Editorial

Year in, year out many thousands are hit by the influenza bug. Thanks to antibiotics and good medical care, the vast majority survive it. Pandemic influenza is another matter because we are not dealing with the "normal" virus but with its genetic mutation. Against this mutation there is no immediate vaccine available.

Most people are unaware that pandemic 'flu occurred three times during the last century. As many have, however, read about the outbreak of 1918 when the death toll exceeded the number of soldiers killed during the Great War. There is one great difference between the world of 1918 and today's world: the advance in medical science.

Recently, the possibility of pandemic 'flu breaking out has been hitting the headlines all over the world. Avian influenza, which has been around for some time in stretches of Asia - where it is endemic - has so far been limited to domestic birds. We have seen the culling that goes on when these animals are affected. It is feared that this bird 'flu could mutate, especially if culling and its supervision is not 100 per cent effective, and transfer to humans. Naturally, this has disturbed people who are naturally curious about how the world, and in our case Malta in particular, is equipped to deal with an outbreak should it visit our shores.

Governments are pinning their hope on an antiviral drug with properties to block the replication of the virus. The World Health Organisation is attempting to stock up with this drug in a bid to slow down any pandemic 'flu that emerges. It all seems to depend on how fast the virus spreads should it break out. Saving lives and halting the outbreak require drug stockpiles to be in place.

But as the New Scientist weekly magazine pointed out last June, the trouble is "that most stockpiles of Tamiflu are being acquired by rich countries in Europe and North America, not poor countries such as Vietnam, where any H5N1 pandemic is likely to start". This is presumably why the WHO is currently negotiating for a supply that will enable it to rush the drug out to areas where countries are not rich enough to stockpile enough of the stuff.

So far as Malta is concerned, the government is stocking up with the antiviral Tamiflu for 25 per cent of the population in accordance with the WHO's recommendations. The antiviral will be available in the private sector later this year and can be bought against a prescription. Malta has placed an order for 350,000 doses of the vaccine for the pandemic strain when this becomes available and increased the number of doses it orders for the annual epidemic from 30,000 to 150,000.

Containment is the name of the game but there is not much evidence of international co-ordination. Equally important at this stage, as the Malta Chamber of Pharmacies (MCP) has pointed out, is the need for a national strategy to inform and educate the public about differences between seasonal influenza, avian' flu and the pandemic, together with information about vaccines and anti-viral treatments.

The MCP correctly reckons it has a role to play within such a strategy, which must surely include forward preparations (hospital space and staff) for an influx of patients who cannot be treated at St Luke's Hospital. The medical department should assure the public that plans to cope with this have been drawn up.