Anthony Fauci on Avian Flu
How scary is it?
Interview by Carole Fleck, December 2005
As the world's attention turns to avian flu and fears of a deadly pandemic, Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases, talks about the lethal virus that has spread from Asia to Europe.
Q. As avian flu continues to spread to more countries around the world, how scared should we be?
A. It's a serious issue. The concern over the issue should prompt preparednessâ€”not fear, not panic.
Public health officials are very closely monitoring cases of [avian flu] infection in humans and are trying to see whether the virus is being transmitted from person to person in a sustained manner. If a person contracts the virus from a chicken, can they pass it on to another individual, and can that person then transmit it to someone else? When that begins to happen, we will have a very serious situation, particularly if the virus retains its virulence.
Q. Is our public health system adequately staffed, equipped and trained to handle a pandemic?
A. Clearly, there are challenges and problems that remain to be worked out. To address these issues, the Department of Health and Human Services [HHS] just released a Pandemic Influenza Plan that will serve as a blueprint to help the states and local governments handle a pandemic.
Q. What are the symptoms of avian flu?
A. They are similar to the initial symptoms of seasonal flu. You get muscle aches, high fever, headache. The difference is that avian flu rapidly progresses to become a debilitating lung issueâ€”breathing, bacterial pneumonia, viral pneumonia, the requirement for intensive care and respiratory support. Some people fortunately have recovered, but it takes a very long time to get back to normal.
Q. Is any group more susceptible?
A. Avian flu does not know age boundaries as well as seasonal flu does. A significant portion of the people who were infected [in Southeast Asia] were young people, in many cases children.
Q. I've read that avian flu could become less lethal as it spreads.
A. Right now we are seeing a flu that is very inefficiently spread from chickens to humans and very, very inefficiently spread from human to human. However, the mortality rate among humans who do get infected is over 50 percent, which is very high. When a virus starts to evolve and spread from person to person, usually it becomes less virulent and less deadlyâ€”as it spreads faster, it kills less. We don't know whether that's going to happen with the current avian flu, but it is more likely than not.
Q. How should we prepare for this?
A. There are three or more components of preparedness with public health measures: the ability to have good surveillanceâ€”to identify, to isolate, to make the public health system kick in to avoid spread. Then there are drugs like Tamiflu and vaccines, and a whole bunch of other things that constitute a comprehensive, balanced approach to preparedness.
Some countries are equating strictly whether you're prepared to how many doses of Tamiflu you have, and that is not necessarily the best gauge.
Viruses naturally evolve to evade our efforts to suppress them. They change enough so that vaccines do not provide optimum protection each year. With drugs, certainly there's the potential to develop resistance, and that's the reason why you pursue the avenue of trying to develop alternative drugs.
Q. What's the difference between a vaccine and the drug Tamiflu?
A. A vaccine is totally to prevent infection. It can stimulate the immune system to recognize and kill the virus. Tamiflu primarily is used to treat someone who is already infected, usually within 24 to 48 hours of the onset of symptoms. However, if there is a lot of flu going around and you have health care workers or members of a family who've been exposed and you don't have a vaccine, you can treat them with Tamiflu on a daily basis to try and prevent them from getting infected.
Q. Roche has reportedly said that it can supply the United States with enough Tamiflu to cover 25 percent of the population by the end of 2007. Isn't this a problem?
A. The Department of Health and Human Services is in active negotiations with Roche to increase our supplies of Tamiflu. It's an evolving situation. Roche is now in discussions to work out a way to license the Tamiflu patent to other companies.
Q. Do we have the capacity to produce the amount of vaccine needed?
A. It will depend upon issues such as the current negotiations going on between the vaccine manufacturers and the federal government. Many of the manufacturers appear to be willing to take a look at their capacity to determine how they can respond to an emergency. Nowhere in the world at the present time is there enough vaccine-manufacturing capacity to meet the needs should a flu pandemic occur right now.
Q. Which companies are making vaccine for the United States?
A. Sanofi Pasteur and Chiron are the only two companies making the H5N1 [avian flu] vaccine for us. We have completed one study, and preliminary data indicate the Sanofi Pasteur vaccine is safe and capable of inducing an immune response. This vaccine is now being tested in an elderly population and will also be tested in children by the end of the year. We are awaiting vaccine from Chiron and will conduct safety studies early next year.
Q. Will the vaccine be distributed, and if so, how?
A. This is not like the seasonal flu, where you make it and distribute it. None of this will be distributed because we don't know if this is the right vaccine to match the virus. If there is a consistent spread from human to human, distributing vaccine in a priority manner may be considered, but that's not the plan right now.
In general, when you distribute scarce resources, you give them to the highest-priority peopleâ€”health care workers, those older than 65, people with chronic illness, pregnant women, those who care for people in hospitals and nursing homesâ€”the same prioritization as with the seasonal flu vaccine.
Q. You just returned from Southeast Asia with officials after observing the nations worst hit by bird flu. What did you learn?
A. The nations vary in how they are handling the chicken flock problem. It's not easy for people from the West to appreciate the strong traditional links and customs between people who raise their own chickens on their small farms or in their back yards versus the classic commercial poultry farms.
The bottom line is that surveillance for us in the Western world is going to be critical to being able to monitor the progression, if there is progression, of this disease among humans. In some situations that surveillance is reasonably good, and in others it is not.
Q. Did anything surprise you or change your views about avian flu?
A. What came home to me is the willingness of the leaders of the affected countries to cooperate with the World Health Organization, the U.S. Centers for Disease Control and Prevention and our HHS.
What surprised me was this: You would think that countries with authoritarian or communist rule would have very strict control over what goes on in the provinces and in the communes. That's not necessarily the case. It's quite decentralized in many countries, so you really have to work with local provincial people to make sure the surveillance is as good as you want it to be.
What I was impressed with was the extraordinary link between the economy and the subsistence of the public and the disease at hand. You have these people who are barely making it from week to week. If, when you cull their flocks, you don't compensate them well, or at least modestly, they will resist being open about what is going on.
Q. Is it safe to eat poultry?
A. [Laughs] When I was in Southeast Asia, I ate it. First of all, if you cook poultry from a farm that isn't grossly contaminated, you don't have any problem. If you eat poultry in the United States, you really don't have any problem because we do not import any poultry from there. This should not alter the poultry-eating habits of people in the United States.