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As I speculated last week, as a durect result of tests showing only one vaccination might be required to confer full immunity to H1N1/2009 "swine" flu, the WHO is asking the wealthier nations to donate vaccine to the poorer nations.

I had speculated that the United States should seriously consider this option, as long as we could also gain a functional amount of "herd immunity."  Go back two or three blogs and you will find the story, dated 9/11/09.

Here is the story from Bloomberg.  Remember you can always count on this blogsite to give you good, informed speculation.  Share it with your friends!

One-Shot Swine Flu Results May Spur Vaccine Sharing, WHO Says

By Michelle Fay Cortez

Sept. 16 (Bloomberg) -- The World Health Organization is in talks with the U.S. and other developed countries about using pandemic flu vaccine from their stockpiles for poorer nations after studies suggested only one shot is needed for protection.

Half a dozen trials released in the past week found a single injection of swine flu vaccine protected most healthy adults from the virus known formally as H1N1, with infection- fighting antibodies produced in as little as eight days. U.S. regulators approved shots from four manufacturers yesterday, clearing the way for immunizations to start within weeks.

“This is all contingent on these early reports” from the studies, said David Mercer, acting head of the communicable diseases unit of the WHO’s European region, which met in Copenhagen this week. “It may be possible that a single dose is protective, which would double the number of people that could be immunized.”

Public health officials expected it would take two doses to trigger immunity to the infection, a novel mix of swine, avian and human influenza. Countries including the U.S., U.K., France, Belgium, Finland, Sweden and Australia have already placed orders for the vaccine. Additional studies are needed to confirm the finding that only one shot is needed and can ensure protection for children and other high-risk groups.

“Some countries may have excessive stocks of vaccine and some won’t see the demand they have expected,” said Thomas Zeltner, director of Switzerland’s Federal Office of Public Health. “What is needed here is a good dialogue to ensure the reasonable use of vaccination.”

Active Discussions

The U.S. is in “very active discussions” about donating some of its supply to countries that need it, said Nancy Cox, director for the flu division of the U.S. Centers for Disease Control and Prevention. The U.S. has about 600 million doses in advance purchase agreements from GlaxoSmithKline Plc, Novartis AG, CSL Ltd., AstraZeneca Plc and Sanofi-Aventis SA.

In a best-case scenario, the U.S. may need only half that amount, said Rebecca Martin, medical officer at the United Nations health agency’s European communicable diseases unit. It’s too soon to know if that will be the case, she said.

“We welcome the initial findings of some clinical trials,” WHO Director-General Margaret Chan said in a statement. “We cannot conclude now how many doses would be required for different groups.”

The U.K., which has ordered 132 million doses, is still planning two shots for each person and is monitoring the clinical trials, according to a Department of Health spokeswoman who declined to be named in line with government policy.

Age Groups

More data from the studies will be coming in mid-October about how effective the vaccine is in different age groups, Martin said in an interview.

“This is not just in the European region,” Martin said. “We’re all dipping into the same pool of vaccine.”

CSL, based in Melbourne, said it plans to donate the vaccine to developing nations in Asia and the South Pacific and is discussing a pilot program with the WHO to start by providing as many as 100,000 doses. Paris-based Sanofi, London-based Glaxo, and Basel, Switzerland-based Novartis are among the other companies making the vaccine.

As many as 2 billion people, or 30 percent of the world’s population, may become infected by the new virus as it spreads globally, according to the Geneva-based WHO. While fewer than 0.5 percent of sufferers may need hospitalization, those who do may require critical care for up to three weeks, overwhelming intensive-care units.

Concern that vaccine bought by governments might not get used by their people may make countries more inclined to share supplies with poorer nations, said Marie-Paule Kieny, director of the WHO’s Initiative for Vaccine Research.

“Some countries may take a more altruistic view now,” she said. “We will see this fear of not being able to use all of it and concern of public money being spent unwisely, and you may now start to see generosity mushrooming.”

###

The newspapers are positively aglow with the recent studies which seem to indicate the H1N1/2009, (aka swine flu) vaccine can confer immunity with one shot, and after only ten days. And justifiably so!  For the news is good.

Previously, scientists and researchers postulated that it would take two jabs, spaced three weeks apart, in order to deliver enough attenuated inert virus  to confer immunity to swine flu.

So this study, on the surface, is decidedly good news.  The ramifications of this are nothing short of spectacular.  First, it means the entire seed virus-to-vaccine chain performed surprisingly well and was also surprisingly nimble.  As you recall, initial seed virus stock was very slow to grow, and the CDC and WHO had to whip up a faster-growing batch of seed virus stock to send to vaccine manufacturers.

