All aflutter about nothing
The panic over bird flu is laughable in a country where public health clinics run short of TB drugs and a one-time hospitalisation can wipe out a family?s assets.india Updated: Jan 27, 2006 00:15 IST
No other public health disaster seems to be as ominous as an impending bird flu threat. A single case in a distant part of the world is enough to drive it into headline news and make the threat appear that much closer. Any day, we are made to believe, the virus could morph into a deadly form that spreads through the air, infecting and killing millions. The picture seems that much more real as the forecasts resurrect the death and gloom that surrounded the 1918 flu pandemic. The government, in turn, whips up its own frenzy by announcing an immediate stockpiling of ten lakh doses of the only available drug, Tamiflu.
Yanked out of scientific journals and scientific debates, it is beginning to sound more like the Chicken Little story, where everyone is rushing to save themselves because the sky is falling. Look at the facts: out of six billion people on this planet, since 2003, avian flu has killed 78. Most of these deaths have been in Vietnam, Thailand and more recently Turkey. All those infected were in close contact with infected birds. For the bug to turn lethal and start a human to human transmission it will need to mutate. Drugs or vaccines that are able to effectively respond will need to work against its possible mutated form. Even if the flu were to strike, present drugs may be quite ineffective.
Dr Anthony Fauci, director of National Institute of Allergy and Infectious Diseases, said, “I want to caution the committee that we cannot equate stockpiling and availability of Tamiflu with preparedness. We have no hard scientific data of how well the anti-viral will perform under the conditions of a pandemic.’’ He went on to say that Tamiflu does not even cure everyday flu. It diminishes the duration of symptoms. It doesn’t kill the virus. It slows it down so that the body’s immune system can catch up. At best, it may prevent 53 per cent of people from needing hospital care. But we won’t know how well it works until the pandemic strain emerges.
We are way behind developing a disease surveillance system, which could detect the emergence of new bugs or re-emergence of a disease. Every year, there are outbreaks of ‘mysterious fevers’ that remain undetected and undiagnosed. Public health institutions are crumbling, the poor have little or no access to healthcare, 350 women per 10,000 continue to die during childbirth.
But the Union Health Ministry has stockpiled 10 lakh doses of Tamiflu, which lulls us into a false sense of relief. And if the bird flu were to appear, would 100,000 doses be enough? Clearly, in the wake of the avian flu fear, threats closer home seem so innocuous. Never mind the fact that children continue to die from preventable and treatable diseases such as diarrhoea and pneumonia. India accounts for one-third of global TB and the largest number of persons suffering from active TB in the world. About 2.2 million people are added each year to the existing load
of about 15 million active TB cases. Of these new cases, a most disturbing fact is that 20 per cent of 15-year-olds are reportedly infected; and among women in the reproductive age group, it causes more deaths than all the various causes of maternal mortality put together. Yet, visit some of the areas outside the NCR and you would find that TB drugs are not available — at least through the public health system.
Bird flu threat could be good news for some. Among them is the US Defense Secretary Donald Rumsfeld, who owns a stake in Gilead Sciences, the California biotech company that owns the rights to Tamiflu. According to Fortune, Rumsfeld holds a Gilead stake valued at between $ 5 million and $ 25 million. In the past six months, fears of a pandemic and the ensuing scramble for Tamiflu have sent Gilead’s stock from $ 35 to $ 47. That’s made the Pentagon chief at least $ 1 million richer.
But for us, the bird flu threat should alert policy-makers to the urgent need of a public health system. Sadly enough, this has never been on the agenda. Band-aid treatment is what they have always been subjected to. The India Health Report, put out some hard facts: just one episode of hospitalisation is enough to wipe out the assets of a family. The number of poor who do not seek treatment for financial reasons has been increasing — from 15 per cent to 24 per cent in rural areas and 10 to 21 per cent in urban areas in the decade 1986-96. Stockpiling Tamiflu has little meaning for us.