Antiviral stockpiles and value systems.

Antiviral stockpiles, against the influenza virus tell a lot about the value systems of a society. This silent action - to stock or not to stock - speaks eloquently of what is important to a government: saving money, or saving lives.

Around the world, different governments have made different decisions on this saving money, saving lives spectrum. You see the problem that some governments see, regarding stockpiles, is that it could all be money down the drain. A large stockpile of antiviral drugs may never be used because, after all, it will only have a shelf life of a few years - perhaps five or so. It will, therefore, have to be replaced if maintained. Thus, some governments are cautious as to how much money they tie up in such stockpiles. Again, what we are seeing is how much they value the lives of their citizens, versus the money on hand.

America has a stockpile of 50,000,000 courses of appropriate antivirals according to Bloomberg. That is enough for one in six of the population. Britain, on the other hand, is showing greater caution and clearly placing greater value on the lives of its citizens, by stockpiling 33 million doses (source: The Guardian newspaper). That is enough for 55% of the population: a three fold preparedness advantage over the USA.

However, the USA is not doing too badly. Canada has only 1,400,000 courses of antivirals on hand (Bloomberg), for its population of 33.6 million people. That is only enough for one in twenty-four, or just over 4.1% of the population. To my eyes, that seems rather unprepared since swine flu could easily infect a large fraction of a population, if it behaves like the flu pandemics of the past. Norway, also has 1,400,000 courses of antivirals on hand. However, they have a population of just 4.8 million - and so have enough to treat 29.1% of their population. There is some confusion as to just how much antivirals Singapore has on hand. At the beginning of the week, the Singaporean media mentioned 500,000 courses of Tamiflu, for a population of 4.8 million, allowing the treatment of 10% of the population. Today, the newly stated number for courses available is 1.15 million courses of Tamiflu and Relenza (50,000 courses). Should these newly issued figures turn out to be true (the sudden change could indicate new purchases of anti-virals, and I hope this is so, or could indicate PR spin) then Singapore now has enough antivirals for 25% of the population. This is much less than for the UK...but rather better than that of Costa Rica, whom Nacion.com says has just 3,000 courses of antivirals for a population of almost 4.6 million. This is enough to treat just one person in 1,533. (These figures for stockpiles are checkable on Wikipedia, too).

Clearly, there is no international agreement about how much a nation should plan ahead, against a flu pandemic. There is such a great range of preparedness that it is quite clear no two nations quite see the situation in the same way. Yet, the truth is, all face the same potential outcome: large scale sudden deaths in their populations, from a flu pandemic. It has happened many times before, in human history and it will happen many times, again, until there are no humans left to suffer from it. All we can do is prepare.

I am puzzled, however, that so many developed nations are so relatively undefended. The antivirals cost about one hundred dollars per person, per course. This is not a great sum for a developed nation. To my mind, it seems an easy decision to make to have enough antivirals on hand to treat the entire population. The upside is the minimization of death in the population in the face of a pandemic, the downside is the loss (if unused) of about 20 dollars per year, per person, to protect the nation. (Since the drugs will probably have to be replaced every five years or so). This assumes that only one type of antiviral is stocked. It would be wise to stock more than one type to guard against resistance. In any case, the cost of stockpiles is minimal, compared to the cost in life that would be paid, in the event of not having enough drugs on hand.

What surprises me, therefore, is how much many nations seem to value money, over human life - for so many of them are relatively unprepared for what humanity could soon face. I use the word humanity deliberately, for pandemics put all of humanity at risk, in the sense that anyone could die, of a flu pandemic.

My hope is that this particular "pandemic" turns out to be much more moderate than feared - and that all nations learn from it, to be better prepared for the next one to come. Perhaps the stockpiling of antiviral drugs should not just be a national responsibility, but should be taken up at the international level at the United Nations. It would seem to me to be sensible for the United Nations to ensure that ALL nations have good stocks of antivirals on hand - even the poorest nations. The rich nations could, in effect, buy antivirals for the poor nations. This should be done, at least to some extent, to moderate any pandemic. It would be the humane thing to do - and not only that, but moderating the pandemic anywhere in the world, will help reduce its spread everywhere in the world, for we are all interconnected.

