No Magic Bullet
By Mike Gomez
September 11, 2001 will long be remembered by many in the "free world" as a day of infamy, barbarism, treachery, cowardice, and a lot of other negative vibes felt towards Osama bin Laden and others of his cause. Indeed, no freedom-loving American or ally of the United States and what it represents was happy about what happened on that day.
But some opinion makers pointed out that the attacks on the US proved advantageous in some bizarre manner to Gracia Burnham. If the American people had not become so enraged at the atrocities committed by the Al Qaeda fanatics, the US government may not have decided to send crack troops to the Philippines to assist AFP personnel in tracking down the Abu Sayyaf bandits.
Another sector that somewhat benefited from the tragedy was the virology unit of the Research Institute for Tropical Medicine (RITM). Why? The bioterrorism-jitters engendered by the Al Qaeda threats resulted in the proverbial school flu incident several weeks later in which hysterical parents "rescued" their little darlings from the purportedly virus-ridden campuses for fear of an anthrax attack. Of course, few of these dutiful parents really knew what anthrax was. The word ended with an "x" that made it sound pretty malevolent; while those of us who admit to have already been in long pants in the 1970s probably recall a rock group by that name.
The school flu incident prompted the Health Secretary to beef up the influenza surveillance his people at RITM had been banging their heads with for three years. While Dr. Manuel Dayrit might have sounded like the typical government official who calms the rabble by ordering the organization of a "task force" to address a crisis, the system had already been up and running with data coming out of its ears. It was the personnel of the influenza surveillance effort who conducted the impromptu investigation of the incident, securing pathogen samples from the affected persons with the hope of getting to the bottom of things after some laboratory work.
This laboratory work took as long as it had to take. Samples transported via cold chain in appropriate culture media were whisked to RITM laboratories for analysis. Notwithstanding the modernity and efficiency of these facilities, everyone had to wait just the same for the cultures to grow before the evidence came to light. After a few weeks of incubation, the laboratories determined that the evil bug was not the dreaded Influenza A virus strain that would have denied Dr. Dayrit of sleep for at least two weeks. It was nothing more than a variant of the ubiquitous Influenza B virus.
Flu Who?
But what particular variant was it, and why was it able to cause an alarming outbreak?
Having established the general strain, RITM dispatched specimens to its counterpart laboratories in Australia for identification. When all was said and done, the folks in the white lab gowns came out and said the Philippine School Flu was caused by the Shandong variant of the Influenza B strain.
Shandong? Not really that exotic, except that the flu variant has not reared its ugly head in this part of Asia for decades. Because it has not been regarded as a significant pathogen in this place at this time, there was no focused campaign against it among vaccine manufacturers.
The current WHO recommended vaccine formulation for the Northern Hemisphere stipulates the Moscow and New Caledonia variants for Influenza A, and the Sichuan variant for Influenza B. The school flu incident took place only a few weeks after the WHO issued its recommendation for 2002 influenza vaccines. Unfortunately, the vaccine against Sichuan does not offer the needed immunological effect against Shandong.
The increased activity of influenza among the students in these exclusive schools prompted RITM researchers to suspect a different variant because the level of immunization with influenza vaccine is highest among them. Not surprisingly, many of the parents did not realize that the influenza shots they paid good money for did not guarantee total protection. Some even asked the investigating doctors if all the schoolchildren should be subsequently immunized to protect them from whatever was making the other kids sick.
While a rose is still a rose under any other name, influenza viruses under different names behave quite differently, further complicating the public health message about vaccination that stresses the value of lifetime protection with a few needle jabs or oral drops.
Weapons in the Works
While measles, diphtheria, pertussis, tetanus, polio, and hepatitis-B vaccines are pretty straightforward, the vaccine against influenza is a dynamic, continuously fine-tuned product of medical science and a global health information system. This system commits a reasonably large amount of human and material resource each year simply to keep close watch of the hovering and pulsating flu pandemic, to get a better idea of what it looks like at the moment, and what particular bug happens to be hovering around at any specific time.
As in many monster movies, this band of heroes determines the monster's weakness, and mobilizes the government or the friendly neighborhood mad scientist to quickly cook up the weapon that would save everyone from the beast. Indeed, the preparation of influenza vaccines is a frenetic race against time every time the WHO issues its recommendation for the composition of vaccine for the area. The few drug facilities able to manufacture such vaccines can only come up with so much in the few months they have to get them ready.
But this massive global effort has relatively little effect on public health in the Philippines because the government does not see it fit to include influenza in its EPI. It is difficult enough to get all susceptible children to get their once-in-a-lifetime shot against measles. Imagine the financial and operational nightmare of giving every Filipino an annual flu injection.
As in many cases, the painstaking work done in monitoring the flu pandemic will benefit only the thin upper crust of the Filipino community who can afford immunization each year. For the vast majority, the option would be to take a calculated risk that their children would not be among RITM's statistics in the coming year. It is very much like deciding whether or not to get a costly health plan. Having no health coverage is no guarantee that one will get sick; but it certainly diminishes one's much valued peace of mind.
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