[Viewpoint] The future of the fight against flu

Since June, when the World Health Organization declared a global pandemic of the H1N1 influenza virus was under way, hundreds of thousands of people have fallen sick and thousands have died, fanning fears worldwide. The pandemic declaration - the first since 1968, when an H3N2 flu strain was initially detected in Hong Kong - means the new virus has jumped across continents.

Flu originally occurs in birds, and bird flu virus is presumed to be transmitted to humans through pigs, whose organs are similar in size and structure to humans. The seasonal flu that occurs in winter can be prevented by vaccination, but pandemic flu can hardly be contained because development of a vaccine for the new virus is completed only after the virus has spread. Flu strains are categorized according to two proteins found on the surface of a virus: hemagglutinin (H) and neuraminidase (N). Hemagglutinin is a glycoprotein that binds the virus to the cell being infected, while neuraminidase is an enzyme that helps the virus breach cell membranes. There are 16 subtypes of hemagglutinin and nine subtypes of neuraminidase. Theoretically, there could be 144 flu subtypes, but only the variants H1, H2, H3, N1 and N2 are commonly reported among humans.

The current pandemic is the fourth since 1918, when the Spanish flu (H1N1) killed 20 million people. The 1957 Asian flu (H2N2) caused 2 million deaths, and the 1968 Hong Kong flu killed up to 1 million people. The 2009 H1N1 is a variation of an H1N1 seasonal flu virus that has been circulating since 1977. The most notable characteristic of the new flu is the speed with which it spreads; only six months transpired since the first warning to pandemic status. Still, the flu has killed fewer than 0.1 percent of its victims so far, much lower than the 2 percent in past pandemics.

It is difficult to contain a flu pandemic, and more frequent occurrences are expected going forward. A virus is the simplest living organism. Its structure is unstable, making for easy mutations. A flu virus is particularly prone to mutations, which explains the variations that crop up annually. Types of bird flu that have not been transmitted to humans are monitored as they may jump to humans at any time.

The fast spread of the flu can be attributed to three factors. The first is urbanization and globalization. Second, massive breeding of poultry, a major infection source, has led to the higher possibility of collective infection and mutation. Third, vaccines take six months to develop using the traditional method of cultivating the virus in chicken eggs. This makes it difficult to prevent infections in the early stages, allowing for massive spread.

Since it is difficult to fundamentally prevent the occurrence of the flu, it is necessary to contain infections and find more effective solutions. The government will need to store sufficient vaccines and antiviral drugs and prepare emergency countermeasures. Also crucial is a crisis management system to calm public fears. Companies should prepare plans to cope with decision-making paralysis caused by the absence of managers and other personnel. But the most important task to prevent the flu is to prepare to diagnose it, vaccinate against it and cure it. The size of the world vaccine market was $111 trillion in 2008. Annual average growth of 9 percent is expected until 2013. Vaccines to conquer viruses such as pandemic flu and AIDS are likely to lead the future market.

Vaccines need to be produced every year, so major global pharmaceutical firms that are struggling with falling sales due to the expiration of patents for key products are aggressively entering the market through mergers and acquisitions, while companies in emerging economies such as China and India are growing quickly thanks to low labor costs and loose government policy.

The markets for molecular diagnosis and immunity diagnosis device systems for viruses reached $23 trillion and $62 trillion, respectively, in 2007. Flu symptoms are similar to those of many respiratory diseases, and thus the need is growing to develop diagnosis devices that can find and identify a virus promptly and accurately at its early stage. Mid-sized to large systems suitable for specialized institutions like general hospitals are prevalent now, but in the future small “point-of-care” systems that allow real-time diagnosis will arrive.

The market for antiviral drugs, which stood at $219 trillion in 2008, is predicted to see 9.5 percent annual growth on average into 2013. The drug market for flu treatment is relatively small, currently standing at below $10 trillion and dominated by Tamiflu, made by the Swiss drug company Roche Holding, and by Relenza, a product of the Britain-based GlaxoSmithKline. But tolerance to antiviral drugs builds up and at some point, their effectiveness is lost. Hence, uninterrupted research and development for new drugs is imperative. Most recently, a new kind of antibody-based flu drug is being actively developed.

Since the death rate of the 2009 H1N1 flu is lower than past pandemics, the current situation should be approached calmly, rather than with extreme fear. Industry-wide, vaccine-related biotechnologies should be developed to prepare for the next new pandemic. There is time to cope with pre-development of vaccines and antiviral drugs for the possible outbreak of H5N1 bird flu, considered the next threat. These viruses have yet to mutate into a form that is infectious to humans on a large scale. Non-biotechnologies that prevent the spread of disease such as air sterilizers and purifiers should also be simultaneously developed. One example is to introduce home devices that kill viruses by applying ultraviolet rays or by using ozone.

*The author is a research fellow at the Samsung Economic Research Institute (www.seriworld.org).

by Koh You-sang