Bird-Flu - Lack of treatment options18 Jun 2024 10:35
Key takeaway from today's article (paywall so truncated below) in the NYTimes is that there are too few drugs that are available and effective to treat H5N1 and vaccines aren't the magic bullet. I'm sure all relevant authorities are acutely aware of this, the public perhaps not yet;
“If it goes into the general public, it’s too late,” she said. “We’ve missed the boat.”
Flu is typically most severe in older adults and children under 5. (An outbreak of swine flu in 2009 was not as devastating as feared, yet it killed nearly 1,300 children.) The severity of illness also depends on how much virus the infected patients are exposed to and for how long, as well as the route of entry and their genetic background and general health.
Infected people generally have fever and respiratory symptoms; some cases advance quickly to pneumonia or death. If the bird flu virus were to adapt to people, the world would need billions of doses of vaccines and antivirals to stave off these outcomes.
The federal stockpile holds four types of flu antivirals, but the drugs must be taken within 48 hours of symptom onset to be effective. One recent review found too little evidence to gauge the effectiveness of three of the four drugs, including the commonly used oseltamivir, sold as Tamiflu.
Some new versions of H5N1 have mutations that make the virus resistant to oseltamivir and to the other two drugs, but those changes, fortunately, have not been widely transmitted in animal populations. No mutations have been observed against the fourth drug, baloxavir.
But there are only a few hundred thousand doses of that drug in the stockpile, according to David Boucher, the infectious disease director of the federal Administration for Strategic Preparedness and Response.
Vaccines are a better bet to stem a pandemic, but enough doses are not likely to be available for many months, at the least. Even if global production of seasonal flu vaccines were entirely shifted to vaccines against H5N1, the number of doses manufactured would be enough for fewer than two billion people, assuming two doses were needed for each person.
In the United States, the national stockpile holds hundreds of thousands of vaccine doses that could be rolled out to those at risk, including children. Companies contracting with the government could make more than 100 million doses in the first 130 days, Dr. Boucher said. Officials recently announced that they had taken steps to ready 4.8 million doses that could be bottled without disrupting seasonal flu vaccine production. But most of these plans will help only if the virus cooperates. Since H5N1’s first appearance, it has branched into many forms, and scientists have created a library of 40 so-called candidate vaccine viruses to match. Having them ready to go saves crucial time, because creating a new candidate can take three months, said Todd Davis, a virologist at the Centers for Disease Control and Prevention
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