I would like to see a shift, in national priorities, away from saving money, towards saving lives. Too many nations, seem to have chosen to guess what kind of need they might have, and so have stocked, like Singapore, an "adequate" amount. They don't seem to see that the only adequate amount is full coverage of the population. Anything less is not only short-sighted (for a pandemic could truly be one that infects almost everyone), but also immoral. It is not moral to have to force doctors to choose how they ration the medicine available; it is not moral to have doctors choose who will live and who will die. That is not a choice for humans to make. All lives are valuable, all lives should receive, therefore, the best of care, humanity presently has available...and that includes anti-viral drugs.

(If you would like to learn more of Ainan Celeste Cawley, a scientific child prodigy, aged eight years and seven months, or his gifted brothers, Fintan, five years exactly, and Tiarnan, twenty-eight months, please go to:http://scientific-child-prodigy.blogspot.com/2006/10/scientific-child-prodigy-guide.html I also write of gifted education, IQ, intelligence, the Irish, the Malays, Singapore, College, University, Chemistry, Science, genetics, left-handedness, precocity, child prodigy, child genius, baby genius, adult genius, savant, wunderkind, wonderkind, genio, гений ребенок prodigy, genie, μεγαλοφυία θαύμα παιδιών, bambino, kind.

We are the founders of Genghis Can, a copywriting, editing and proofreading agency, that handles all kinds of work, including technical and scientific material. If you need such services, or know someone who does, please go to: http://www.genghiscan.com/ Thanks.

This blog is copyright Valentine Cawley. Unauthorized duplication prohibited. Use Only with Permission. Thank you.)

Swine Flu: is Singapore ready?

Swine flu is spreading around the world. In Mexico it has already killed 152 people (a 50 % jump from the previous tally, on Monday). Cases have been noted in various parts of the world: the USA, Spain, New Zealand, South Korea and Israel. The World Health Organization have declared this a level 4 threat (out of 6 levels). This is the highest they have ever declared, since the system was put in place, five or six years ago. It looks like the world could be in for a rough time. The question is: is Singapore ready?

Singapore has already set up infra red cameras at the airports, scanning arrivals from known infected nations. This is exactly what was done in the face of SARS. Hospitals have isolation rooms available. Doctors and nurses have been trained for this occasion. But is it enough?

I ask this question for a reason, you see, I was struck by something: Singapore has a population of 4.8 million people, yet it has on hand only 500,000 courses of the antiviral, anti-influenza drug Tamiflu. (Figures are from Singapore's daily newspapers...) Thus, in the worst of all possible scenarios, with a virus that is easily transmitted between people, Singapore only has enough drugs to treat 10% of the population. Now, there is a dilemma. Who do you treat? What if those not treated die? Is this the kind of choice we want our Doctors to have to make? The choice of life or death?

It need not be this way. All the rich state of Singapore would have to do to ensure the complete NATIONAL SECURITY of its population, is to have enough Tamiflu stockpiled to treat the entire nation. Sure, it would cost ten times as much...but what is money compared to the deaths of thousands, tens of thousands or hundreds of thousands of people?

Let us look at the example of Mexico, the epicentre of this new disease outbreak. They have had an estimated 2,000 cases. They have also had 152 known deaths. That is a lethality rate of 7.5%. Now, that might not seem much compared to the plagues of history, but in modern times, it is a completely unacceptable, even horrifying, degree of lethality. What is worse to consider is just who is dying. The flu commonly kills the old. Now, while tragic, we all see this as less tragic than the death of the young. The elderly have lived long lives, have had the chance to express their natures, have a career, children and grandchildren and come to understand the world and their place in it. However, this is not so for the young - and the young is precisely who are being killed by the H1N1 swine flu emanating from Mexico. This particular disease loves to take away young adults in their prime, by ravaging their lungs in one last bout of pneumonia. It sounds a terrible way to die...and that way is on its way across the world, even as I write.

