World Renowned flu expert: the next pandemic can kill millions

Here we go again? The experts keep talking about influenza pandemics, but how bad is it really? We asked one of the world's leading flu experts

By: Charlotte Price Persson, Journalist

14th November 2011 pm. 14:38

As a distant disliked cousin bird flu reappears from 2009 from time to time when someone dares to mention the word 'pandemic'. Oh no, not the old trotting again. Earlier this year there was a big international influenza conference in Malta, and here it was otherwise banned words repeated again and again in a series of lectures on the potential future threat.

Videnskab.dk (Science.dk) put the conference's biggest name, the Dutch virologist Ab Osterhaus, chair of the door and got an exclusive interview about the next flu pandemic.

We sought answers: Why should we be talking about these pandemics year after year - honestly, how dangerous could it really be ... The world famous Dutchman has worked with the flu since the 70s - Osterhaus played among other things an important role in the identification of the SARS virus that struck more than 8,000 people in 28 countries and he has experience as an epidemiologist, immune biologist and virologist.

Will there be a worldwide flu epidemic, called a pandemic again?

"We have to be very careful when we talk about the next pandemic, for everything is really speculation. In Europe there is now a general perception that the last pandemic in 2009 was relatively mild - and since then there have been some kind of flu fatigue, where people do not really seem to think it is necessary to do the large preparations up for the next pandemic."

"It's a very difficult balancing act for us, we will not create panic or frighten people, but we have to be realistic: Over the past 120 years we have seen five pandemics, ie influenza outbreaks caused by viruses from the animal world, especially from birds. "

Can we predict where, how and when the next pandemic frames?

"No. The only thing we can predict is that there will be a new pandemic. It is a fact."

Where does the biggest pandemic threat from right now?

"Two things are necessary before a virus derived from the animal world, the pandemic in humans. The first is that it has to be pathogenic to humans, thus pose a health hazard, not just for animals. The second is that it must be able to cross species barriers, so it can be transmitted between different species and ultimately humans, or that it can be transmitted from human to human. "

"Right now we are all afraid of viruses such as H5N1 (bird flu in the past year has erupted in many parts of Southeast Asia) and it is also good reason to. In cases of H5N1, we have seen in humans, more than half have been fatal, so of course it is a very dangerous virus."

"But we must not forget the viruses found in pigs - they can be just as dangerous if they acquire the ability to infect from human to human. Most scientific studies now focus on what is needed before it happens."

Why is there so much focus on bird flu H5N1 these days?

"As some of the scientific data that has been presented here at the conference shows the H5N1 virus do not even need to reassortere to evolve to infect via the respiratory tract - a reassortment is when the virus gathers genetic material from other birds or mammals flu up, and thus changes his own look."

"Reassortment is still an opportunity for H5N1, but even without the mechanism of virus may still mutate itself, ie without help from other virus types, in a way so that it becomes contagious. That makes it worth keeping an eye on, especially because it has been shown that it requires so few mutations."

Is it realistic that these mutations will happen by itself in nature?

'All the mutations that H5N1 needs to be contagious through the respiratory tract, have been found in birds outside the laboratory. So they are already out in reality - just not in that combination. Now you ask what the probability is, that it's going to happen, and nobody has the answer."

"But at least we now know it can happen. We saw it in Holland in 2003 where we had an outbreak of H7N7 (another type of bird flu), where 90 people became ill, and one of them died. The unfortunate were veterinarian, and when we studied the his virus, we saw that there were 13 mutations compared to the original virus in birds. We do not know exactly where and when the virus mutated, but now we know then that it has the potential to change and create mutations."

Before 2009 I thought that the next pandemic would come from H5N1. It surprised everyone, as H1N1 instead was the culprit.

Is not 'dangerous' to focus so much on H5N1 now?

"Before the last pandemic broke out, we were all quite excited. We had meetings, we were ready for H5N1 to come, but we were also saying: Be careful because it is not certain that it is H5N1."

