Bird Flu: The Perils of Relying on a Single Drug

If, like public health authorities in the U.S. and many other countries, you're counting on the anti-viral drug Tamiflu (generic name oseltamivir) to save you should bird flu become pandemic, you may have to think again. A Hong Kong expert told Reuters on Friday that a strain of the H5N1 virus isolated in northern Vietnam this year is resistant to Tamiflu. More common human flu viruses have also recently been shown to be developing a resistance to another set of antivirals called adamantine drugs.

If the Vietnam report proves true, the implications will be particularly worrisome for public health programs to combat bird flu: Many governments have made stockpiling Tamiflu the centerpiece of their planning for a possible pandemic. U.S. Health and Human Services Secretary Michael Leavitt wants to create a big enough stockpile to treat 20 million Americans, and about $3 billion of the $4 billion the U.S. Senate last week proposed allocating to the Centers for Disease Control and Prevention to prepare for bird flu is to be used to buy Tamiflu. Never mind the fact that Tamiflu is produced in only one facility in the world, which is unlikely to produce enough to fill everyone's stockpile for several more years.

What this tells you is that the medical, private and public sectors had better have more than one big idea on how to deal with a potential pandemic of bird flu among humans. Debating — as a number of health experts have done recently — over whether a pandemic would kill 2 million or 150 million people is kind of beside the point. (For the record, the World Health Organization is telling governments to prepare for between 2 million and 7 million deaths worldwide.) You need to have contingency plans to find extra hospital beds, respirators, masks and syringes. You need to have a plan for keeping the peace when a significant percentage of the police and fire forces are at home sick in bed.

Bird flu is a crisis that's unfolding in slow motion. We know for certain that it has killed 60 people. It may be years, even decades before it spreads easily from human to human and becomes pandemic. But if that happens this year, we're in trouble.