Readers of Dr. Baltimore's article may have come away with the wrong impression about the utility of stockpiling the current experimental vaccine against avian influenza (H5N1). While I agree with his general tone -- we at all levels of public health should be ratcheting up our preparedness level against a possible incursion of H5N1 -- his advice on vaccine stockpiling is somewhat misleading. While there are many unknowns about the likelihood and course of a pandemic, there is one thing all experts would agree on: The shift from the current bird flu strain that would permit human-to-human transmission would produce a virus significantly different genetically from the current strain, which infects birds almost exclusively.
For that reason, it seems a waste of precious resources to stockpile huge quantities of vaccine against the current H5N1 type, knowing full well that it will be largely ineffective. We need the actual pandemic variant to produce an effective vaccine. It is true, although unfortunate, that this vaccine will not be available in sufficient quantities to protect most of us until the human pandemic virus has been around for at least several months.
I am not advocating a retreat from vaccine research on the current epidemic strain, but I am advising against mass production of a vaccine that is bound to be poorly effective, if it is useful at all. Increasing production of anti-virals, researching newer anti-virals to prepare for the resistance that will inevitably develop to current drugs, applying strict hygiene practices, and increasing the availability and proper usage of N95 masks are other more effective measures that we can implement now.
Gilbert Ross, M.D.
Medical Director
American Council on Science and Health
New York
