By Anne Applebaum
Wednesday, October 26, 2005
Have you got Tamiflu? I haven't, but a friend of mine has. He proudly told me he scored a prescription for his whole family. Another friend is also trying to wangle a prescription, even though there's no guarantee that Tamiflu will work. "It saved 80 percent of the mice in the laboratory study," he said.
In case you haven't heard, Tamiflu is the antiviral drug that might, or might not, provide some protection against avian flu, the bird epidemic that might, or might not, mutate into a deadly disease that humans can catch from other humans. Already there are reports that the virus that causes avian flu has mutated at least enough to become immune to Tamiflu. Nevertheless, I predict a run on Tamiflu in this country, if only because Americans are a pragmatic people. They have observed what happened after Hurricane Katrina. They have heard the president talking about deploying the military during a pandemic. And they have guessed that, whatever their government is doing to prepare for the arrival of bird flu, it isn't enough.
As it happens, they have guessed correctly -- more so than they may realize. For despite our technological advantages and our wealth, this country is uniquely badly positioned to prepare for a global flu pandemic, or indeed any kind of pandemic, whether natural or terrorist-made. It isn't that we aren't smart enough: It's that the culture, at the moment, doesn't encourage it. Here's why:
Short-termism . A few weeks ago, a sudden blitz of front-page stories announced new bird flu initiatives. The president met with vaccine manufacturers! The secretary of health and human services went to Asia! As far as I can ascertain, much of this happened because the president and his Cabinet colleague had recently read John Barry's excellent book "The Great Influenza," on the Spanish flu epidemic of 1918. But while there is nothing intrinsically wrong with the president reading books (it's possibly a better use of presidential time than mountain biking), a week's worth of publicity doesn't substitute for many years of sustained collaboration between the government, the pharmaceutical industry and the rest of the research community. In the end, the solution to this flu and to any pandemic disease lies not merely in the development of vaccines or cures but also in the development of scientific techniques, legal mechanisms and commercial incentives to speed up production of vaccines. Instead of years, it should take weeks -- or even days -- to move from identifying a deadly virus to finding a vaccine that prevents infection. Instead of looking for temporarily effective antiviral drugs, this country should be putting its resources into finding ways of boosting the human immune system itself. But that's a project that a flurry of news stories can never sustain, particularly in a country that at the moment produces no vaccines at all.
Of course, before the politicians start investing in vaccine technology, both they and the voting public will have to get over their hatred of the drug companies . To some degree, this hatred is rational: The high drug prices paid by Americans and by no one else in the world are a huge social burden. To some degree, it is irrational: After all, drug companies make miracle cures, not weapons of mass destruction. Either way, dislike of the pharmaceutical industry has been a major obstacle to Congress's efforts to persuade American companies to start making vaccines. Companies need incentives to do the research; or guarantees that someone will buy their finished vaccines; or protection from lawsuits by users of vaccines that will not have been widely tested; or some combination of the above. The Senate's subcommittee on bioterrorism has recently written a sensible bill proposing that the government pay for the research in the early phases of pharmaceutical innovation, much as the government pays for the research in the early phases of warship innovation. It makes sense -- but ask yourself if, deep down, you can bear the thought of Merck or Pfizer collecting a single cent of your tax dollars, and then you'll understand the depth of the problem.
Finally, Americans and their leaders will have to get over their love affair with intelligent design . Polls show that most don't believe in evolution. But it is actually impossible to talk logically about bird flu, or any other rapidly evolving and constantly changing virus, without using the language of evolution -- specific words such as "mutant," "recombination," "genome" and "selection." Without that language, a sensible popular or political discussion, let alone a scientific discussion, is impossible: We're stuck talking about the virus "jumping" from birds to humans, as if it were a magic bug with a mind of its own. We're stuck thinking that a virus is a hex that can be lifted with a single lucky charm, not something that will change over time.
We're also stuck with magic solutions: silver bullets, protective amulets, Tamiflu prescriptions. And until we are willing to elect the politicians, pay the businessmen, and support the scientists and science educators who can come up with something better, that, I'm afraid, is all the flu preparedness we'll ever have.