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  Bird Flu: the scare and some sense

Modern world’s first pandemic was the HIV/Aids. If you do not hear scare headlines too often now, it is because drugs have been discovered that control, if not cure the disease. And India played a part in making the drugs affordable. Dr Yusuf Hamied of Cipla led the battle to reduce the cost of Anti Retro Viral [ARV] drugs therapy. That the over 80% reduction that Cipla has achieved is still too high for many of the afflicted poor is another story. The point is whether drug company interests in times of scary diseases queers the pitch for common people. In the current Bird Flu thread of news, for example?

“Bird flu could kill 150 million people,” headlines the BBC quoting Dr David Nabarro, a consultant to WHO. Rattled, WHO says, “I don’t think you will hear Dr Nabarro say the same sort of thing again.” Well, Dr Nabarro says the “same sort of thing” again with some strange logic thrown in: “My reason for giving the higher figure is simply that I want to be sure that when this next flu pandemic does come along, that we are prepared for the worst as well as for the mildest.” So the numbers may not happen but are broadcast to alert [-scare?] people. An Indian glossy magazine stares at you from supermarket news stands: “50 million will die: Is India ready?” is the line of the cover story. Paraphrasing Nabarro, it can well claim it was only trying to increase its sales.

Roche, which holds world-wide patents for Tamiflu, the only known drug that can control the flu, has just reported a 17% increase in sales in the current quarter. “The firm is now producing Tamiflu as fast as it can after the World Health Organization (WHO) advised countries to stockpile supplies to help combat a potential bird flu pandemic,” says the BBC. So the scare industry is succeeding.

Let’s be clear on one thing: Bird Flu threat is real and serious. But we need to delve deeper to understand the size and shape of the threat. Of the 15 varieties of flu that affect fowl, the strain H5N1 is currently causing the most alarm. But it is currently a threat to only fowl. It is feared it can hop on humans; that hasn’t happened yet. And when it does and becomes transferable between humans, yes, it can become a serious threat. Tamiflu can contain it in an infected human and give his body a chance to recover but no more. It is no cure and there is no vaccine yet.

India is alive to the threat. Dr Hamied of Cipla says his scientists have cracked the Tamiflu and have learnt how to make a generic version of it. He mocks the claim that it can not be easily manufactured. It currently costs Rs.300 a shot. The New York Times quotes Hamied as saying he would sell it “at a humanitarian price”. He expects governments faced with a pandemic will revoke patents. Reading the reality correctly Roche, has begun talks to license manufacturing rights to others.

Is an abundant supply of Tamiflu [’oseltamvir’, generically] enough? It is not. For one it is not a cure. For another the virus can mutate easily and often. So what happens when we face the predicted apocalypse? 

Alone in the cacophony an Indian voice is talking reassuring sense. Dr M Vidyasagar says current knowledge will find a solution once the virus transfers to humans.

He is a scientist who has studied and worked in the west and the east, in private sector and the government. He is currently Executive Vice President of Tata Consulting Services. He is known to hundreds of thousands of young Indians for his seminal paper in 1993, that persuaded many of them to return to India.

In a private correspondence Dr Sagar says, “Now that I understand a little bit about such things, let me say that genomics has advanced to such an extent that if the world as a whole believes that there is an imminent danger from some virus/bacterium/parasite that can migrate/mutate rapidly, then the whole world would buckle down and come up with at least a first-cut cure in less than a month.” He is quite appalled by the whole scare-mongering. He asks: “...for all the hullabaloo about SARS, how many people *actually died*?”

And GoodNewsIndia is appalled by Indian mainstream media not unearthing the point of view of Indian scientists like Dr Vidyasagar. He explains why deaths of millions will not occur. In normal times a drug’s development cycle is very time consuming. “The usual regulatory framework is based on the premise that, first and foremost, a drug shall do no harm.  Positive benefit comes later.  Also, most of the pressing diseases of the day are NOT infectious (e.g., cancer, diabetes, etc.).  This is why it takes years and years to find AND TO APPROVE new drugs,” he says.

“In contrast, the predicted avian flu ‘pandemic’ is clearly infectious, caused by an external agent invading the body.  If, say, thousands of people are dying every day, every regulatory agency in the world would give the go-by to the its normal procedures, and permit all sorts of experimental drugs to be tried out on the patients.  Developing such ‘candidate drugs’ based on (i) determining the genes and functions of the invader, and (ii) using some kind of gene knock-out therapy, isn’t all that difficult—IF one does not insist on proving the ‘no harm principle’ first.  In short, so long as the avian flu is just a cloud on the horizon, regulatory agencies are quite right to insist on all the usual procedures.  If the predicted pandemic really materializes, the scientific community will very quickly come up with ‘candidate cures,’ which will at once be tried out, depending on the severity of the pandemic.  So people won’t die like flies while the world watches helplessly.”

It has taken a knowing Indian mind to speak the truth. And that should assuage fears and thwart avarice.

Email exchange with Dr Vidyasagar