The Department of Health is to present a Human Influenza Prepared-ness Plan to the Cabinet next week — but doctors and scientists are worried about the speed and effectiveness of South Africa’s preparations for what could be a devastating epidemic.
If the lethal form of the H5N1 bird flu currently spreading across Asia and Europe mutates to become a specifically human killer, it is thought that a third of South Africans could become sick, 8% of whom could require hospitalisation.
This means that more than a million could die within a year, and the country could virtually be closed down.
This week, scientists met in Johannesburg at the National Institute of Communicable Diseases to plan a response to both seasonal and pandemic flu, while veterinary experts gathered in Pretoria to consider their role in a potential bird flu epidemic.
Professor Guy Richards, head of intensive care at Johannesburg General Hospital, said he believed another flu pandemic would occur — the question was when. “I believe it is very likely to happen within three years.”
Richards’s concern was that South Africa’s medical services would not cope, and that plans should be made to care for sick people outside hospitals and clinics, which were likely to be overwhelmed.
Girish Kotwal, professor of medical virology at the Institute of Infectious Diseases and Molecular Medicines at the University of Cape Town, acknowledged that the government did an excellent job in containing the outbreak of avian flu among ostriches in the Eastern Cape in 2004. “But pandemic flu is a different animal; it’s never easy to prepare for something like that. Government is aware, agencies and scientists are talking … but without vaccine and proper treatment all this preparedness means nothing.”
The best available vaccine against avian flu, Tamiflu, was registered for use in South Africa in February, and the health department has ordered a stockpile from Roche, with the first shipment due to arrive in May.
But there are worries about its effectiveness, and neither the health department nor Roche could confirm how many doses had been ordered. Roche said it was raising production, but could only make 300-million treatments by the end of the year worldwide.
A key difficulty is that virus samples are needed to manufacture a vaccine against the feared human-hopping virulent mutation — which either does not yet exist or has not been identified.
The World Health Organisation estimates it could produce the proto-type vaccine in three weeks once the virus has been isolated. But even with all vaccine production dedicated to the new vaccine, there would not be enough for the world.
South Africa must import its vaccines, and would stand near the back of the distribution queue. A study by the Macroepidemiology of Influenza Vaccination Study Group, which tracked 95% of the 292-million flu vaccine doses distributed in 2003, found that 62% were distributed to just 11,8% of the world’s population — those living in the nine manufacturing countries of Australia, Canada, France, German, Italy, Japan, Holland, the United Kingdom and the United States.
The health department said that on March 15 it would present its “macro” strategic document to the Cabinet. The finer details and implementation of South Africa’s fight against pandemic flu will be the responsibility of provincial departments of health.
Department spokesperson Solly Mabotha said that, according to expert opinion, a flu pandemic was unlikely for another two years, and South Africa was on track to be as ready as possible.
In a country wracked by HIV/Aids, tuberculosis and other infectious diseases, “bird flu” in Europe and Asia may sound like a relatively minor problem. But even if H5N1 does not become a human killer on a par with the 1918 virus, there is a near-universal belief that planning for it is not a waste of resources — because in time another flu virus will.
Flu viruses are named after their two envelope proteins — HA and NA. Currently, H5N1 is an avian virus that occasionally infects humans who have close contact with birds. It is lethal to humans — 96 people worldwide have died of bird flu out of 175 laboratory-confirmed cases, a mortality rate of more than 50%.
Although the 1918 “Spanish flu” epidemic had a 2,5% mortality rate, 50-million people died worldwide, many turning blue as they suffocated from lack of oxygen. In an age without mass air travel, the virus spread across the globe in months.