The number of infections and deaths from bird flu in China is increasing, so is the mystery around its origin. Since early March when the first case was reported in Shanghai, it’s still not known where this virus resides and if it’s transmissible from human to human. Though China suspects the virus could be spreading from human since in 40 percent of the 80+ cases of infection, there was no poultry contact.
For all we know, the infection will be contained within some Chinese provinces and the fear of a pandemic will fizzle out. Let’s hope for that. Still, countries have begun their preparedness, in one way or the other. On April 4, the Centers for Disease Control and Prevention in Atlanta, US, said it had begun work on a vaccine against H7N9, a new strain of virus that’s detected in humans for the first time. That’s been a standard practice in recent times when different strains of virus have been surfacing. The vaccine is readied so that in case of a large scale need, it can be scaled up and manufactured quickly.
Contrast that to what the Indian government has done: Burn its bridges with the local vaccine manufacturers, to the extent that Cyrus Poonawalla, chairman of the Poonawalla group which includes Serum Institute, one of the largest pediatric vaccine manufacturers in the world, says in exasperation, “If there is a pandemic or slight epidemic, that time I will strike [the government] hard.”
During the swine flu pandemic of 2009-2010, the Ministry of Health and Family Welfare gave a grant of Rs 10 crore each to three vaccine manufacturers: Bharat Biotech, Serum Institute and Panacea Biotec to develop the cell-culture based technology to make vaccines. This method is different from the more commonly used egg-based technique. The decision was strategic and all three of them spent additional matching funds to build manufacturing capabilities. But before a fresh bird flu outbreak could stare at us, the manufacturers and the government are locked in a court case.
The reason is bizarre. Instead of procuring the vaccines after placing orders in 2009, Ministry of Health cancelled the order because the scare subsided. What’s more, now the government has even asked for a refund of the money at 12 percent interest.
Bird flu vaccines are not like children’s immunization vaccine that you can sell it to some other buyer in some other market, says Krishna M Ella, founder and managing director of Bharat Biotech in Hyderabad. They are made specifically for the government. “We have three batches lying with us which will expire in December.”
Governments around the world work with the industry to jointly develop capacity to fight any national emergency. Unlike pharmaceuticals, biologicals take time to manufacture and require special facilities. In fact, post 2009, the US government, which did not have cell culture based vaccine manufacturing capability, heavily funded Swiss company Novartis to build one such facility in North Carolina. The first batches of seasonal flu vaccines from that facility were approved by the US FDA in 2012.
How myopic can the ministry get? If they follow scientific developments, they’d know that last year, several studies were published which showed that the scare of flu pandemic is real. It’s not a question of “if” but “when”, such is the unpredictability and rate of mutation in the virus. In 2012, Indian surveillance, which, in any case, is not active but event based, noted 10-15 percent rise in bird flu and mortality, with deaths of crows in West Bengal and Jharkhand.
Keeping this unpredictability in mind, in 2011, China spent nearly $1.2 billion on its three companies to build their vaccine manufacturing capabilities, says Ella. “I was in the meeting where this presentation was made. It was clear China was strengthening its local industry with a long-term view,” he says.
Indian authorities need to take a long term strategic view as well. “We are still strategically, in the field of immunization, far behind Africa, Bangladesh, Sri Lanka and Nepal,” says Poonawalla.
Even though an international team has reached China, all we know is that the virus is a “re-assortant” one (combining genetic material from more than one parent) based on an haemaglutinin antigen A (H7) to which most humans have not been exposed. So “if” it starts spreading then population immunity cannot be taken for granted. While there is no need to be hyper cautious about it unless traveling to China, it helps to bear in mind that if any influenza virus becomes readily transmissible from person to person, then it can travel halfway around the globe and start infecting people in a day.
One could argue a ‘poor’ country like India cannot afford to spend on preparedness when its public health system is creaking under the burden of infectious and non-communicable diseases. It can also be argued that Tamiflu, the anti-viral drug from Roche that is known be be reasonably effective against influenza, costs countries dearly. (Here’s a fascinating account by an academic on how some of its benefits maybe exaggerated).
But from the national security point of view, ensuring local technological preparedness is a no-brainer. As we saw in 2009, we’ll see in future: vaccine manufacturers will first supply to their countries of origin. Does then it make sense for the government to lock horns with the manufacturers?