address Hurricane Katrina,” he wrote two weeks ago, “President Bush has been taking steps to make sure another disaster doesn’t embarrass his administration.” Just as Katrina exposed how the levees in New Orleans hadn’t been properly protected, Schulz hopes that the avian flu threat will illustrate how American anti-business policies have slowly eroded our ability to combat new health threats.

According to Henry I. Miller of the Hoover Institution, the H5N1 strain already has two of the three characteristics of a pandemic: it can jump from birds to humans, and it can cause a very serious – even fatal – illness.  If the strain evolves into one that is highly contagious among humans, a pandemic may very well occur.

In an age of technology and innovation, Americans rarely have to worry about illnesses spreading uncontrollably. However, there is no vaccine for this new flu strain, and nothing is coming down the pike either. There is only one anti-flu drug that has proven to prevent some cases of the H5N1 strain: Tamiflu, distributed by the Swiss drug company Roche. 

As expected, governments around the world are now stockpiling as many doses of Tamiflu as they can get their hands on – which isn’t much.  Currently the U.S. can treat about 2 million people, and their next order of 3 million treatments won’t be filled until next year. Just yesterday Roche temporarily halted Tamiflu shipments to the U.S. to prevent hoarding. As U.S. Sen. Bill Frist (R-TN) noted recently, “our national stockpiles of anti-viral drugs sit at dangerously low levels – about 2 percent of what we would need in a serious outbreak.” 

Of course, we’re not the only ones waiting for Tamiflu, and several other nations – Japan, Indonesia, Croatia, Russia, Sweden, Romania and Greece – have already reported finding the strain. Imagine their sense of urgency.

It all leads to two big questions: 

How can the U.S. get more Tamiflu?
Not surprisingly, many have called for Roche to give up its patent rights to Tamiflu, so that anyone can make the drug. It sounds like a generous idea, until one considers that the offer isn’t from those who have paid millions of dollars to develop and distribute the drug. Benjamin Zycher of the Pacific Research Institute does a marvelous job describing what a similar policy did to the makers of Cipro during the anthrax scare:

When the potential terrorist use of anthrax became a serious concern in 2001, the Centers for Disease Control and Prevention asked Bayer Pharmaceutical (the producer of Cipro) to obtain Food and Drug Administration approval to label the drug for treatment of anthrax. Bayer did so at its expense, and then donated 4 million doses to the federal government.

The feds then demanded an additional one million doses at a discounted price. When Bayer balked, the government threatened to suspend the patent on Cipro and thus forced Bayer to sell the additional doses at one-quarter of the market price. Other major purchasers of Cipro then demanded that same price. Moreover, Bayer enjoyed no liability protection against potential lawsuits stemming from any side effects of Cipro. Inside the Beltway, it is no mere cliché that no good deed goes unpunished.

Those who believe that drug companies have a moral responsibility to lose money in order to save lives “ignore the future lives that will not be saved because of an artificial decrease in incentives to develop new and improved medicines,” says Zycher.

For its part, Roche is trying to be cooperative. It donated three million doses of Tamiflu to the WHO for distribution in poor nations. The company also agreed earlier this month to consider granting licenses to qualified drug manufacturers who were able and willing to produce Tamiflu. In addition, Roche plans to build a plant in the United States, although the American plant wouldn’t be able to produce drugs until late 2006.

Other proposed free-market solutions would also respect the property rights of Roche while encouraging further production. Tyler Cowen of George Mason University suggests that the United States “offer Roche a large prize for speeding up the construction of the U.S. plant.” TCS editor Schulz would like President Bush to have the FDA “fast-track approval of other, already established plants in the United States for manufacturing the ingredients of Tamiflu.”

It seems that property rights, profit, and production can coexist after all.  But Tamiflu isn’t the ultimate panacea.

The real need: A vaccine

Tamiflu is not a cure for bird flu, or even an effective long-term solution.  According to Miller:

[I]n the absence of sufficient amounts of an effective vaccine – which is not yet within reach – to blunt a pandemic we would need to treat perhaps a third to a half of the population with Tamiflu.  Do the math: 100 million people for 100 days equals 10 billion doses, at retail costs of $80 billion, in order to blunt the pandemic’s first wave.

Flu pandemics tend to have two or three waves, and the U.S. has plans to buy only 20 million doses when 10 billion are needed for one wave alone. Obviously, Tamiflu is not the permanent answer. We need a vaccine, a drug that will provide long-term immunity after just one or two doses. 

But thanks to the anti-business policies of the U.S. government and international community, the number of companies producing vaccines has fallen by 80 percent since 1970.  Pinkerton notes, “U.S. government mismanagement… is undercutting the productive and lifesaving fundamentals of the pharmaceutical industry.”

Even if bird flu isn’t the next big pandemic, the world faces a vaccine crisis that will come to a devastating climax unless long-term solutions are established. 

“Panicking is not going to do us any good.  When people panic due to needless alarmism, they make poor decisions either on the individual or government level,” said Schulz.  “We need to decide now what sort of structures we need to have in place to make sure we have technologies and techniques ready in the U.S. and elsewhere when the next outbreak occurs.”

For instance, Miller suggests, “public policy must reward both inputs on research and development (via grants, tax credits and the waiver of regulatory registration fees) and outputs of products (with guaranteed purchases, payments for the regulatory approval of new drugs or vaccines, and indemnification from liability claims).” 

Tech Central Station, which has been covering global health and other science and technology issues since its founding five years ago by American Enterprise Institute fellow Jim Glassman, is a fitting place to compile ideas such as these – ideas that if implemented, will save millions of lives.