The three biggest influenza pandemics of the last century are...

The three biggest influenza pandemics of the last century are all believed to have originated in bird flu in Asia. With scientists fearing it may be happening again, Catalyst reporter Jonica Newby investigates the Asian Bird flu crisis. This special report goes into one of the worlds most highly secure microbiological facilities the CSIRO Australian Animal Health Laboratory in Geelong. It’s here where samples of H5N1 have been sent from Asia. The report investigates the very real threat of bird flu mixing with human flu to create a lethal new virus with the killing agent of avian influenza, and the transmissibility of human influenza. With predictions that another influenza pandemic is inevitable and maybe imminent this report ask - is this a dress rehearsal - or the real thing? Is Australia ready for the next flu pandemic? Where are our weapons of mass protection?
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Across Asia we are witnessing the most widespread outbreak of deadly bird flu ever seen…

Yet the numbers of people infected are relatively small.

So why has this flu got scientists so nervous?

Could this be the start of an influenza pandemic?

Alan Hampson:
The pandemics occur 3 or 4 times a century. So I guess on average something like 25-30 years apart. It’s over 30 years since the last one and so most people believe we’re overdue.

Narration:
The three biggest influenza pandemics of the last century are all believed to have originated in bird flu.

Now scientists fear it may be happening again…

Prof John Mackenzie:
The odds are significantly higher than they’ve ever been in the last 20 years, 30 years, 40 years probably.

Narration:
Where are our weapons of mass protection if they’re right?

Dr Bryan Eaton:
Vaccine would take 6 months, 5 months to produce, and a lot of damage, a lot of lives could be lost in 6 months

Narration:
Is Australia prepared for the next flu pandemic?

Dr Bryan Eaton:
The virus could be round the world in hours

Narration:
The killer Asian strain of avian influenza virus - known as H5N1 – is already in Australia.

But – fortunately– it’s contained in a lab.

Dr Bryan Eaton:
Each of us has to flash this card, ill do it first and you follow.

Jonica Newby, Reporter:
So it actually takes two cards to let you through.

Dr Bryan Eaton:
Yes

Jonica Newby, Reporter:
Pretty high security

Dr Bryan Eaton:
Yes it is

Narration:
Here, in one of the worlds most microbiologically secure facilities, lie clues as to why this virus is such a threat…

Dr Bryan Eaton:
If you go into the shower block here, Ill go into the next one and Ill see you on the other side.

Jonica Newby, Reporter:
There’s a lot of airlocks.

Dr Bryan Eaton:
Yeah, a lot of airlocks.

Jonica Newby, Reporter:
You obviously don’t want to be the ones to let the virus out.

Dr Bryan Eaton:
No, no, the sample that arrived have been brought to the laboratory over here, where we do all the avian flu.

Jonica Newby, Reporter:
So there could be actual avian flu here?

Dr Bryan Eaton:
Yes, yes

Narration:
Virologist Bryan Eaton, is part of a team, fine tuning Australia’s ability to detect H5N1.

Narration:
We’re not allowed inside where there’s live virus, but Brian has agreed to take us to the inactivated version, under the electron microscope.

Jonica Newby, Reporter:
Is that it? That’s the virus?

Dr Bryan Eaton: Yes

Jonica Newby, Reporter:
So these are the very first images of the virus in Australia?

Dr Bryan Eaton:
Yes, I’m sure it is…and you can see three virus particles here.

Jonica Newby, Reporter: Yes

Dr Bryan Eaton:
And that fringe indicating the spikes on the surface of the virus.

Jonica Newby, Reporter:
Is that what you call the H5 spike is it?

Dr Bryan Eaton:
That’s where the H5 spike is located on the surface of the virus.

Narration:
All flu viruses have protein spikes. These are their battering rams – allowing the virus to get inside our cells and cause damage.

This virus has evolved a particularly dangerous spike - the ‘H5’.

In birds it’s capable of penetrating every cell in the body
lungs, liver, heart, even brain…causing total organ shutdown.

Dr Bryan Eaton:
The data from the field would indicate that this is highly virulent and the major factor leading to that virulence is the property of this H5 molecule.

Jonica Newby, Reporter:
So its a nasty spike.
Dr Bryan Eaton: Yes, a nasty spike…

Dr Bryan Eaton:
This virus can kill overnight. It kills with respiratory symptoms, sometimes swollen heads, diarrhea, very rapid death is what the hallmark is with this virus.

