Disease outbreak As the threat of a new flu pandemic in humans was confirmed last week, cross-border talks on pandemic preparedness measures were taking place in Newry, Co Down.
The talks were a crucial final step in ensuring alignment between the two departments of health in planning for communicable disease outbreaks and, in particular, the next influenza pandemic, which the Geneva-based World Health Organisation (WHO) says is inevitable.
WHO is urging governments to do all they can to be prepared for the coming pandemic, particularly in light of the re-emergence of the highly pathogenic H5N1 strain of avian influenza in Asia, which has killed 23 people in Thailand and Vietnam so far this year.
"It was a meeting that we had long planned in relation to the development of our own generic contingency plans. A huge amount of work has been done over the last five months on refining our pandemic preparedness in light of the latest developments in communicable diseases at the global level," said Dr Darina O'Flanagan, director of the National Disease Surveillance Centre (NDSC).
The new plan, due to be rolled out shortly, involves modules devoted to preparedness and response measures for outbreaks of SARS, smallpox and an influenza pandemic.
Dr O'Flanagan acknowledges that Ireland, like most other countries without any vaccine production capacity, will have a particular challenge when it comes to accessing vaccine stocks for an influenza pandemic, as there are no international agreements in place to ensure equitable sharing of vaccines. "It's a problem that has not yet been resolved though it has been raised in various international forums," she said.
WHO operates on the assumption that if any country succeeds in developing a vaccine, it will only release stocks once it is assured that all its own population's needs have been met.
The head of the WHO Global Influenza Programme, Dr Klaus Stohr, said he was disappointed at the general lack of investment in developing influenza vaccines. He said the United States was the only country investing in a vaccine against H5NI, which will be tested over the winter months.
A further mutation in the H5N1 virus could render this vaccine useless, but it would be a potentially important step towards developing a vaccine against any new pandemic influenza strain resulting, for example, from an exchange of genes between human and avian influenza viruses in a person simultaneously infected with the two viruses.
Dr Stohr said that while it was far from proven that the H5N1 strain was widespread in pigs, the possibility of co-circulation of avian, human and pig influenza viruses in swine was of concern because of the potential for a genetic exchange, or "reassortment" of material, between these viruses. Pigs have been implicated as sources for influenza outbreaks in the past.
If any newly emergent virus contained sufficient human genes, then transmission directly from one person to another could occur rather than from birds to humans. This would create the conditions for a new influenza pandemic, with the potential to generate waves of infection with high mortality.
Estimates vary, but many more people have died from influenza than the 20 million lost to AIDS over the past 20 years.
Dr Stohr said nothing had changed to suggest the world would not face another pandemic, just as it has done every 20 to 40 years over the last century. Even taking into account the advances made in medicine, epidemiological models from the US Centers for Disease Control and Prevention suggest a pandemic today could result in over seven million deaths globally.
Many of these deaths would occur in developing world countries which lack the resources to purchase adequate stocks of vaccines against even routine annual epidemic outbreaks.
WHO spokesman Dick Thompson said the organisation would launch an advocacy campaign in September to convince pharmaceutical manufacturers to make influenza vaccines available at affordable prices.
He said it was ironic that countries in Asia, where the influenza viruses thrive, were the main suppliers of the seed stock for the development of the annual influenza vaccine which would be used in Ireland in the coming weeks, and yet many of these countries could not afford to buy the vaccine itself.