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  Unease over Swine Flu: The Inexorable March of H1N1

Unease over Swine Flu The Inexorable March of H1N1

By Marco Evers and Veronika Hackenbroch

Part 2: The Race for a Vaccine

Despite the pandemic, mass events like concerts, football matches and festivals have not been cancelled. However, health officials could change their minds quickly if the situation becomes acute. Temporary school closings are believed to be one of the more effective ways of containing an influenza outbreak. Experts see children as the most important carriers of the flu, because they tend to come into close contact with one another and often stick their fingers in their mouths and have poor hand hygiene. Hong Kong, for example, has taken the precautionary step of closing all kindergartens and primary schools for two weeks.

Vaccine manufacturers have already begun production of a vaccine against the pandemic virus, with the first batches expected to be ready in about four months. At that point, a fierce competition will ensue over who gets the protective vaccine. There will only be enough for a minority of the population.

WHO estimates that there will be enough vaccine worldwide for between 500 million and one billion people in the entire first year of the pandemic. Everyone else will be forced to wait and hope -- and face the probability that the virus will reach them before a vaccine does.

Flu vaccines are traditionally grown in incubated chicken eggs. This is an effective method, but it has an important drawback, especially in a pandemic: It is impossible to produce large amounts of vaccine quickly, because one egg is needed for each dose of vaccine. To overcome this problem, a number of pharmaceutical companies are trying to convert their production to cell cultures.

Elderly Unaffected

In the western German city of Marburg, vaccine giant Novartis has, for the first time, successfully produced an initial batch of swine flu vaccine using cell cultures. "This proves that it works," says Stephan Becker, director of the Marburg Institute of Virology, which works hand-in-hand with Novartis.

Cell cultures make it possible to produce vaccines within weeks instead of months. Novartis says it will begin human clinical trials with the cell-based vaccine in July, and the company plans to have the new vaccine ready for approval by December. If all goes well, millions of vaccine doses could leave the Marburg plant every week, while a new plant Novartis is building in North Carolina could produce even more.

But the world will have to make do with rationing until there is enough vaccine for everyone. The WHO will soon issue recommendations on which patient groups are most endangered by the swine flu. They would be given priority for vaccination.

The most likely candidates are pregnant women, people with heart disease, diabetics, people with autoimmune disorders, the obese and those aged 30 to 50. Children will also likely be included. Although their symptoms are not usually severe, they tend to contract the virus in large numbers. In the Mexican town of La Gloria, one of the early sites of the epidemic, more than one in two children became infected.

Unlike the ordinary flu, H1N1 is apparently not particularly threatening to the elderly. Physicians speculate that this may be because they were exposed to a related virus many decades ago.

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