So far, no-one outside of Mexico has been killed by the disease. Perhaps this is due to effective treatment being ministered to the victims. However, we should not be complacent because medical infrastructure has inherent capacity limits - and a global pandemic would soon overwhelm that capacity to treat people properly. There could, in a bad scenario, be far too many cases to treat. Many would not receive adequate care...and many would die, therefore. Returning to the matter of drugs: there simply is neither the supply nor the production capacity to meet potential demand for Tamiflu, in the event of a global pandemic. The manufacturer of Tamiflu, Roche, said they could supply an additional 5 million courses to the world, if required. What is that in a world not far short of 7 billion? The stockpiles that exist around the world, of Tamiflu, are adequate for a moderate outbreak - but they cannot meet the needs of a global pandemic. Quite simply, Doctors would have to choose whom to treat, and with whom to let nature take its course: to live or to die - let the virus decide.

We are fortunate that the H1N1 swine flu (a mixture, apparently, of avian, swine and human influenza viruses) is treatable by both Tamiflu and Relenza. Tamiflu has been specifically stocked in Singapore, however, this seems inadequate to me, on two counts. Firstly, different viruses are likely to be resistant to different drugs and there are FOUR drugs available to treat influenza. These are: Symmetrel (amantadine), Flumadine (rimantadine), Relenza (zanamivir) and Tamiflu (oseltamivir phosphate). The H1N1 swine flu is resistant to amantadine and rimantadine, but susceptible to Relenza (zanamivir) and Tamiflu (oseltamivir phosphate). However, it could easily have been resistant, for instant, to Tamiflu, as well - and what good would Singapore's Tamiflu stocks have been then?

What is needed is for Singapore to stock ALL types of influenza drug, as a precaution against any and all influenza pandemics, which are CERTAIN to come, at some point in time. Not only that, but the stockpiles should be large enough to treat the entire population of Singapore, if need be. The only thing that is needed to ensure this is money - and money is the only thing that is risked. On the upside, Singapore's people would be made as safe as possible from flu pandemics as it is possible to be. This is, in fact, the only wise choice. It is the choice that defends against the worst possible scenario, rather than being optimistic about patient numbers. One must assume the worst in such planning - and the worst is a disease so transmissible that almost everyone gets it. Thus, there should be treatment available for everyone - and in all possible varieties, in case the disease is resistant to several drugs.

Of course, it is possible that there could be a flu pandemic resistant to all drugs...in which case, human civilization could be struck a very hard blow indeed. Let us hope, though, that our luck holds and that at least one of our drugs works, on all future pandemics. Let us hope, too, that we will have had the wisdom to stockpile it sufficiently.

This swine flu may or may not become a global pandemic. It may or may not become a wholesale killer. However, the fact remains that one day there will be a wholesale flu killer of mankind. It is the responsibility of the state - of all states, in fact - to ensure that the national defenses are as strong as possible against such an eventuality (which shall eventually come). The price that unprepared states could pay, is too high to contemplate. In the 1918 Spanish Flu pandemic, some states lost up to 30 % of their people (according to Wikipedia, Western Samoa, for instance lost 30 % of adult men, 22% of adult women and 10% of all children). The most recent estimates of total deaths worldwide are from 50 to 100 million people. This was in a much less populated world of only 2 billion people. Comparable figures for today would be in the region of 175 to 350 million people, were we as badly affected, today, as the world was in 1918.

I hope that the swine flu does not become a global pandemic. I hope further that all states learn this lesson: to prepare for the worst possible scenario, by having enough drugs to treat the entire population of their countries, with all possible drugs: anything less, is dangerous foolishness.

(If you would like to learn more of Ainan Celeste Cawley, a scientific child prodigy, aged eight years and seven months, or his gifted brothers, Fintan, five years exactly, and Tiarnan, twenty-eight months, please go to:http://scientific-child-prodigy.blogspot.com/2006/10/scientific-child-prodigy-guide.html I also write of gifted education, IQ, intelligence, the Irish, the Malays, Singapore, College, University, Chemistry, Science, genetics, left-handedness, precocity, child prodigy, child genius, baby genius, adult genius, savant, wunderkind, wonderkind, genio, гений ребенок prodigy, genie, μεγαλοφυία θαύμα παιδιών, bambino, kind.

We are the founders of Genghis Can, a copywriting, editing and proofreading agency, that handles all kinds of work, including technical and scientific material. If you need such services, or know someone who does, please go to: http://www.genghiscan.com/ Thanks.

This blog is copyright Valentine Cawley. Unauthorized duplication prohibited. Use Only with Permission. Thank you.)