Outlook: Flu Vaccine

Wendy Orent
Freelance Science Writer
Monday, April 18, 2005; 11:00 AM

In the wake of the flu vaccine shortage last winter and of growing anxieties about a bird flu outbreak, it was announced last week that Meridian Bioscience, a contractor for the College of American Pathologists, had sent the kits containing the strain of flu that caused the 1957 pandemic to labs around the world. But Wendy Orent, author of "Plague: The Mysterious Past and Terrifying Future of the World's Most Dangerous Disease," argues that the greatest danger may lie in the release of an artificially recreated virus--the one that caused the lethal 1918 pandemic.

Orent was be online Monday, April 18, at 11 a.m. ET to discuss her Sunday Outlook story on the distribution of the 1957 flu strain to labs around the world.

A transcript follows.

Editor's Note: moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.


Wendy Orent: Hi, this is Wendy Orent. Thanks for joining this discussion! Let's get started...


Blacksburg, VA: Thanks for taking my question Mz. Orent. I am wondering exactly what you are referring to when you mention that you are more afraid of releasing the same virus that caused the 1918 pandemic. This virus in particular has the membrane proteins in combination of H1N1, but people now are reasonably immune to this combination form my understanding. What combination of proteins in your opinion would be the most effective, possibly the H5N1 that can be found in China's chicken population? And also how are these various combinations manufactured artificially?

Wendy Orent: Thanks for the interesting question. Yes, the H1N1 virus which is now circulating has the same type of surface antigens as the 1918 flu. This suggests that we MAY have some partial immunity to the 1918 flu strain, but from what I understand, the antigens are different enough that 1918 flu could still cause major problems. The flu virus is a slippery customer, adept at just slightly shifting its surface proteins to evade acquired immunity. That's why you need a flu shot every year, even if the same sort of flu virus (H1N1, H3N2) remains in circulation for decades.I was not sure I fully understood the rest of your question- did you mean proteins that would be most effective for protection? H5N1 proteins would do nothing to protect us from 1918 flu.


Arlington, Tex.: It looks like we dodged a bullet last year with the flu vaccine shortage. Unfortunately, that also means that Congress feels no pressure to do anything about the current supply of the flu vaccine. It seems dangerous to rely on one or two companies for an entire country's supply of a crucial vaccine. Is anyone in Washington paying attention to this issue? The next time me might not be so lucky.

Wendy Orent: Thast's an excellent question. The whole system of manufacturing flu vaccines is antiquated - it dates to the thirties - and not very effective. Newer technologies using DNA-based vaccines would alleviate all the problems of current vaccine production, and allow scientists to develop flu vaccines that might remain effective for longer than one year. Why don't they do this? I asked the FDA, and they didn't have much of an answer.As a society, we really need to address this issue.

One thing, though; if people didn't go to work, or send their children to school, when they are ill, it would cut down dramatically on flu transmission, as apparently we don't shed very much virus before we show symptoms of illness. Also, vaccinating all school-age children would help a LOT.


Philadelphia, Pa.: Is it possible to be immune to the flu? I haven't gotten sick from the flu and recently I learned I didn't get sick as a baby during the 1958 Asian flu. Maybe you don't know the answer to this, but if I am not coming down with the flu, am I missing out on building up antibodies so that I may perhaps be more vulernable sometime to a new flu strain? Or, is it possible to continue this weird immunity to the flu?

Wendy Orent: Immune to all strains of the flu? I doubt it; I've never heard of complete natural immunity to flu, though I wouldn't swear it could never happen. If you are concerned with building up antibodies, just get a flu shot - the shot isn't nearly so bad as the illness! Count yourself lucky if you've never had the flu. I have had it several times, and it is miserable - even the moderate strains. None of us wants to know what the 1918 strain was like - probably not much more pleasant, if you had a bad case, than pneumonic plague.


Annapolis, Md.: Hi-

Is the Meridian Bioscience story really such a big deal?

I'm asking since on the day that the story broke, HHS Secretary Mike Leavitt was enjoying a doubleheader at Wrigley Field in Chicago, rooting for the Cubs. He even appeared on WGN during the first game to joke with the broadcasters.

Wendy Orent: No, I don't think it is such a big deal. It is important that manufacturers know what strains they are handing out - that's the disturbing part. And it shows how easily these accidents can happen, so it's a wake-up call. But the 1957 strains are not "killer" strains - they're just regular flu. Nasty, but not terribly lethal. And chances are that this particular strain, H2N2/Japan, has been passed repeatedly through cell cultures in laboratories, which tends to attenuate or weaken the strain. And it's really mostly dangerous to people under 37, who are not going to be as vulnerable as the older people who probably already have considerable protection.


Blacksburg, Va.: I appreciate the answer and I feel you have shed some light on my question. When I had mentioned most effective, I was using it in terms of having the most drastic effects on the world population as a whole. I am wondering what virus combination could hit humans the hardest.

