Development & Aid, Global, Global Geopolitics, Headlines, Health, North America

CANADA: Flu Pandemic Plan a World Away from South’s Preparations

Marty Logan

MONTREAL, Feb 13 2004 (IPS) - The release of Canada’s multi-million-dollar plan to prepare for a global flu outbreak highlights how tough it would be to fight a pandemic in the developing world, says an expert here.

The blueprint, the Canadian Pandemic Influenza Plan, outlines measures for surveillance, vaccine programmes, the use of antiviral drugs, provision of health and emergency services, public health measures and communications.

It was released in Ottawa on Thursday as a strain of avian flu continued to batter East Asian nations and after months of warnings that the world is overdue for a pandemic like the Spanish Flu outbreak of 1918-19 that killed as many as 50 million people.

“We have to be prepared for the unlikely event that currently circulating strains of avian influenza might acquire the characteristics of a pandemic strain,” Health Canada’s Ron St. John told reporters at a press conference.

If it did, preparations in the Canadian plan include readying 165 portable hospitals containing 33,000 beds for deployment anywhere in the country within 24 hours, added St. John, the director general of Health Canada’s emergency preparedness and response centre.

But in the developing South, where urban poverty is one of the biggest changes since the 1918 outbreak – known as the most devastating epidemic in world history – “I would say that things don’t look so good”, says Anne-Emanuelle Birn of the University of Toronto.

“You’ve got two million children dying of respiratory infection – bronchitis, pneumonia. You’ve got a million dying of malaria. These are all preventable diseases and so this doesn’t bode well for what could be a much more virulent ailment.”

“These populations that were largely rural in 1918 are now going to be exposed to infectious diseases, (and are) susceptible because of the dire living conditions, and also much less likely to be able to survive” because of factors like poor nutrition, added Birn, who holds the Canada research chair in international health at the university.

The plan states that “the overall goal of pandemic influenza preparedness and response is first to minimise serious illness and overall deaths, and second to minimise societal disruption among Canadians as a result of an influenza pandemic”.

According to a model it describes, “an estimated 4.5 to 10.6 million Canadians (15-35 percent of the population) would become clinically ill such that they would be unable to attend work or (do) other activities for at least half a day”.

“In addition, it is estimated that between 2.1 and 5.0 million people would require outpatient care, between 34 thousand and 138 thousand people would require hospitalisation, and between 11 thousand and 58 thousand people would die in Canada during an influenza pandemic,” adds the plan.

“The economic impact (direct and indirect) on the health care system is estimated to be between 10 to 24 billion dollars,” says the plan.

Underpinning the country’s reaction to a global outbreak would be production of a vaccine to prevent Canadians from catching the flu, and ensuring supplies of antiviral drugs, to both prevent and treat mild cases of the sickness.

Canada is one of fewer than a dozen countries worldwide where flu vaccines are produced, and leads the world in taking steps to ensure adequate supply during a pandemic, largely by developing production facilities with a domestic drug-maker.

The country’s flu pandemic preparations cost about 5.3 million U.S. dollars annually.

“It is estimated that the next pandemic virus will be present in Canada within three months after it emerges in another part of the world, but could be much sooner due to increases in the volume and speed of global air travel,” according to the plan.

“Upon arrival, the virus may spread across Canada with great speed.”

The plan forecasts the domestic manufacturer will need 48 days to start producing a vaccine, and within two to three months will be making six million doses of vaccine a month. Health Canada’s goal is to produce eight million doses per month, Arlene King, the agency’s director of immunisation and respiratory infections, told reporters.

Canada is also taking steps to ensure it has adequate amounts of antiviral drugs, which are in short supply worldwide. The plan warns that “in 1997 when a strain of influenza that was believed to have pandemic potential was identified in Hong Kong, antiviral drugs rapidly became virtually unavailable for purchase world-wide”.

Added King, “Canada is collaborating with other countries and is co-leading discussions with the United Kingdom related to the use and supply of antivirals within the global health security action group of G-7 countries”.

The World Health Organisation (WHO) is meeting in Geneva this month to make plans for the next flu season, and will assess the situation in the developing South.

The chief of WHO’s global influenza programme told IPS in January, “our concern is that during an influenza pandemic, first, influenza vaccines will not reach developing countries until developed countries would have set aside their demand because (vaccine-producing) companies are there”.

“Secondly, developing countries have not yet started with the other items that belong to pandemic preparedness”, which includes deciding whom to vaccinate first, how governments will allocate hospital and other medical resources, and developing treatment guidelines, Stohr added.

But Birn says health systems in these countries have been “gutted” in recent decades, “including cuts in social services spending, privatisation, introduction of user fees”.

“It would be very difficult to ask a country like Nicaragua, where access to basic clean water (is an issue) or South Africa, (which is struggling with) providing anti-retroviral drugs to deal with AIDS. It would be very difficult to ask them to stop all of these very dire needs to cope with a potential influenza pandemic,” she adds.

“In a way this is a luxury of countries that don’t have such pressing needs.”

Birn says she uses four M’s to describe the situation in the developing world – migration, mega-cities, misery, “all leading to mortality. This is a good sort of underpinning of the story … which is mostly (being) ignored”.