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Another Call For a Manhattan Project on Infectious Diseases
August 14, 2005
In the 1918-1919 influenza pandemic, the mortality rate was 3 percent, which seems merciful in comparison with the 50 percent mortality rate of today's highly pathogenic H5N1 avian flu. In just the past 18 months, avian flu has caused the death or destruction of more than 140 million birds in 11 Asian nations. And, most alarming, in four of those nations, H5N1 has taken the worried jump from birds to infect humans.
Should the virus shift and human-to-human transmission become sustained, the cost in human lives could be substantial -- especially when vaccine would not become available, at best, until six to nine months after the outbreak of a pandemic. And even then, the vaccine would not be available to every American. Nor do we have enough of the only effective anti-viral agent Tamiflu stockpiled to treat more than 1 percent of our population.
To meet this threat, I propose an unprecedented effort -- a "Manhattan Project for the 21st century" -- not with the goal of creating a destructive new weapon, but to defend against destruction wreaked by infectious diseases such as H5N1 and biological weapons.
Such a project would include substantial increases in support for fundamental research, medical education, emergency capacity and public health infrastructure; the unleashing of the private sector and unprecedented collaboration among government and industry and academia; and the creation of secure stores of treatments and vaccines and vast networks of distribution.
But, above all, I speak of action -- without excuses, without exceptions -- with the goal of protecting every American and the capability to help protect the people of the world.
Many benefits other than survival would follow in train. We will come to understand diseases that we do not now understand and find the cures for diseases that we cannot now cure. It will add to the economy both a potent principle of organization and a stimulus like war, but war's opposite in effect. It will power the productive life of the country into new fields, transforming the information age with unexpected rapidity into the biotechnical age that is to come.
The above comments by Senator Bill Frist are welcome. As H5N1 gather speed and begins to spread into Europe (see map) it is clearly time to significantly increase efforts. The initial results on the pandemic vaccine are in, and there is clearly room for improvement. The titers are marginal after two injections of 90 micrograms each. Efforts are being made to try to improve the immunogenicity of the vaccine, but even it it worked well, it is directed against a 2004 H5N1 from Vietnam, and a new version of wild bird flu is rapidly spreading in Europe via migratory birds. The current vaccine will have little effect on this strain, yet it is the only available vaccine, Russia and Hungary are planning trials next month, but there are at least 22 amino acid changes in the HA alone, and the vaccine will be of little use.
A call for a Manhattan style project is appropriate. Vaccines should be developed against several strains because H5N1 evolves via recombination and uses existing viruses as parental strains for progeny viruses. Thus, some immunity against the emerging H5N1 will be useful, even if only some of the genetic information is used to produce a new pandemic version that is efficiently transmitted human-to-human.
Similarly, new emerging virus also evolve via recombination, and aggressive vaccine programs should be initiated in these areas also. The technology clearly exists, but is be under utilized. Translation from the lab to the clinic should be accelerated to keep pace with evolving and emerging genomes.
The comments by Senator Frist are welcome and appropriate government action on the front is long overdue.