“I realize that pandemic planning is an unpleasant — even scary — topic that most of us don’t consider the best luncheon chat. . . . Nevertheless, I am compelled to educate you on the facts.”

Just after noon one Thursday last month, the main ballroom of the Missouri Athletic Club in St. Louis filled with perhaps 150 Rotarians. They had come for an unlikely double bill: bird flu and lunch.
They also got a glimpse at what makes the American health care system different from that of any other developed country. And what that might ultimately mean.
Pandemic influenza — an outbreak that occurs simultaneously in many different places — has fallen off the front pages in recent years. But it remains a serious, global threat.
The lack of media attention is a problem for health officials. It’s their job to encourage an easily distracted public to prepare.
It’s an even bigger problem for companies such as Hoffman-La Roche that are in the business of selling relatively expensive anti-viral drugs for treating influenza.
Developing countries in which bird flu outbreaks have occurred have small budgets and virtually no public health systems. India and Vietnam, for example, each spend an average of less than $50 per person per year on medical care.
Hoffman-La Roche’s best-selling influenza drug — Tamiflu — retails for about $82 per dose in the United States. But the U.S. market is limited. So far, at least, there have been no bird flu outbreaks here.
Increasing sales of Tamiflu is what brought George B. Abercrombie, president and CEO of Hoffman-La Roche’s U.S. operations, to a meeting of the St. Louis Rotary Club last month. It is Mr. Abercrombie’s quote that appears at the top of this essay.
“Global health authorities — not me, not Roche — warn that another global influenza pandemic is inevitable and actually overdue,” he told the Rotarians. “Former Secretary of Health and Human Services Tommy Thompson . . . believes that pandemic planning may give businesses a competitive edge,” he continued, “because when we have a pandemic, companies that are prepared will build market share.”
Mr. Abercrombie has given similar speeches dozens of times in cities across America. He’s selling pandemic preparation, which undeniably is a good thing.
He’s also selling Tamiflu.

Like humans, birds have been getting influenza forever. Public health officials started receiving reports during the late 1990s of an especially deadly strain of bird flu called H5N1. It had jumped from birds to humans — mostly, humans who lived in very close proximity to the bird flocks they tend in Southeast Asia.
That the virus had mutated to infect humans was worrisome. But the real fear was that it might mutate further, to the point that it could spread easily from person to person.
Making an effective vaccine would take six to eight months after the virus was isolated — that is, after it started spreading from person to person. With a six-month head start, the virus could produce a pandemic the likes of which hasn’t occurred since the so-called Spanish Flu killed 20 million people in 1918 and 1919.
The only hope of preventing it is anti-viral drugs that were developed to fight seasonal flu — Hoffman-La Roche’s Tamiflu and GlaxoSmithKline’s Relenza. But no one knows how well they would work against a fully mutated strain of H5N1. In the flu strain that’s circulating now, the drugs can reduce the death toll drastically, if given quickly enough.
Federal and state health officials have stockpiled the drugs. But in keeping with the Bush administration’s minimalist approach to government, HHS Secretary Mike Leavitt bluntly warned that there won’t be enough to go around. “Don’t expect the federal government to swoop in and rescue everyone,” he said.

The federal government’s pandemic prep plan calls for companies that provide essential services, such as utilities and hospitals, to consider obtaining anti-viral drugs themselves to protect key workers.
That’s a very non-traditional market for drug companies — and a potentially lucrative one. They could use the money. Because of economic hard times, some American consumers have stopped filling some of their prescriptions. They just can’t afford them.
In June, Hoffman-La Roche announced a new program that provides, in effect, pandemic insurance. In September, competitor GlaxoSmithKline followed suit.
Under the Roche program, businesses pay $6 per dose per year for a guarantee that they’ll have access to Tamiflu at the retail price when an epidemic occurs. “We’ve sold to 350 companies so far,” Mr. Abercrombie said during his St. Louis visit. “They range from large, multinational corporations to a small, mom-and-pop lawn-care business.” The company declined to say what percentage of the Tamiflu market these sales represent.

A century ago, before effective medical interventions were available, epidemics represented the ultimate democratization of risk. Diseases such as yellow fever, malaria and tuberculosis struck rich and poor alike. That’s no longer true as a result of new medicines and improved understanding of how diseases spread.
Is Hoffman-La Roche’s effort to develop new Tamiflu markets among corporations a bad thing? Greg Evans, who directs the Institute for Biosecurity at St. Louis University’s School of Public Health, doesn’t think so. Roche’s educational and commercial efforts can help public health agencies if a pandemic occurs, he said. If he were running a business, he would want to have the drug available for his key employees.
“That, I guess, is how our medical system has worked in the past,” he said.

After all, people who work for big companies are more likely to have health insurance than those who don’t. People without health insurance are less likely to get care.
In normal times, that means their kids don’t get well-child visits, and they don’t get cancer screenings or preventive care.
During a bird flu pandemic, it would mean that many Americans simply won’t get anti-viral drugs — which gives Mr. Abercrombie something interesting to talk about.
“Pandemics come in waves,” he explained last month. “During the first wave, officials expect 30 percent of the population to get sick. “Here in St. Louis County, that’s 200,000 to 300,000 people who will get very sick in a very short period of time, inundating emergency rooms.”
How you feel about that depends on whether you and your family are in that group.
And, of course, whether you’re in a financial position to do anything about it.

– John G. Carlton