AGGRESSIVE quarantine measures and the closure of schools, theatres and cinemas would be needed to contain a flu pandemic because of a global shortage of effective drugs, according to new research.

While modern antiviral drugs and vaccines could contain a virus similar to the “Spanish flu” that killed between 20 million and 50 million people in 1918-19, a dearth of these medications means that few countries would benefit.

As a result, the strict isolation and movement controls employed against the recent outbreak of Sars would be the only practical way of limiting a pandemic, scientists from the Harvard School of Public Health have concluded.

They advise governments to start stockpiling antiviral drugs as a matter of urgency and to invest in vaccine development facilities that could respond rapidly to a new strain.

The researchers’ detailed analysis of the 1918 strain, known as H1N1, has revealed that it was not a particularly contagious virus, with each person infected passing it to between two and four others — a similar rate to Sars (severe acute respiratory syndrome). However, it was unprecedentedly lethal, killing ten times more infected people than any other pandemic influenza strain.

The relatively low infection rate means that it would be feasible to contain a similar strain today — provided that sufficient quantities of antiviral drugs and vaccines were available. Only a few countries, such as Japan and Australia, have anything like the drug stockpiles required. In Britain the Department of Health said this week that it was considering the role of antivirals but it has yet to place a big order.

The NHS at present provides drugs like oseltamivir or Tamiflu only for groups at high risk from flu outbreaks, such as the elderly. An estimated 20 million to 30 million doses, which would take manufacturers years to produce, would be needed in a pandemic.

“A similar pandemic (to 1918) could in principle be prevented by vaccinating or administering antiviral prophylaxis to 50 to 75 per cent of the population,” the researchers wrote in the journal Nature.

“Unfortunately, controlling a future pandemic will not be so simple. At present, vaccine production capacity and antiviral medication stockpiles are insufficient to provide broad coverage, even in wealthy countries.”

Quarantine alone was unlikely to contain a pandemic, because the virus had such a short incubation period. Instead, control measures that reduced contacts between people might be used to close places where people mingle, such as schools, cinemas and theatres.

The study comes amid growing concern that the H5N1 bird flu circulating in Vietnam, Thailand and China could trigger a pandemic. It has been transmitted from person to person, and the World Health Organisation recently issued a warning that a pandemic was possible.

There is no vaccine available against H5N1, though several teams around the world are trying to develop one. The virus can, however, be treated with antiviral drugs.

Marc Lipsitch, a member of the research team, said: “This study is optimistic, except we don’t have the vaccine. It is now even more important to put resources into the development of vaccine technology, manufacture and distribution systems to make possible a rapid response to the next outbreak of an entirely new flu strain.”

WORLDWIDE TOLL

• The “Spanish flu”, or the H1N1 strain, caused the world’s worst pandemic in 1918-19, killing between 20 million and 50 million
  
• Other pandemics hit in 1957, killing 100,000, and in 1968, when the “Hong Kong flu” killed 700,000
  
• Current concern surrounds the H5N1 strain, which developed in poultry in South East Asia and has caused 32 human deaths. It has been transmitted from person to person.
  
• The World Health Organisation has said that H5N1 could trigger a pandemic that could cause seven million deaths

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