Second, there had to be enough eggs, and those eggs had to be free of cross-contamination.  So as Earl Butz, late of this earth and the Ford Administration famously said, the roosters of America did their duty.

It also means very little virus "drifted" during manufacturing, and it speaks volumes about the research and quality control that the vaccine industry has undertaken since the debacle of 2004-05's flu season.  For more information and a superb primer on vaccine manufacture, read the book "A Warning Shot: Influenza and the 2004 Flu Vaccine,"by Timothy Brookes and the staff at Johns Hopkins. 

The US government ordered 195 million doses of the new H1N1/2009 monovalent vaccine.  The calculus performed was that most Americans would need two jabs, as I said earlier.  Now if these initial test results hold firm, it means we will now have double the available vaccine than we thought we had a month ago.

The projected available vaccine doses equals 62% of the American population.  I dare say that if we were to vaccinate everyone in the high-risk groups, plus virtually all school-age children under 25, we stand a very good chance of reaching the Holy Grail of Herd Immunity. Herd Immunity is when enough people are vaccinated against a virus, that virus can no longer gain a beachhead in a community.  It fails to achieve the critical mass necessary to sustain human-to-human transmission.  Herd Immunity means the virus cannot infect enough hosts in a chain, and the chain breaks.  Think a viral chain mail/email scheme that breaks due to unwilling participants.

Same thing:  The virus' chain of transmission is broken when enough people are vaccinated, predominantly the young.  It is the young -- schoolchildren and college students -- who pass this virus (and all flus) on to their family members and then on to the community at large.  You break that chain, you break the pandemic.

So the Quest for Herd Immunity against a pandemic virus is within the reach of Americans.  It decidedly does not mean the same for persons within developing nations, however.  And I would not be the least bit surprised if persons such as Supari of Indonesia and others begin clamoring for vaccines, since everyone thought it would take two jabs anyway. It might be appropriate for the favored nations to siphon off some of their vaccine to the WHO for use in developing nations. 

Even if we were to siphon off some vaccine, the goal of herd immunity against H1N1/2009 could be within reach.  Let us hope that the final test reports confirm the initial speculation.  We could use some good news now!

CIDRAP stands for the Center for Infectious Disease Research and Policy at the University of Minnesota.  Its director is the world-famous Dr. Michael Osterholm.  Dr. Osterholm advises everyone from the White House to Oprah on infectious disease.  Dr. Mike is also an expert on bioterrorism and has advised DHS many times on lethal bio-engineered pathogens.  He wrote a book, Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe. I should point out that Dr. Osterholm wrote this a year before the anthrax attacks of October, 2001.

The upcoming summit is titled "Keeping the World Working During the H1N1 Pandemic -- protecting employee health, critical operations and customer relations."  Its focus is on those final steps that corporations, businesses and governments need to take to ensure they do not implode when the second and third waves of H1N1 traverse the globe.

Brazil has just passed the United States in the number of confirmed deaths due to H1N1(2009)V Skyhook swine flu. Or whatever the Heck we are supposed to call it these days.

Anyway, the number down there is 557, compared to 522 in this nation. This is a race we do not need to win. Argentina is third, with 439 deaths.

The bad news within the bad news is that South America leads the world not just in the sheer numbers of swine flu deaths, but in overall mortality.This is further reinforcement of the blog I wrote a few weeks ago, talking about just how hard South America got hit with H1N1v.

Here's the AFP story:

Brazil tops global swine flu toll with 557 deaths: officials

(AFP) – 17 hours ago

SAO PAULO — Brazil now has 557 swine flu deaths, making it the country with the highest number of fatalities in the world from the disease, according to figures announced by the health ministry Wednesday.

The toll puts it ahead of the latest count from the United States, which as of August 20 had 522 swine flu deaths, according to the US Centers for Disease Control and Prevention.

Brazil's health ministry said in a statement the government was freeing up one billion dollars to buy 73 million doses of a new vaccine being developed against swine flu, as well as Tamiflu stocks, hospital equipment and diagnostic gear.

It added that the infection rate appeared to be diminishing in the country, which is about to exit the southern hemisphere winter at the end of this month.

The ministry stressed that, as a ratio of its population of 190 million, Brazil's mortality rate from the virus ranked 7th in the world.

Argentina, Chile, Costa Rica, Uruguay, Australia and Paraguay all had higher rates on that basis, it said, referring to data from the European Center for Disease Prevention and Control.

The United States, which has a population of 300 million, came 13th on the list.

The Americas is the worst-hit region in the world in terms of swine flu deaths, accounting for more than 90 percent of the global count given by the World Health Organization.

After Brazil and the United States, Argentina is the country to suffer the most, with at least 439 swine flu deaths.

