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October 09, 2005

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The 20-40% is not just to protect specific groups, but also to be able to create buffer zones around places where it hits, to contain the virus.

The Tamiflu alikes might not help thant much btw. So not having enough might be less bad than you think.

dutchmarbel: yes, I saw that. But it turned out to be a mistake:

"It appears a misunderstanding, not a mutation, is behind recent reports suggesting the H5N1 avian flu strain is developing resistance to the drug Tamiflu.

The professor of pharmacology from Hong Kong University quoted as warning of an emerging resistant strain of the virus says he was citing old data, not new evidence, when he gave an interview last week. (...)

When the reports quoting Chui started to circulate, flu experts around the world sent out urgent e-mails trying to find out who had found new evidence of resistance. The flu community keeps close tabs on the efficacy of these important drugs, known as neuraminidase inhibitors.

They came up with a puzzling blank.

Except for that one partially resistant H5N1 isolate from Vietnam, no researchers have reported new discoveries of Tamiflu-resistant viruses isolated from human cases of H5N1, both the WHO and Tamiflu's manufacturer, Hoffman-La Roche confirm.

"There is a network of laboratories that has been set up to follow antiviral resistance among influenza strains," says Michael Perdue, a scientist in the WHO's global influenza program.

"One of the first things they look at (when they get new viral isolates) is the antiviral sensitivity and resistance. And the papers that have been published thus far have shown all the strains to be sensitive."


That doesn't mean there might not be evidence of resistance out there, being kept under wraps by researchers pushing them through the publication pipeline of medical journals.

Still, Perdue thinks word might have gotten around.

"There's no hard and fast rule. But generally people let WHO know information like that. And we have not heard.""

Ah, I see. Not a bad thing that we ordered a few million than ;)

No. You are lucky enough to live in a well-governed country.

And if only my great-grandfather had not had to leave the Netherlands, one step ahead of the law, after defrauding widows and orphans and losing both their shirts and his, I might live there too...

You all were probably lucky he left, though.

Sounds like the proper Dutch attitude in that time ;)

I think that all countries with national healthcare and worker protection have an advantege with the flu:It is easier to stay home when you are ill and go to the doctor to get a diagnose and/or medication.

We are small though, so easier overwhelmed. Also, the Netherlands *is* a travel hub so lots of people are travelling through the country which makes isolation harder.

Pre-Katrina I would have said that the US has the advantage that the rest of the country can compensate if there is an outbreak in a specific area. Now, I'm not so sure.

BTW: you recommend that people get a flu shot as a precaution. Are *those* available enough now?

Actually, every nation in the world with the ability should be turning out oseltamivir in mass quantities. They should be paying Roche to release their data so that everyone could set up facilties. Buying the stuff from one vendor just isn't going to cut it.

Tim's point seems important to me. If a pandemic should take hold, would governments really sit around, respecting intellectual property rights and previous contracts?

And even as I think that they shouldn't, my dialectal self wonders why, if private companies are even almost able to meet the demand, their property rights shouldn't be protected. It is surely in the interest of the state to buy out medical patents that are or might be vitally important to the national interest, but, oy, that might get expensive.

I'd be interested to hear a more traditionally conservative side of this argument. The historiography of epidemics has almost always favored the centralized government argument, but since I exist in this world today, and the avian flu crisis remains only a possibility, I'm still open to the property-rights argument, if it can be done well.

(As someone who's spent months in the stacks reading up on cholera, however, my inclination is towards seizing the IP in the name of national security, and, should the worst present itself, seizing whatever facilities are convenient for producing anti-viral medication or vaccines. Politically unpalatable, I know, but pandemics are, well, scary.)

I find myself often wondering how in the world we ended up with such an incompetent administration at such a critical time in our country's history!!!!

I think it is important to imagine how a pandemic would play out to get a better purchase on the question of IP. If the pandemic occurs, the disruption to the world economy would occur regardless of the manufacture of vaccines. One could make an argument that a quick resolution would be less painful, but the businesses that would be hurt would still be in very bad shape. Thus, you wouldn't have a push by them to seize IP. You would have a lot of pushback by the drug companies (I am now thinking of the thread that had discussion socialized medicine and the advancement of medical research). In addition, if the rate of death (probably less than the Spanish flu's rate of 1-4% because secondary complications will be taken care of?) would not, I sadly believe, generate the necessary political will to take steps, especially since those who die would again more likely be the poor and uninsured (I do note that the Hong Kong bird flu seems to have a 30% mortality rate, which may be enough to generate political will) There will be no property seizure until the pandemic is upon us, and at that point, the bell can't be unrung.

Probably von can speak more informatively to this, but I think that there is now an exemption to pharmaceutical patents in the case of public health emergencies. It may be only for poor countries, though: in any case, the context in which I've heard of it has been HIV in sub-Saharan Africa (how to get AIDS cocktails to people in countries where the annual per capita spending on health care is $5? And thus where there is absolutely no chance whatsoever that they or their governments will be able to pay full price? Suppose one could make a cheap knockoff and somehow sell it only there: would that be OK? Etc.) I suspect the arguments would be less convincing if made by the US. And it's unclear to me why Roche couldn't just ramp up production, and whether, if it can't, there's any reason to think that someone else could.

Or, in brief: the problem here isn't the lack of a market, or the lack of someone with IP willing to manufacture the drug. Whatever it is, then, it's not clear that voiding a patent (or whatever) would solve it.

It's just that I'm remembering how, during WWII, the Richard, CA shipyards were supposedly able to turn out an armorclad warship in a single week.

If at some point we really are in a pandemic, I would hope that the government could really mobilize nationally. I would hope that seizing IP wouldn't come too late, and I would hope that commandeering laboratories wouldn't come too late. I would also hope that such extreme measures would never be invoked except in the case of grave emergency--and I'm really glad I'm not in a position to make such calls.

The problem is, as I see it, that the best preventative measures presume a nationalization of health care that is currently unthinkable in the US, and that the best responsive measures available today involve militarily enforced quarantines. Somewhere between we must be able to seize IP and labs to mitigate harm to the nation, right?

To Hilzoy: I think that if one voided Roche's patent and commendered laboratories in the name of national security, one might be able to produce huge amounts of anti-virals or vaccine. This would require a real state of emergency, yes, and a real trust in the central authority.

Von? IP lawyer? Advice, here?

If the situation around anthrax is an indication it will not need that much to override patents in case of a threat.

I know it sounds crazy, but you could always pay for the drug.

It is not about payment Sebastian, it is about availability of the product. Production cannot keep up with demand.

It's not even Roche's drug. They license it from the guys who developed it. What is their IP is the production method. Considering that the Chinese are apparently already making a cheaper version it might even benefit Roche do go along with making their process public.

Of interest is this from the NYTimes


A major Indian drug company announced yesterday that it would start making a generic version of Tamiflu, the anti-influenza drug that is in critically short supply in the face of a possible epidemic of avian flu.

"Right or wrong, we're going to commercialize and make oseltamivir," said Dr. Yusuf K. Hamied, chairman of Cipla of Bombay, using the drug's generic name and acknowledging that he might face a fight in the Indian courts with Roche, the Swiss pharmaceutical giant that holds the patent.

Although generic manufacturers cannot legally sell the patented drug in the West, all national patent laws, including those of the United States, allow governments to cancel patents during emergencies and either buy generics or force patent holders to license their formulas to rivals.

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