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<div>'Just thought I'd call your attention to Kendall Hoyt's Op-Ed in
the New York Times Today. Kendall did her Ph.D. at MIT in Science,
Technology, and Society in 2002, on the history and science policy of
vaccine development and is now on the faculty at Dartmouth Medical
School. When addressed to a broad audience and accessibly written,
STS makes a difference in public discourse and science
policy.</div>
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<div>dm</div>
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<div>New York Times</div>
<div><font face="Times" size="-4" color="#000000"><b>March 3, 2006<br>
</b></font><font face="Times" size="-4" color="#666666"><b>Op-Ed
Contributor</b></font><font face="Times" size="-4"
color="#000000"><b><br>
<br>
</b></font><font face="Times" size="+2" color="#000000"><b>Bird Flu
Won't Wait<br>
</b></font><font face="Times" size="-4" color="#000000"><b>By KENDALL
HOYT<br>
<br>
<br>
</b>Hanover, N.H.<br>
<br>
AS avian flu makes its way from Asia across Europe, the United States
has yet to meet the challenges that this potential epidemic and other
biological threats pose to our health and security. One challenge in
particular needs attention: the shortfall in countermeasures like
vaccines.<br>
<br>
Most biological threats are likely to be unannounced and unfamiliar
(like the outbreak of SARS in 2002 and 2003), so rapid drug
development is critical. With few exceptions, the United States lacks
the ability to develop, manufacture and administer vaccines in
response to specific threats as they arise. That ability is within
reach, but only if we invest wisely.<br>
<br>
Congress recently appropriated $1.8 billion to develop and purchase a
pandemic flu vaccine. Any vaccine we develop now, however, may not
work against a human-to-human transmissible strain that could emerge
later. The problem is that the government has been focused on a
prognostic model of developing and stockpiling countermeasures aimed
at specific pathogens. This "one bug, one drug" strategy
makes sense for a small number of biological threats that are highly
communicable, lethal or easily weaponized, like smallpox and
anthrax.<br>
<br>
It is less sensible, however, for many other threats, for two reasons.
First, the number of pathogenic threats far outstrips our drug
development resources. Second, epidemiological forecasting and
intelligence about such threats are unreliable: witness the
vaccination campaigns against botulinum toxin in World War II, swine
flu in 1976, anthrax in the 1991 gulf war and smallpox before the Iraq
war, which all addressed threats that failed to materialize. Creating
stockpiles of vaccines for high-consequence pathogens is important.
Beyond those, however, it's wiser to build a system that will allow us
to react quickly to rapidly evolving or unexpected biological
threats.<br>
<br>
Agencies like the National Institutes of Health and Department of
Defense have spent a lot of money on building early-stage research and
development programs and laboratories for combating biological
threats. But there have been no commensurate investments in late-stage
research and surge manufacturing. Without that, the value of
early-stage research is greatly diminished.<br>
<br>
These capabilities can and should be developed, starting now. It now
takes 8 to 10 years on average to develop one vaccine. As the Defense
Advanced Research Projects Agency has been urging, it may be
technologically feasible to build a "bug to drug" program
that yields a countermeasure within months, rather than years, of
identifying a novel pathogen.<br>
<br>
A "bug to drug" program would accelerate the translation of
early-stage research into new countermeasures. Such a program would
make broad investments in technologies to speed development (for
example, microarray diagnostics, computerized model immune systems,
DNA vaccines and animal models for diseases of particular concern). In
some cases, it could build a library of clinical-grade vaccine seed
strains to allow the rapid production of vaccine. In other cases, it
could establish manufacturing protocols, as well as emergency
administration and distribution procedures.<br>
<br>
Besides investing in rapid response mechanisms, such a program would
also support research projects. These projects could include the
development of production methods to reduce the time and cost of
vaccine manufacturing, ways to boost an immune response after a single
dose and thermostability innovations and "no needle"
vaccinations to make it easier to distribute vaccines in an
emergency.</font></div>
<div><font face="Times" size="-4" color="#000000"><br>
Unless we act now, we will have to rely on primitive and probably
ineffective methods, like quarantine, when a new pathogen arrives.
Such methods will take an unnecessary and unprecedented human,
economic and political toll on the United States and on all nations
that do not prepare.<br>
<br>
Kendall Hoyt is an assistant professor at Dartmouth Medical School and
an associate with the New England Center for Emergency
Preparedness.</font></div>
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