Countries Hit by Bird Flu Have Little Medicine to Treat Humans

A worker hauls ducks in late June through a market in Hanoi, Vietnam, the country that has been hit the hardest by bird flu. The government has stockpiled enough medicine for at least 12,500 people in case a flu epidemic occurs.
A worker hauls ducks in late June through a market in Hanoi, Vietnam, the country that has been hit the hardest by bird flu. The government has stockpiled enough medicine for at least 12,500 people in case a flu epidemic occurs. (By Richard Vogel -- Associated Press)

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By Alan Sipress
Washington Post Foreign Service
Wednesday, July 6, 2005

JAKARTA, Indonesia -- As highly lethal avian influenza circulates among poultry in East Asia, posing the prospect of a worldwide human pandemic, most of the countries now affected have virtually no stocks of the medicine needed to treat the virus, according to officials in the region.

"When we have an epidemic, we cry for help," said Santoso Soeroso, a physician with a helpless smile, shuffling along the spartan hallway of the isolation wing in Jakarta's Sulianti Saroso Infectious Disease Hospital. "What else can we do?"

Soeroso said his facility, the premier hospital for treating diseases such as bird flu, has enough influenza medicine on hand to treat eight people. Each of the 33 other hospitals across Indonesia designated to receive bird flu patients have enough, on average, to treat two.

Since early last year, the virus has ravaged poultry flocks in nine Asian countries and killed at least 55 people in Vietnam, Thailand and Cambodia. The World Health Organization has warned that the virus could undergo a genetic change that would make it easier for humans to contract the disease, threatening a worldwide outbreak capable of killing tens of millions of people.

The one effective influenza drug, oseltamivir, marketed under the name Tamiflu, costs up to $40 per treatment, meaning bulk purchases are beyond the means of most developing countries, officials said.

"Even if we spend all of our WHO budget, we still can't buy enough for these countries," said Hitoshi Oshitani, an influenza expert with the World Health Organization in East Asia.

By contrast, wealthier nations, primarily in Europe, already have begun ordering sufficient quantities of the drug to treat up to half of their populations should the disease spread beyond Asia.

In the United States, the government has set aside 2.3 million treatments, each of which includes 10 capsules to be taken over five days. The Infectious Diseases Society of America, based in Alexandria, last month called that amount "totally inadequate," urging the Health and Human Services Department to spend about $1 billion to buy enough oseltamivir to treat about a third of the U.S. population.

The gap between rich and poor raises questions not only about whether Southeast Asian governments will be able to cure their people in case of an epidemic but also whether these countries have enough medicine available to contain an outbreak before it races beyond the region's borders.

Walter E. Stamm, president of the Infectious Diseases Society, said his group had not taken up the question of addressing Southeast Asia's shortfall. He said the best bet for stemming a global bird flu pandemic could be to stop it where it starts. "What goes on where this first strikes has a great impact on the rest of the world," he said.

Roche, the Switzerland-based manufacturer of oseltamivir, has quadrupled production in the last two years, according to company officials. But the production has not kept pace with surging demand from developed countries seeking to build stockpiles. The typical lead time of 12 months for filling orders has grown even longer, Roche officials said.

The current backlog of orders grew after scientists determined last year that bird flu had grown resistant to another common influenza drug, amantadine. Researchers blame this on the widespread use of amantadine by Chinese farmers to treat their poultry in violation of international livestock guidelines.


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