Superbug: Are We Prepared for The Next Great Plague?

Paul Hoffman: When do we think there will be a vaccine available for this [swine virus]?

 

Peter Palese: As Dr. [Barry] Bloom said, we are much better prepared now than just five years ago. And companies are, as we speak, preparing new vaccines against this swine virus. So we have the regular formulation for the seasonal influenza, and those vaccines have been prepared. In additional, the companies prepare a forced strain, which will be a separate vaccine strain against the swine virus.

Because the swine virus is very similar to other H1 viruses which are circulating, there are no real technical challenges to make a vaccine, and companies are really able to make large quantities of this new vaccine.

 

Paul Hoffman: Jeff, in terms of the public health response to swine flu, what have we learned from this? What might we do differently if, say, a year from now another virus pops up?

 

Jeff Koplan: It think, as was indicated earlier, we’ve learned a lot year after year in a number of different episodes such as this. We’ve learned that the importance of the linkage of laboratory and epidemiologic information. We are learning but have much further goal in learning, something that Michael [Worobey] pointed out, which is that animal disease, and what goes on in veterinary medicine, and either will we commonly think of as agriculture, is extremely important to indicate upcoming risks for human populations. And that interplay, over and over again over the last several decades, has brought us disease after new disease. And that’s something we still have to do a better job of in the future, of getting a handle on animal infections as they apply to human population.

We talk about preparation. And that’s always one of the first questions asked: Are we prepared? And the answer is: Prepared for what? Prepared for an anthrax attack that involves ten thousand letters, and is mailed from forty different sites around the world? Prepared for ten thousand cases of a new illness, or a million cases? So preparation is very relative, and we are better prepared scientifically, in terms of vaccine production and gearing up quickly, and probably recognition of new diseases, but it’s maybe very difficult to be adequately prepared for the clinical sequela of a serious case, because the number of respirators you’d need for a hospital, isolation rooms, protective equipment, is such that given our healthcare system, we can’t afford buying all that you would need for the worst case scenario, or even a medium case scenario.

So it is unlikely we will ever be prepared in the way people that people would say, that’s great, we’re really prepared for that. Nor would you want us to try to be because the expenditure in the healthcare sector would be so great, we wouldn’t be spending it on things you wanted now.

 

Michael Worobey: To get back to your question about how we can be better prepared, I think this epidemic has taught us that we could do a lot more for surveillance, not only in humans but also in animals. And just being aware that there is a new subtype of virus circulating somewhere in the world, four months earlier than we were in this case, would set us up so much better to try that, isolate it, or at very least prepare a vaccine for it.

And I think that the convergence of that kind of thinking, with technology that’s out there, for sequencing these days, you can take a single sample from someone and produce amounts of data on the order of what the complete genome project produced over a several years, in a few hours now, for not very many dollars. And I think it’s reasonable to look into the future and see a time when doctors routinely take swabs from patients who might have influenza, when abattoir semblance samples, from a large sample of animals, and they go to somewhere, or multiple places, and if there’s any virus, we will detect it before it gets to the stage it is now.

Peter Palese, Jeffrey Koplan and Michael Worobey discuss our readiness to handle future pandemics.

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