Wendy Orent: Yes, I understand. I am one of a relatively small group of flu skeptics who are NOT especially worried about the H5N1 chicken virus. It is very deadly, but it is not very transmissible. I am mostly worried about the chicken farmers and their children who are exposed to high doses of the virus, or to people who drink raw duck blood - a very effecient way to get H5N1! While it is circulating among chickens and ducks, it is NOT going to suddenly mutate to acquire the ability to infect and transmit effectively among people. When I hear people talk about the flu virus suddenly mutating and acquiring the ability to spread among people, I realize they are not thinking clearly in evolutionary terms. H5N1 in Asian chicken farms is well-adapted to chickens, and it has acquired its especial deadliness because of the conditions under which chickens are kept (I had a long article about this in February's Discover Magazine)They chickens are packed together and the virus incurs no cost if it grows very virulent.

That's not the way human flu spreads, except under the Western Front conditions of 1918. H5N1 would have to drop in virulence in order to spread from poerson to person. It could cause a pandemic if it reassorted with a common flu strain - but NOT a lethal pandemic.

Hope this helps -


Blacksburg, Va.: If the 1918 virus has been "recreated" - its antigens are known and therefore a vaccine can be easily made - the risk of a another 1918 pandemic (based on the 1918 virus itself circulating) is hardly going to cause a global pandemic. Don't you agree ? The H5N1 avian virus, on the other hand, is a scary prospect.

Wendy Orent: See my answer above


N.Y.: There certainly are several worrysome errors in H2N2 story (accidental global distribution of a lethal strain, and accidental contamination of a patient sample by that strain), although the identification of H2N2 was fortunate.

Do these rather large mistakes bother you?

Are you confident that all of the distributed H2N2 samples eventually be accounted for now that the notice is out?

Wendy Orent: Accidental distribution of a strain you hadn't intended to send out is disturbing - but this ISN'T a lethal strain, as I explain above. And remember, this was sent out as a reference reagnet, part of a testing kit. It is in the freezers of scores of flu researchers already. And it would be very difficult to turn this strain into an active, live virus - you would have to aerolize it, spray it somehow into the air. The risk of this bug getting out, as the CDC has insisted from the beginning, was always very small.

I think this is a good example of a story being hyped beyond all rationality. It's a wake-up call, but so far as I can tell, that's it.


N.Y.: Do you think that fears of scientists recreating the 1918 flu strain through chemical DNA synthesis have been overhyped (a guy at SUNY Stony Brook pushed this idea a year or so ago)?

Wendy Orent: Well, in general I tend to be a bit skeptical about the threat of "designer" bioweapons agents - but not about this one. I do think it could be done once the entire sequence is published. I do not know whether you are referring to Erhard Wimmer, who successfully created poliovirus in his laboratory in order to point out that this sort of thing can really be done. I think, given today's technology, that it would not be at all difficult to assemble the 1918 genome, if you could build all the parts - which scientists could do once they have all the sequences (they've built five of the eight genes already, after all.) So no, I don't think this threat has been overhyped at all, though I do think that the Meridian test-kit matter was - and I think the threat from H5N1 bird flu as a lethal worldwide pandemic has been overhyped as well.


Anonymous: Re: Immunity to flu. I never had the flu until I reached my late 40s (now 62). After my first bout of flu I started taking the flu shot annually. I still caught it, but my doctor said the flu shot lessened the severity. Three years ago, my neighbor advised me to try 500 mgs. of Vitamin C daily. I have done so and haven't caught the flu since (I still get the yearly shot). Why don't doctors recommend Vitamin c as a preventative?

Wendy Orent: I don't know anything about the efficacy of vitamin C as a flu preventative.I am glad it worked for you!


Palm Springs, Calif.: Our government's mailing of deadly flu samples
throughout the world has been labeled a mistake. Has is
it been established what the actual intent may have been?

Wendy Orent: It wasn't our government, it was Meridian Biosystems, a contractor for the College of American Pathologists. The intent was to send out a testing kit with different flu strains for reference in case a particular laboratory needed to find out what sort of strains are circulating in a population at a given time (you take samples of flu virus from patients, and then you match them up against the strains in your kit.) The mistake was that these strains are not needed for reference now - no H2N2s are currently circulating. There was no sinister conspiracy here - just an oversight. Much too much hype!


Dallas, Tex.: My concern is the distribution network...these pathogens are not transported hand to hand as an organ donation for transplant. While H2N2 is not the 1918 virus (this time), over 3700 known labs received it and many of the "destroyed samples" were confirmed only by telephone according to the CDC. Frankly, I see this as a case of a bullet dodged. It is not that I am paranoid, but our defenses are not adequate to deal with educated, committed and refined zealots. Lest we forget that the B. anthracis postal exposures, while very limited and not aerosolized, the spores were considered to be of weapons grade...not produced in someones garage! Minimizing the Meridian incident tends to invite a lax attitude
toward such a potential international threat.

Wendy Orent: I don't think so. There is simply no comparison between the deliberate distribution of highly processed anthrax spores and including the wrong strain in a test kit. This was never an emergency situation. I think it is very dangerous to hype the less than emergent problems, and conversely to ignore very real threats like the possible re-creation of the 1918 flu strain, or the less than secure controls on very dangerous pathogens such as anthrax (though controls are much tighter now.)

Assessing relative risks, both of threat agents and of various sorts of public health situations, such as H5N1 in Asia, is of vital significance. Not all threats are equally threatening!


Wendy Orent: I want to thank everyone very much for the interesting questions submitted, and for having participated in this discussion.

Wendy Orent


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