The mortality rate was up around 100% on some farms/ So you can imagine what it’s like for a farmer who gets up one morning and walks over to his chicken shed and finds out over half of them are dead on the floor of the shed – very traumatic.

Narration:
H5N1 not only kills birds, it kills us.

In the past, bird flu was transmitted from birds to humans, via pigs.

But in 1997 in Hong Kong, for the first time the virus passed directly from birds to humans,killing 6 people. It was H5N1.

Only the rapid slaughter of 1.5 million birds stopped the spread.

Now, H5N1 is back.

Dr Bryan Eaton:
It’s really very scary. You walk up to your computer in the morning – you bring up the material that comes in from the web and suddenly it says H5N1 reappears in Hong Kong – chickens are dying in their 100s or 1000s and you think “Oh god we’re here again. What are we going to do this time?

Narration:
So far, the virus has only been caught from infected chickens.

In order to cause a pandemic, a global epidemic, it would need to change …it would need to become able to pass directly from human to human.

And that brings us to the other feature of H5N1 that’s giving the experts nightmares…

Narration:
Flu viruses constantly shuffle genes. But this one is a master shuffler.

It’s proven it likes to mix - having already acquired genes from duck, goose and quail viruses.

The big fear is if it shuffles the deck again – this time with human flu.

An avian virus exchanges material with the human influenza virus.

Taking the killing power of avian influenza… and the transmissibility of human flu.

… hitting the genetic jackpot.


Prof John Mackenzie:
All it takes is somebody suffering from avian flu and very ill – somebody comes in with the human flu – the patient will then be infected with the human flu as well as the avian flu – bingo that’s all it takes to make a new pandemic strain.

Dr Bryan Eaton:
And of course this is an H5 – humans have never met an H5 influenza virus before, so we have no antibodies to protect us.

Jonica Newby, Reporter:
We’d have no immunity?
We’d have no immunity.

Narration:
In the movie Outbreak, filmmakers presented a vivid portrayal of the ease at which a pandemic could begin…

While this scene may seem overly dramatic, it could reflect a worst case scenario…

Alan Hampson:
Look it is the disease which travels fastest I think of all known infections in humans. /if you take the available information which suggests that from the first case when the virus starts to spread within a month you could easily have a million cases.

Alan Hampson:
It could be 4 million or more Australians ill and requiring medical attention within a short period of time. It could be maybe 100,000 requiring hospital treatment and maybe somewhere around 10 or 20000 deaths occurring.

Prof John Mackenzie:
We’re looking at 100 million people dying in one worldwide pandemic in one season. I mean just consider what SARS killed - 8,000 people, consider what HIV has killed since we’ve known about HIV maybe 30 million people. You’re looking at 100 million people in one pandemic season

Narration:
Fortunately, the risk of hitting the ‘jackpot’ … where the human and avian flu viruses co-infect the same person at the same time …
and swap genes… is extremely low.

But …the greater the current spread of avian influenza in birds…

… the more people may become infected…

… and the odds increase that someone with bird flu will also catch human flu.

Prof John Mackenzie:
We have more avian influenza now than we’ve had for a long, long time. We are now approaching the influenza season for humans, so the chance of those viruses circulating at the same time increases. So the chance of that little event occurring where you can have re-assortment and a new much more virulent human virus emerge increases.

So, how well prepared are we… just in case?

Alan Hampson:
Okay let me show you around.

Jonica Newby, Reporter:
Okay

Alan Hampson:
This is the containment laboratory because these viruses are very dangerous. Could you close that door?

Jonica Newby, Reporter:
Okay sure… a lot of doors.

Alan Hampson: Yes there certainly are.

Narration:
Around 2000 people die in Australia every year from flu and its complications. The government spends millions providing vaccines, particularly for the elderly. But the current vaccines don’t work on H5N1. A new vaccine is needed.

Alan Hampson:
Okay so this is where you make the vaccines is it?
Well this is where we start the process of working on the viruses that will make the vaccines at the end of the day if they’re needed. /

Narration:
A new vaccine will take 3 – 6 months to produce, and cost millions.

The question is: should we start producing the vaccine now?
This virus may never ‘shuffle’.

