Facing Down the Enemy

The truth is, we should have been afraid of H1N1, because the threat of a flu pandemic is real.
Jul 01, 2009


Laura Bush
In the 1992 film "A Few Good Men," Nathan Jessup, played by Jack Nicholson, is an aggressive marine colonel in charge of the US military base in Guantánamo, Cuba (pre-9/11, when communists were the enemy). In a trial over the death of a marine in a hazing gone awry, a cocky young Navy lawyer named Daniel Kaffee challenges Jessup, questioning his leadership methods, and trying to get him to admit responsibility for the marine's death.

Jessup is appalled by Kaffee's arrogance. This young navy officer has never been in battle, yet has the gall to criticize those like Jessup who live on the front lines, staring down the enemy, defending freedom. In the final confrontation, Jessup declares, "You curse the marines. You have that luxury. [But] deep down . . . You want me on that wall. You need me on that wall."

Jessup is not a sympathetic character—his extreme approach to discipline leads to a young man's death—but he is passionate, and willing to protect others, whether they appreciate it or not. This reminds me of the threat of an influenza pandemic, where some work tirelessly to defend all of us, even when the public has little appreciation of what is involved, and is even critical.

When the H1N1 influenza virus appeared in May, many people became fearful. A few weeks later, when it appeared that the strain was not particularly deadly or virulent, many expressed anger that they had been made afraid.

But the truth is, they should have been afraid, because the threat of a flu pandemic is real. Using the egg-based manufacturing systems that still predominate today, it takes about 20–24 weeks to produce a vaccine for a new viral strain; in past pandemics, the first wave of mortality already took a serious toll weeks before that. Furthermore, as of just a few years ago, the total worldwide influenza vaccine manufacturing capacity was about 900 million doses, enough for 10–15% of the world's population. And those doses are not distributed evenly throughout the world; it is widely assumed that in a pandemic, national borders will close to stem the spread of disease, making vaccine distribution difficult. Lastly, if the strain is avian and kills chickens, egg-based production could grind to a halt.

Fortunately, many players have been working hard to reduce these risks. A key approach has been to seek manufacturing methods that are faster than egg-based systems. A few firms, like Novartis and Baxter, have been developing mammalian-cell–based production. Small vaccine companies, in turn, are advancing other options, such as an adjuvant-free vaccine made in the faster-growing E. coli (VaxInnate), a vaccine made in insect cells (Protein Sciences Corporation), a virus-like particle vaccine (Novavax), and a DNA vaccine (Vical). Some of these programs include efforts to accelerate scale up and reduce facility costs. Several firms, meanwhile, are working on a universal influenza vaccine approach, to provide protection against both seasonal and emerging pandemic strains, so that we don't have to wait for a new vaccine to be produced in response to a pandemic strain.

Because such development programs take years, many of these vaccines are not yet fully tested and may not prove ready for this round. Yet these firms—along with a host of health agencies, regulators, and government funding sources—kept their eyes on the target long after the fear of an avian flu pandemic ceased to make headlines. And it is because of their work that the rest of us—including the unappreciative public—can have some peace of mind.

So to all of you engaged in the fight against this and every potential new viral strain, my hat is off to you. Thank you for getting us prepared. Thank you for being on the wall, staring down the enemy.

Laura Bush is the editor in chief of BioPharm International,