Tamiflu shortage, influenza and other infectious diseases: What needs to be done?

Kathleen Blanchard's picture
Is this year's flu epidemic a wake up call?
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Reports of a Tamiflu shortage have been raising concerns as influenza outbreaks sweep across the US. But what does the shortage really mean for public health? There are little if any implications when you take a closer look. The bigger focus might instead be geared toward preparing for infectious disease spread.

This year’s epidemic raises many questions about how to stop spread of infection in general that can occur anywhere in the world. What should we do and what sort of research still needs to be done to keep the public safe?

Why Tamiflu doesn’t matter much

The drug Tamiflu is an antiviral agent that is supposed to shorten flu duration when taken as soon as symptoms occur.

But given research showing Tamiflu or other drugs in its class may not even work, the shortage might not have much impact for most people.

It is also not going to stop influenza from spreading. It’s going to take a different approach altogether to stop diseases like the flu and more from spreading.

The drug works by blocking replication of the flu virus. That means your symptoms may not become as severe as they might if you didn’t take the drug – supposedly.

But last year, a Cochrane review questioned the efficacy of the antiviral, making it curious that there is a focus the drug being in short supply.

Public health officials have diligently studied ways to stop outbreaks of infectious diseases. Tamiflu won’t help curb flu spread.

Even the Food and Drug Administration describes the drug as being only modestly effective for ameliorating symptoms of the virus.

How do we stop influenza and other infections from spreading?

We know taking the influenza vaccine can help stop the virus from spreading. No, it isn’t foolproof, but it definitely helps. Yet just half of Americans have taken the vaccine.

One new study sheds some light on why the vaccine is shunned by so many people. Researchers at Wake Forest University explored what drives people to take a chance at getting the flu or any other type of infection.

They used an online game to study why people are willing to take such risks.

The game results found it’s simply because ‘one size doesn't fit all’ when it comes to risk taking. Some people were willing to gamble with their virtual health and others were not.

The study was conducted by economists Fred Chen, PhD, Allin Cottrell, PhD, and Amanda Griffith, PhD, and computer scientist Yue-Ling Wong, PhD, who devised the game to conduct an experiment that they say couldn't be done in real life.

In one game, the cost to protect players’ health was low. In the other, the cost was high.

"Players were rolling the dice to see if they could stay healthy without paying the costs of protection. But even those players who were more inclined to take risks chose to self-protect the more often they got sick," Chen said in a press release.

They concluded people might not take the flu vaccine, protect themselves from sexually transmitted diseases or take other preventive measures to protect their health because of cost.

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The authors explain cost might equate to fear of needles, side effects from the flu vaccine, lost wages from missing work or just time spent. Other factors could be financial including cost of a flu vaccination or gas to drive to the doctor or flu-shot clinic.

But in the end, the more players that got infected and the more times a player got ‘sick’, the more likely they were to take precautions.

The study authors suggested more people might be willing to take a flu shot this season if they know how many people are sick. They also suggest policy makers and employers make disease prevention a priority by offering paid time off for employees who get flu shots or providing free flu shots onsite.

The new study also coincides with a call for manuscripts from researcher Richard A. Stein, MD, PhD, about how we might stop the spread of infectious diseases. Stein explains that learning about the host-pathogen interface, and curbing epidemics, are going to take a ‘paradigm shift’, in an editorial published in the International Journal of Clinical Practice.

It’s not just the flu that we need to be worried about. Evidence is mounting that drug resistant bacteria are continually emerging that threaten public health.

Stein writes: “...the field of infectious diseases...has represented one of the most challenging and dynamic medical areas.”

Studying infectious diseases has become “interdisciplinary”, Stein explains, and indeed it seems so as evidenced by the recent virtual study from economists trying to track behaviors that have adverse health consequences.

Dr. Stein suggests it’s time to look at the ‘host-pathogen interface’ that is shaped by a variety of factors.

Prevention is the best option to stop influenza and other emerging infectious diseases that have a huge impact on the physical and emotional well-being of large populations.