But if we wait, by the time we discover H5N1 has mixed with human flu it will be months before the vaccine is ready. Millions may die.

Alan Hampson:
One of the problems is that it’s a very costly exercise to actually go out and produce vaccines and not have them used. Somebody’s got to make a decision that we are actually going to do this

Narration:
This is the man at the front line, Australia’s Chief Medical Officer.

John Horvath:
You’ve got to make a risk assessment at any one time of the money you spend on a vaccine which may or may not be needed as against all the other health care dollars. That’s a government decision. I will give them the best possible advice and then that decision is made on a risk assessment.

Narration:
In this building, there are teams of experts monitoring the Asian outbreak, advising the Department of Health. A fortnight ago they upgraded to 7 days a week

There’s always a level of anxiety 'til you see the direction in which it is going. Hopefully, with all our preparations, we’re ready. But more importantly, hopefully, we’re starting to see the peak.

Jonica Newby, Reporter:
How do you feel watching it?

John Horvath:
Anxious as everybody else.

Alan Hampson:
Realistically even if we started gearing up tomorrow there would not be enough vaccine if the pandemic stated tomorrow – not for everybody anyway.

Narration:
There is another option…

Jonica Newby, Reporter:
So I’m now protected from flu?

Jenny Breschkin Yes, yes.

Narration:
The worlds first specific antiviral against flu was developed here in Australia.

If used daily, Relenza, like its international rival Tamiflu, is effective in treating every known strain of influenza… and research suggests it may even prevent infection.

Jenny Breschkin:
So if someone has sneezed or coughed on you and you’ve come down with flu, you can use it to kill the virus that has already started to multiply inside you, but it can also be used as a prevention if someone has sneezed on you before you come down with symptoms, you can actually then use these drugs to prevent that infection from then developing.

Jonica Newby - Reporter:
Very useful in a pandemic?

Jenny Breschkin:
Yes because in a pandemic if you can reduce the spread of the virus, then you’re going limit the severity of that pandemic.

Jonica Newby, Reporter:
Are stockpiling anti-virals at the moment?

John Horvath:
We started stockpiling anti-virals after 911 and looking at what are the appropriate anti-virals to put into our stockpile.

Jonica Newby, Reporter:
And you mean the anti-virals that work with flu?

John Horvath:
Mmm. And along with other anti-virals, yes.

Jonica Newby, Reporter:
Well, I guess the question that a lot of people would want to ask is how much is in that stockpile?

John Horvath:
Well, how much is in the stockpile, like the United States and like the United Kingdom, is a part of a whole national security agenda. And we really don’t talk about what’s in it, how much is in it and where it is.

Jonica Newby, Reporter:
You can’t tell us that?

John Horvath:
No, I cannot tell you that, and that’s in line with how the U.S. looks at it, how the U.K. looks at it, and what’s been government policy.

Jonica Newby, Reporter:
What’s the reason?

John Horvath:
That it is a part of the national security stockpile. So really I'm not, you know, I can’t discuss contents, size and where.

Narration:
So in the event how prepared are we?

Alan Hampson:
We will have scarce resources. There’ll be demand for more vaccines, more anti viral drugs than the world can supply but I think we’re probably fortunate in Australia where we do use influenza vaccines, we do have the anti virals available and we will be better placed than many people. We’ve done some forward planning. In fact Australia’s probably one of the best-prepared nations as far as pandemic planning is concerned. But all we can hope to do is to minimize the impact of a pandemic. We can’t stop it.

Narration:
So what are the odds of H5N1 shuffling its genetic material with human influenza… creating the pandemic strain?

Dr Bryan Eaton:
The chance of it happening is low, very very low, but of course should the event happen then it could turn into something that’s very very significant.

Alan Hampson:
We know these viruses are out there. We see them moving between species at the moment. You’d be crazy not to plan for it.

John Horvath:
It’s a bit like the lottery. A negative lottery. The more tickets you buy, regrettably, the more chance you’ve got of winning/ it is now more than a neglible risk. 09:06:11 / But //let us hope that all our preparations are a total waste of time

Narration:
So far there is no evidence of H5N1 mixing with human flu…

…so hopefully, this is a dress rehearsal.

But history suggests… and the experts agree…

sooner or later… a flu pandemic will occur.