Over the past three days, it has been my pleasure to bring you the journal of the South American swine flu ordeal suffered by FSU law student Christin Foster.  She documented concisely her negative experiences in Argentina, along with her successful diagnosis and treatment in Chile.  She concluded the series with a comparison of her experience with her friend Malady, who had to suffer both the virus and the Argentine government's incompetence and mishandling of the entire incident.  My words, not hers.  But can any rational person conclude otherwise?

So what are the lessons learned from this South American onslought?  Plenty. 

First, treat people as thinking individuals who can withstand news, as bad as it might get.  I am so sick and tired of hearing "We have to be careful not to induce panic or incite panic."  It is the absence of reliable information that incites panic, not the presence of it!  Those who would withhold information for the sake of reducing panic are the same people who think people cannot think for themselves.  That line of thought is encroaching into the national health care debate, with predictable results. 

Tell people the truth.  If it's bad, tell them it's bad.

Second, prepare for inconsistencies before they happen.  Try to anticipate these things.  Look at the mishandling of the Tamiflu situation in Argentina.  That government's inept decision-making borders on the criminal.  Imagine withholding Tamiflu until the flu is typed, a process that took more than two weeks!  I guaran-damn-tee you people died because of the Argentine government's outright stupidity.

Third, the buck stops at the top.  Harry Truman said it, and leaders will not find easy nor willing scapegoats if this pandemic is worse than the one they planned for and told the people to expect.  Presidents and prime ministers need to take note of this.  Sacking some lackey will do little to fix the situation, especially if people are dying.

And we know that people will die in this pandemic in far greater numbers than we have seen so far.  I will address this in a future blog; suffice it to say that the easier this virus gets to catch, the more people will die, and that law applies even if the virus does not return more lethal.  It's simply the law of large numbers.  This virus is already more destructive than seasonal flu simply because the elderly are not dying from it; the young are.  There is a huge psychosocial difference between 40,000 old people dying of seasonal flu and 40,000 people ages 1-40 dying, especially if 6% of those are pregnant women.

A recent study has already theorized this virus is up to 100 times more virulent than seasonal flu, which I will address in that future blog. 

Telling people not to worry, or (worse) not telling them the honest truth in some vain attempt to forestall "panic," just won't cut it.  I have spent the better part of my life in public service and dealing with the press at a very intimate level.  My experience has told me to trust people and respect people enough to give them the truth.

Fourth, do not automatically believe the health care establishment knows what they are doing.  Let me relay a personal anecdote:  My wife is currently undergoing chemotherapy, her second time around on this carousel.  Her last treatment was last Friday.  Another person in the "chemo room" asked a nurse about the H1N1 vaccine.  The nurse could not tell her anything about the vaccine, nor the virus itself, and actually began confusing it with the seasonal flu vaccine!  She knew nothing about the CDC target groups; otherwise, she would have responded authoritatively that she needed to get her H1 vaccine as soon as it was available.

I found this so distressing as to bring it up to the head nurse as we left the facility.  Chemo patients will be at the top of the vaccine priority list, along with pregnant women, I emphasized to her (she herself is pregnant).  But that vaccine is not the seasonal shot; it probably won't get here until late October; and people will either need a doctor's note or will need to go to a special facility to receive the two shots in the first place.

I asked the on-call oncologist (the regular oncologist was at the hospital) about interactions with Tamiflu.  He said Yes, my wife could take Tamiflu.  But he counseled not to begin taking the drug until flu was confirmed.  Doctor, I said, they are not encouraging testing anymore!  But it only takes five minutes, he told me.  Yes, doctor, but five minutes in a crowded waiting room, or ER, and the test kits might be all gone!  Not to mention further exposure to the virus.  But it only takes five minutes, he again replied.

So is it any wonder, then, that a recent Hong Kong study said that 50% of the health care establishment there will refuse -- refuse -- to accept the H1 vaccine into their arms?!?!

The Argentine government's dangerous and inept bureaucracy regarding the dispensing of Tamiflu created shortages and facilitated deaths.  Contrast that with Chile's comparatively calm approach to diagnosis, treatment with antivirals and reasonable measures to isolate or quarantine suspected patients.  Other than looks of apprehension from hotel staff and others (reread the passage in Part Two about the Chilean hotel proprietor who doused Ms. Foster with Lysol!), the treatment of Ms. Foster was worlds ahead of the Neanderthal treatment experienced by her friend Malady back in Buenos Aires. 

Note the "apprehension" was not limited to Chilean or Argentine persons, in case you were about to utter some statement about backward South Americans.  Note that Ms. Foster's own husband was on the receiving end of the same looks and distancing from his American co-workers.  This, weeks after anyone would have reasonably been declared virus-free.

Clearly, we have a lot of work to do. 

I hope you enjoyed the series.