"And so it turned out that in reality it was H1N1, we should be afraid of. H1N1 is actually a completely normal seasonal flu, but then managed the words to mutate, and it may do again. Therefore we must not forget the seasonal flu, although H5N1 has most of our attention right now - potentially two, for example reassortere with each other and create a whole new threat, or seasonal flu virus could become resistant to vaccines."

"But while H5N1 is ubiquitous in Southeast Asia right now, so I think it is logical to delve into what its real potential is. We first discovered this virus in a young boy from Hong Kong who died in 1997 and ever since it has been found in humans - in over half of the cases resulting in death."

"But in addition it is also a relatively simple type of virus, which means that we can work with it in the lab. For the same reason we also make many experiments with H7N7."

You say yourself that you will not create panic. What should we do with all this pandemic talk, when we do not know where, when or where it comes next?

"We have to inform their people, to the employees in the health sector and politicians should have time to prepare, and prepare cost a lot of money - the money has to come from state coffers, so we have a duty to tell people what their money goes."

"When BSE broke out, there were so many people who said it would never be able to cross species barriers and hit people and then did it anyway after 7-8 years. Back then we had warned again and again and proposed a lot of new legislation, and we were not particularly popular until people suddenly began to die. If we had not made all the speed bumps before then, so would the disease have hit us even harder than it did after all."

In 1918 there was a pandemic, which later became known as the Spanish flu, which struck more than 50 million people killed. Could the next pandemic will be as bad as the Spanish flu?

"Of course it could. Why should not it? It all depends on the virus."

"It is very difficult to say that it could never be as bad. We can say that we want to vaccinate, but look how many people live in the world, and see how many we actually CAN vaccinate - that is a very limited number. "

"Although we were fortunate that the pandemic was not as bad last time around, so there were many countries in Europe, where there were not vaccines available. Then the governments of the countries afterwards that it was good that they did not use public money on vaccines, because it was just the industry that tried to cheat them. But try just to imagine what would have happened if the pandemic had been much worse. Think of what had happened in relation to European solidarity, it would be crazy."

"That is why one should strive for joint procurement of vaccines, instead of turning it into a competition to sell the most. Last time, some countries had plenty, while others were too late."

"So overall, the message remains the same as then: You have to prepare yourself for the worst. And you have to hope for the best."

What was the most important thing we learned from the recent flu pandemic?

"It was how to handle health monitoring and making contingency plans for pandemics, such as antivirals and vaccines. For example, you have to be ready with a stock of vaccines, because you can not wait to get started, the outbreak comes. But also how to inform the general population, and how to handle people's hesitation about being vaccinated."

"Today people are reluctant to vaccines because there is such a perception that there were very many, who died last time. But then we saw the most serious cases at the time, and once you've seen it ... So can people say that it was a mild pandemic, but it was still a lot of people."

"It simply is not that people did not die last time. It was perhaps not the Spanish flu (pandemic which raged in 1918 and knocked over 50 million people killed, of whom 14,000 Danes), but young people - in many cases completely healthy children - died, and if you in any way to avoid it ... "

"We managed to actually stop the infection very early in some countries, and as the real outbreak came, we had the vaccines ready. And then people ask then, why we are vaccinated, now that people are not dead ..."

Check this out!!!

http://www.imdb.com/title/tt0080768/  virus 1980 movie

http://en.wikipedia.org/wiki/Virus_(1980_film)

http://en.wikipedia.org/wiki/Ab_Osterhaus

http://en.wikipedia.org/wiki/Spanish_flu

http://en.wikipedia.org/wiki/SARS

http://en.wikipedia.org/wiki/Swine_flu

http://en.wikipedia.org/wiki/H5N1

http://en.wikipedia.org/wiki/Avian_influenza

http://en.wikipedia.org/wiki/Horse_flu

http://en.wikipedia.org/wiki/Dog_flu

http://en.wikipedia.org/wiki/Influenzavirus_A

http://en.wikipedia.org/wiki/Influenzavirus_B

http://en.wikipedia.org/wiki/Influenzavirus_C

http://en.wikipedia.org/wiki/Bovine_spongiform_encephalopathy

http://en.wikipedia.org/wiki/Creutzfeldt%E2%80%93Jakob_disease