IS THIS COUNTRY prepared for the next influenza pandemic? This autumn's troubling dearth of flu vaccine is hardly a good omen, particularly because British regulators say that their American counterparts had advance notice of their intention to ban 48 million doses of British-made vaccine bound for U.S. markets, and indeed they appear to have had time to buy extra doses themselves. U.S. officials deny having advance knowledge and say that they thought problems at the British plant were under control. It is apparent that those at the highest levels of the U.S. government were taken by surprise, a clear indication that information does not flow up the public health bureaucracy as swiftly as it ought to.
This is no trivial problem, because bureaucratic flexibility and rapid information flow will be needed if the world is suddenly confronted with a particularly virulent form of flu, possibly originating in the strains that killed millions of birds in Asia last year and that have spread to humans in several recently documented cases. Scientists have long feared a repetition of the flu pandemics that killed more than 500,000 Americans (and millions more worldwide) in 1918 and 70,000 in 1957. Knowing of these predictions, officials at the Department of Health and Human Services have just begun funding the research and production of new vaccines as well as new antiviral influenza drugs. They are also working on developing a "surge capacity," in the form of spare chickens, whose eggs are used to produce vaccines, in case it suddenly becomes necessary to make large quantities. Unfortunately, this capacity is not yet in place.
Less clear is whether the system would be able to cope with the burden that a virulent influenza epidemic would place on the government's laboratories, which would have to isolate and analyze the new virus and swiftly produce vaccines and drugs for it. Congress's fondness for budget "earmarks" means, for example, that some scientists fear they will not have the flexibility needed to switch their resources rapidly from one project to another. And the private and university labs doing more advanced genetic science are not working as closely with government labs as they could, a failure that might, in the case of a swift-moving virus, result in the loss of critical preparation time. (To put it differently: A few days' delay, in the case of a flu pandemic, could mean thousands of extra deaths.) Together with other specialists, Nancy J. Cox, director of the influenza lab at the Centers for Disease Control and Prevention in Atlanta, has called for the creation of a state-of-the-art genetic analysis lab dedicated solely to flu virus. But Congress and HHS could, if they focused on this problem, establish a more flexible, better-funded system within the CDC, even if they are not ready to fund a large new lab. Although this isn't a problem that many people have yet focused on, they will if a virulent flu virus strikes. By then, of course, it may be too late.