But the big idea, the grand strategy for boosting flu-vaccine development and production, was rolled out in a new administration code word: "certainty." Certainty, Leavitt explained in the October 7 press conference, refers to assurance that drug companies will have a permanent, huge, profitable market for such products.
Leavitt’s idea is that the US can provide this "certainty" by "creating an ethic of vaccinations" — i.e., convincing tens of millions of Americans to regularly get flu shots they don’t particularly need.
More details on this plan will follow, but Leavitt has thus far been doing his part to whip up demand, by scaring the bejesus out of the general populace. For the past two weeks, Chicken Little Leavitt has called the global spread of H5N1 virtually inevitable, and he’s been quoted in major media outlets saying that "the world is woefully unprepared," "a pandemic is essentially nature’s terrorist," and "there will be a pandemic, and our preparation is not adequate." And sure enough: although Leavitt’s call for panic is not the only reason, demand for avian-flu drugs has leapt — Europe is now experiencing a run on Tamiflu, and there are reports that a run may be starting in the US. (Bids for a single course of treatment of Tamiflu on eBay were recently up to $175 dollars, roughly four times the normal prescription price, before the auction site pulled the plug due to its rules against selling prescription drugs.)
Much criticism has been leveled against the Bush administration for failing to stockpile Tamiflu. But stockpiling may prove to be a classic case of fighting a new war with the last war’s weapons.
Any drug useful for today’s virus will likely be useless against tomorrow’s. Viruses evolve through mutation, to survive against the immunity that humans build against earlier versions. Every year, pharmaceutical companies must create a new vaccine for regular, run-of-the-mill influenza, once they identify the new season’s version of the virus.
While Tamiflu, a retroviral drug, seems promising (though far from proven) against the current strain of avian-flu virus, by last weekend signs had emerged that the virus is already developing resistance to it.
Besides, Tamiflu is a treatment, not a preventive vaccine, and it must be administered within two days of contracting the disease. In fact, recent tests at the University of Minnesota suggest that it may need to be taken before exposure to the virus. As we’ve learned from Katrina (see "Will You Die?" sidebar), the US simply doesn’t have the emergency-response capacity to buy, store, secure, distribute, and administer enormous amounts of any needed item in that limited time frame. If anything, producing and stockpiling too much Tamiflu or other retroviral treatment drugs may actually prove counterproductive, because doing so will occupy what limited resources we have — resources we will need for making, storing, and distributing an actual vaccine when the time comes.
That’s why disaster-preparedness plans for virus pandemics, like the one Massachusetts drew up in 2001 and revised this July, assume a period of several months between the first identified case — and thus the first specimen for study — and the availability of a useful vaccine.
And therein lies the rub, particularly for a free-market economy like ours. To be ready to respond to an outbreak, we need to have, at the ready, an entire infrastructure in place for the creation, manufacture, and distribution of a drug that, until the time comes, does not and cannot exist.