Is Canada ready for a pandemic?

By Angela Mulholland, CTV.ca News

If a flu pandemic were to hit Canada, we would have two lines of defence: antivirals and vaccines.

Some vaccine manufacturers, including ID Biomedical, the company that has the government contract for pandemic vaccine development, are already working on an H5N1 vaccine. But there is no guarantee that strain will be the one to create the next pandemic. If it isn’t, the new strain would have to be analyzed for some time, and then vaccines allowed to be cultured and incubated. So a vaccine probably would not be available in the early stages of a pandemic.

That would leave using antiviral drugs as both the method for preventing illness in those still healthy and for treating those in the early stages of a killer flu.

To date, Canada has plans to stockpile just under 16 million pills of oseltamivir, sold under the name Tamiflu, for the first wave of a mild to moderate flu pandemic. That would be enough to treat 1.6 million people -- not nearly enough say some who say we should have at least 10 times that amount ready.

The Public Health Agency of Canada realizes that it would have to ration the pills and that would mean prioritizing. The top priority for use of the drugs would be treatment of people hospitalized for flu within 48 hours of the onset of their illness. Antivirals are not effective after that point.

The second priority would be to treat, at first sign of illness, health-care workers and essential or emergency services workers. Next on the list would be providing front-line health-care workers and key health-care decision makers with prophylactic amounts of the drug, in order to keep them healthy during a pandemic.

After that -- if there were any vaccine left – the rest of the pills would be doled out on an as-needed basis.

Jill Sciberras, an epidemiologist with the Public Health Agency of Canada, says the current planning is based on the scenario of a mild to moderate pandemic hitting about 20 per cent of the population in the first wave. (Pandemics are believed to hit in at least two and sometimes three waves, some weeks or months apart.) There is little plan for how to handle a more vicious pandemic.

And yet, Canada’s federal pandemic plan is considered one of the most advanced in the world. Many countries have no plan at all.

Dr. Michael Osterholm, a leading infectious disease and bio terrorism expert, says that could be a real problem in a global pandemic. Countries like the United States and Canada cannot afford to focus only on protecting the health of their own citizens, he says.

"Anyone who's handling this at just a country level is missing . . . the point that even if you can vaccinate your population, the collateral damage of a world in pandemic state will be so significant that they still will have tremendous, tremendous disruption and loss," he told the Canadian Press recently.

The World Health Organization has said that the next pandemic will likely have the greatest impact in underdeveloped nations, because of their strained health care resources. Osterholm says if developed countries ignore underdeveloped nations, we here in Canada could find ourselves battling crippling shortages of essential medical supplies, consumer goods and even food. What could make the next pandemic unique is that the world will have anticipated it. Never before have we known that the world is due for a pandemic and had experts around the world drafting plans in preparation. What remains to be seen is whether all those warnings from the experts will do anything to save lives.

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