Pandemic plans still under construction

The agenda of EU health ministers meetings is routinely taken up with long-term public health issues such as obesity, alcohol and cross-border patient mobility. But lurking in the background is an awareness that at some moment Europe may be hit by a pandemic which would show scant respect for the niceties of their varied healthcare systems.

The challenge for the politicians is to know how much attention to give pandemic preparedness at any time.

The greatest threat of a pandemic is that avian influenza will mutate into some form of flu that is transmissible between humans. In 2001, five years after the first instance of H5N1 was uncovered in Guangdong province, China, and four years before the first reported outbreak of the H5N1 strain of bird flu in Europe, Roche, the pharmaceuticals firm, began contacting governments in an attempt to make Tamiflu, an antiviral drug, a key part of preparedness planning. Although no vaccine exists for H5N1, Tamiflu can be used as a prophylactic, to stop the onset of the strain and cope with its symptoms.

According to David Reddie, who leads Roche’s Global Influenza Pandemic Task Force, initial contacts were good, but it was not until 2004 that talks with governments intensified.

In March 2004 the European Commission drew up plans on how the EU would respond to a pandemic.

The report noted that "in the event of a pandemic, the swift development and distribution of new vaccines and availability of antiviral drugs will be of utmost importance in tackling the disease".

"Stockpiling of antivirals to cover the lead time needed to develop and produce new vaccines should be encouraged," it added.

Clinical trials are now under way, but firms developing the vaccines, such as GlaxoSmithKline and Sanofi-Aventis, have yet to see their products approved for use.

As H5N1 was found in Vietnam, Thailand and South Korea, governments began incorporating the use of Tamiflu into their planning. Ireland, which had the presidency of the European Council, then called for EU governments to begin stockpiling antiviral medicines to prevent a pandemic.

The World Health Organisation recommended that governments stockpile enough antiviral drugs to treat 20% of the population.

Through national preparedness plans, substantial orders were made, but Roche struggled to keep pace and the firm was reluctant to grant other producers licences to create generic versions of the drug.

"Initially we did not have the production capacity," explained Reddie, "our intention was to get ahead of the demand curve. We have dramatically up-scaled our manufacturing capacity now."

According to Roche, production capacity now outstrips government demand by a factor of two to one.

As it became clearer that a pandemic was not imminent, demand for Tamiflu dropped.

Roche expects the sales of Tamiflu to governments this year to be worth €490-€750 million down from €1.1 billion last year.

Reddie said that the EU’s modelling to predict how a crisis may develop is good, but work needs to be done in order to ensure that future outbreaks are adequately dealt with.

"Some [EU] preparedness plans are good, others are far more patchy," he said. "Stockpiles are not the only issue, it is necessary to get [Tamiflu] to people at an early stage, the logistics of that are difficult."

The European Centre for Disease Control and the Commission have pressed member states to meet their self-imposed targets for stockpiles.

But budget constraints in many countries mean that targets have not yet been met: "they are making progress, but work remains to be done", said one official.

The agenda of EU health ministers meetings is routinely taken up with long-term public health issues such as obesity, alcohol and cross-border patient mobility. But lurking in the background is an awareness that at some moment Europe may be hit by a pandemic which would show scant respect for the niceties of their varied healthcare systems.