It has dropped out of the headlines of late, but avian flu has not gone away. Recent months have brought a steady trickle of new human cases of the H5N1 virus in Indonesia, which has become the country with the highest death toll and the worst mortality rate: of 69 people infected in a year, 52 have died. There have also been isolated cases of suspected human-to-human transmission, a key step towards a pandemic.

It is still uncertain whether H5N1 will jump the species barrier to pass readily between human beings. Most scientists, however, are convinced that even if this strain of bird flu does not take this leap, another virulent form will sooner or later.

The Indonesian experience demonstrates how poorly prepared the world continues to be. South Asian countries are the most likely venues for a leap to humans because of the way people and poultry live at close quarters. If one of the largest is struggling to contain a virus such as H5N1, which is not good at infecting people, what price the chances of stopping a genuinely pandemic strain?

There are two ways of fighting an incipient flu pandemic and of reducing the impact once one has broken out. Antiviral drugs such as Tamiflu should reduce symptoms and transmission, and vaccines can be developed to immunise populations. They form the cornerstones of the world’s pandemic plans.

In practice, both approaches have difficulties. Vaccines must be tailored to the pandemic strain, which takes six months — long enough for flu to gather momentum. There is also a manufacturing problem: global capacity is 300 million shots a year, insufficient for even one in 20 of the world’s 6.5 billion people.

Antivirals fare somewhat better in this respect, as they can be stockpiled, but there is still a supply shortfall. Even after signing up 15 manufacturing partners, Roche can produce just 400 million courses of Tamiflu a year. The drugs are in patent, and thus expensive. While Britain can afford to hoard them, the same is not true of the developing nations from which a pandemic will probably come. The virus may also evolve resistance, further limiting their role.

The world thus cannot afford to rely on vaccines and antivirals alone. They will be important, but other strategies, preferably cheap and simple ones, will also be required. Two promising ways have recently been advanced.

The first, championed by Sir Peter Lachmann, a former president of the Academy of Medical Sciences, would involve taking blood from recovering flu patients or volunteers immunised with experimental vaccines. Antibodies produced by their immune systems to fight the virus would then be separated and injected to protect others. The doses required would be small, so antibodies from a few people could be used on a large scale.

The other possibility, raised in a letter to The Times on Wednesday, is to use statins, the cholesterol-lowering drugs. There is early evidence that these might fight the extreme immune reaction that often kills people who contract virulent flu. Statins are cheap, they have few side-effects and they are already made generically in vast quantities. If they work, they would be ideal.

Neither approach is yet proven, and both need to be tested for safety and effectiveness. But, at present, this work is not being done for lack of support. As neither is suitable for patenting, drug companies are not interested. Professor David Fedson, who organised the Times letter, says seeking public support for statins research is “like beating my head against a brick wall”.

This situation needs urgently to be addressed. There is no guarantee that either approach will be useful, and even if they are, they will supplement and not replace vaccines and antivirals. The extent of the threat from pandemic flu, however, means that every option must be explored. The lives of millions may depend on it.







Mark Henderson is the Science Editor of The Times