Dr. Stein who is a researcher at the Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, reminds us that “The prescription of antibiotics for non-bacterial conditions, their frequently inappropriate clinical use, the extensive global use of certain compounds in agriculture, aquaculture and animal farming, and the circulation of resistance across ecosystem compartments are only a few of the factors that promise to exacerbate an already existing crisis.”

Diseases like malaria, cholera or yellow-fever that were believed to be eradicated are making a comeback and could become epidemic or pandemic in the future. There’s much more to the infectious disease issue that ties in with this year's flu.

In thinking about infectious diseases in general, it is also important to remember that certain pathogens were causally linked to cancer, Dr. Stein explains.

Tamiflu shortage shouldn't be a focus related to this year’s widespread flu. Even if you could get your hands on some, it may not even help you feel better.

In an e-mail interview with EmaxHealth, Dr. Stein writes:

“Understanding infectious diseases requires much more than looking at the host and the pathogen. The dynamic host-pathogen interface is very complex, and is shaped by host, microbial, and environmental factors. Additionally, we need to reach beyond disciplines that historically have been used to study infectious diseases.

These include areas from life sciences, such as genomics, proteomics, and systems biology, which emerged with advances in biotechnology, in addition to disciplines such as psychology, sociology, anthropology, and economics, areas that in the past we did not systematically incorporate in the study of infectious diseases, yet whose importance is continually emerging.

The management of infectious diseases, from prophylactic to therapeutic interventions, requires a complex, multidisciplinary and interdisciplinary framework”.

Researchers are continuing to try to understand how to keep the public safer from existing, re-emerging and drug resistant diseases that can also lead to widespread outbreaks of illness. This year’s flu epidemic should serve as a reminder that we have a lot of work to do to quell infectious disease spread. It’s going to take a cooperative effort from the public, more research and a greater understanding of how to be prepared to thwart outbreaks of any disease.

Sources:
PLoS ONE
“Behavioral Responses to Epidemics in an Online Experiment: Using Virtual Diseases to Study Human Behavior”
Frederick Chen, et al.
January 9, 2013

The International Journal of Clinical Practice
“Infectious diseases: a call for manuscripts in an interdisciplinary era”
R.A. Stein PhD, M.D.
DOI: 10.1111/ijcp.12057
January 11, 2013

Image credit: Morguefile

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Comments

Many people I have spoken to in our community are not in favor of vaccines, no matter how safe they are assumed to be. This is perhaps also due to the cost, (Vitamins are cheap) or perhaps due to gambling with their health. Australians are notorious gamblers and are not scared to throw their money away, so I don't think cost is related to it. They are aware, possibly because of headlines in the papers, that medicine could be a bigger risk than gambling. I feel that many prefer the natural process and the protection that supplementation of Vitamin C, titrating to bowel tolerance and Zinc, (up to 100 mg) can bring to fend off the flu. Personally I prefer this method as well. And, of course, appropriate diet, plenty of clean unadulterated water, and, where possible, reduce stress as stress plays havoc with your immune system,
Yes - one of the things mentioned re: cost in the economists' study did include side effects as a 'cost' of taking vaccines. Interesting.
By the way, since Flu vaccine is now recommended for pregnant women and young children, I assume there are studies about the safety of vaccine additives for the fetus? Or are we getting to see the results in about 8 or 9 months time?
Here is a report: http://www.ncbi.nlm.nih.gov/pubmed/20965490
Since flu vaccine needs to be updates every year, and sometimes more than once a year, that must be the fastest bit of research ever done! I wonder if they can do research on diabetes and cancer with the same alacrity. They have been at that for over 50 years!
Interesting how they do this with the flu vaccine. Each year they put in 3 strains - A/H1N1, A/H3N2, and B. The CDC says that should also give protection against variances of the virus too. Researchers have been trying to develop a 'universal' vaccine. They try to match based on what is 'going around'. You can read more here: http://www.cdc.gov/flu/weekly/