Department of Health Minister Hou Sheng-mou (侯勝茂) has been spearheading Taiwan's efforts to safeguard against the pernicious H5N1 avian flu virus which, to date, has killed at least 68 people across Southeast Asia and Europe. As neighboring countries struggle with the virus, Taiwan has, so far, managed to remain non-affected.
In an interview with Taiwan News's reporter, Jenny W. Hsu, Hou explained the virulence of the influenza pathogen, the effectiveness of the drug Tamiflu, the reasons behind compulsory licensing for drug production, and why he believes the government is not over-reacting to the situation.
Taiwan News: Many health experts have said avian flu is dangerous only to birds. In that case, what is the real threat to humans?
Hou: Avian flu is what we call the "common cold" among birds. Unfortunately, the virus can sometimes infect human beings. So far, there have been over 160 recorded cases in the world, which means this virus has become very toxic to the human body. What scientists are afraid of most is a mutation of the virus which could occur when it crosses with the human influenza viruses. The real problem would occur if the variant becomes efficiently transmittable among humans because, as it is a new virus, no one in the world has immunity or antibodies against it. If that happens, there could be a global pandemic.
TN: Do scientists have any idea of the rate of the mutation? Is there any way to roughly predict if and when a pandemic will occur?
Hou: Well, no one knows for sure. But we know the possibility is very real, because based on historical records, flu viruses develop pandemic potential every 30 to 40 years. Although science has improved greatly since the 1918 Spanish flu outbreak, viruses have also become smarter and deadlier. As we progress, the viruses progress. Also, due to genetic re-assortment, many novel diseases have emerged in this century. AIDS is one example. A few years ago, no one has heard of SARS. And now, we have avian flu.
We continue to make weapons to fight against viruses, but the viruses continue to mutate.
TN: We know that the drug Tamiflu is effective during bird to human transmission. However, if the real enemy is a new hybrid virus that no one knows anything about, then will Tamiflu still be effective during human-to-human transmissions?
Hou: The influenza is a protein-based virus made up of hemagluttin and neuraminidase. For each strand, there is a different combination or H and N subtypes. When these two proteins invade the host cell, they multiply rapidly and destroy the immune system. Tamiflu, or oseltamivir phosphate, is a neuraminidase inhibitor, which has the ability to stop the virus particle from further aggregation and release. Although we do not know exactly what the new combination will be, it is extremely possible the virus will contain H or N, strands or both. Therefore, as long as the flu remains N-related, the drug would be effective in halting replication. We also know that the drug must be administered within the first 48 hours of infection in order to maximize its effectiveness.
TN: In addition to worrying about the virulence of the pathogen, people are also scared of the long incubation period. Should Tamiflu treatment be started if there are no visible symptoms of infection?
Hou: Coughing is the one of the signs of the flu. Countless virus particles are spread when an infected person coughs. If you are around a person who has a confirmed case of avian flu, you must go to the doctor right away because it is highly possible that you are infected with the virus. Tamiflu is effective even when the person does not show any symptoms. Of course, the doctors will to evaluate carefully who should take Tamiflu. We do not want to create a drug resistance problem by giving everyone the drug.
TN: What are the major differences between the regular flu and avian flu?
Hou: Unfortunately the symptoms are quite similar. However, the symptoms for avian flu are more pronounced and more serious than the yearly flu because no one has any antibodies against the new virus strain. I also must say that Taiwan is still relatively safe from avian flu because even our birds are not infected. There is not even a single case of avian flu among the birds. People in Taiwan should not panic if they get sick. They should wear masks, disinfect their surroundings, and seek immediate medical attention. Our labs can have test results back in four hours.
TN: Although Taiwan is still a non-affected country, we are spending huge sums of money on a disease that might only infect a small fraction of the population, while we still have other infectious diseases and health issues like dengue fever, AIDS, and tuberculosis to deal with. Are we over-reacting?
Hou: I agree we are spending a lot of money on this. But over preparation is better than under preparation. For example, in the U.S. and Japan, their per capita budget for avian flu prevention is almost 10 times that of Taiwan's. Japan is stockpiling Tamiflu for 30 percent of its population. The U.S. is aiming to have enough drugs for 25 percent of its population. All I can say is that God favors those who are prepared. Taiwan is short of Tamiflu right now because we only have enough for 3.4 percent of the population, while our goal is 10 percent. This is why it is urgent for Taiwan to acquire more anti-viral medicines.
TN: The Intellectual Property Office (智財局) recently agreed to allow Taiwan to mass produce a local version of Tamiflu under the enforcement of compulsory licensing. However, Roche reacted negatively to the decision and said it is unnecessary because it has been trying to negotiate with the Taiwan Department of Health to reach an agreement, but DOH has not been willing to negotiate.
Hou: It is very unfair accusation against the DOH. We have been in contact with Roche. You see, we have different priorities. To Roche, the most important thing is licensing. But to us, the most important thing is the safety of human lives. We have to make a compromise between the two. I personally respect patent rights. I believe we have reached a good compromise now. The current decision is that we will use locally made drugs only after we have exhausted the supply purchased from Roche. There is no commercial damage to Roche because under the agreement, we can never sell the drugs.
TN: But Roche has agreed to sell us more drugs so we can have at least 2.3 million courses of the Tamiflu. Is compulsory licensing still necessary since we will have enough for 10 percent of the population?
Hou: Just like you said, they are only selling us enough drugs for 10 percent of our country's population. What happens if a large epidemic occurs in Taiwan? There is a possibility that we will need 2.3 million courses of the drug in the future.
TN: Roche has also raised questions regarding Taiwan's ability and capacity to produce the drug. Are we truly capable? What kind of assurances do consumers have that Taiwanese pharmaceutical companies can produce enough effective drugs on time?
Hou: Roche is wrong. Our anti-viral drug is 99.6 percent similar to Tamiflu. We definitely have the capacity to meet our claims. Roche is not producing Tamiflu in Taiwan, so they know nothing about (the process) here. I will never put the people's health in jeopardy. To protect human lives, I am demanding the highest standards from these pharmaceutical companies. I have commissioned two institutions to produce the drug and two more institutions to evaluate the product. Taiwan's scientific standards are some of the highest in the world. There is no need to invite a third country to make judgment. We have already created our own check and balance system. Once again, health is a basic human right. Knowledge is power and capacity is protection. We must retain our rights to help our own people.