Faculty Bibliography

Historically, influenza pandemics have struck unpredictably. The last three were in 1968, 1957 and 1918 to 1919. To Dr. [David Chan], pandemic influenza is a global political and medical problem that requires an international solution. What complicates the task is that the same influenza experts who say that a pandemic will surely come also say they do not know when, what strain of virus will cause it or how many people it will sicken and kill. Indeed, Dr. Chan faced such complaints after the first cases of A(H5N1) avian influenza appeared in Hong Kong in 1997. No vaccine was effective against the strain. But the virus was susceptible to a drug, amantadine, and Dr. Chan authorized the equivalent of $1.3 million to buy a large supply of it in case a large outbreak occurred. None of it had to be used. During the SARS outbreak, Dr. Chan was a daily figure on Hong Kong television. The driver, who had also stopped at the light, recognized Dr. Chan and knew from news reports that the W.H.O. wanted her to go to Geneva to work on environmental health. Rolling down his window, he said, ''It's one chance in a lifetime, and think of what you will do for Hong Kong and for China.''

Polls show that our overall fear has remained fairly constant since 2001. An Associated Press/Ipsos poll the week after the July 7 bombings in London found 57% of us believe an attack on mass transit is inevitable, and 37% are concerned they or their loved ones will be the victims. These percentages have remained steady over the past year. But polls also indicate that recent attacks -- including the failed bombings July 21 in London and the successful ones two days later in Sharm el-Sheik, Egypt -- increase the public expectation elsewhere that the next strike might come soon. A USA TODAY/CNN/ Gallup Poll just after the London bombings found that 55% said an act of terrorism on U.S. soil was likely in the next few weeks. Elizabeth Phelps, professor of psychology and neural science at New York University, has been researching the effects of perceived danger on the human brain. She has added her findings to the pioneering work of Joe LeDoux, another neuroscientist at NYU. It turns out that the brain has a fear center, known as the amygdala. It's a tiny almond-shaped structure deep inside the brain that emits fear signals and initiates an outpouring of stress hormones. Though Ledoux's work on the amygdala is well established in animals, Phelps' applications to humans are still somewhat preliminary. Using the latest techniques in magnetic resonance imaging exam, Phelps has studied the brain's response to videos of dangerous situations rather than real dangers. She has shown that the effects on the brain's physiology are the same with a simulated attack as with a real one. Internet, television, movies -- these are all vehicles for the type of response that Phelps has studied. Visualized threats get our juices going, and we are ready to respond

Officials have been racing to develop a vaccine because they worry that if that strain mutated and combined with a human influenza virus to create a new virus, it could spread rapidly. Tens of millions of birds have died from infection with the virus and from culling to prevent the spread of the virus. About 100 people have been infected, and about 50 have died from this strain of the avian influenza virus, called A(H5N1). So far there has been no sustained human-to-human transmission, but that is what health officials fear, because it could cause a pandemic. The director of the National Institute of Allergy and Infectious Diseases in the United States, Dr. Anthony Fauci, said that while the vaccine that has undergone preliminary tests could be used on an emergency basis if a pandemic developed, it would still be several months before that vaccine was tested further and, if licensed, offered to the public. He cautioned: 'We don't have all the vaccine we need to meet the possible demand. The critical issue now is, 'Can we make enough vaccine, given the well-known inability of the vaccine industry to make enough vaccine?'' 'It keeps changing, it keeps evolving,' he said. 'We don't know how much the vaccine matches.' Another problem lies in initial test results in the United States showing that the new vaccine requires two doses. Moreover, each dose may have to contain several times more material than a conventional human influenza vaccine dose. Vaccine manufacturers already struggle to produce enough human influenza vaccine each winter, even producing a small, single dose for each patient

Officials have been racing to develop a vaccine because they worry that if that strain mutated and combined with a human influenza virus to create a new virus, it could spread rapidly. Tens of millions of birds have died from infection with the virus and from culling to prevent the spread of the virus. About 100 people have been infected, and about 50 have died from this strain of the avian influenza virus, called A(H5N1). So far there has been no sustained human-to-human transmission, but that is what health officials fear, because it could cause a pandemic. The director of the National Institute of Allergy and Infectious Diseases in the United States, Dr. Anthony Fauci, said that while the vaccine that has undergone preliminary tests could be used on an emergency basis if a pandemic developed, it would still be several months before that vaccine was tested further and, if licensed, offered to the public. In Taiwan, Dr. Kuo Hsu-sung, director general of the Center for Disease Control, said that the authorities in Taiwan were so concerned about the long-term risks of an influenza pandemic, as well as the annual harm from more routine outbreaks of human influenza, that the island planned to build its own human influenza vaccine factory. But building a factory and putting it into production will take four years, Kuo warned. For now, Taiwan has a supply of Tamiflu, the only medicine known to work against bird flu, adequate to treat 1 percent of its population

Influenza viruses are grown in chicken eggs, and the vaccine industry has difficulty obtaining enough of them to produce the standard influenza shots each year. That is among the reasons that the industry can currently produce only an estimated 450 million doses of standard influenza vaccine for the human strains, Dr. [Anthony S. Fauci] said. Dr. Kou Hsu-sung, the director general of Taiwan's Center for Disease Control, said the island was so concerned about the long-term risks of routine influenza outbreaks and an influenza pandemic that it plans to build its own human influenza vaccine factory. In years past, standard influenza vaccine has had to be discarded because too few people wanted it. In the case of the human avian influenza vaccine, said Dr. [William Schaffner], the Vanderbilt expert, ''how many people will show up and present their arms?''

He cautioned: 'We don't have all the vaccine we need to meet the possible demand. The critical issue now is. 'Can we make enough vaccine, given the well-known inability of the vaccine industry to make enough vaccine.'' An earlier human vaccine against A(H5N1) avian influenza virus was prepared after it first appeared in the world, in Hong Kong in 1997. That vaccine was never fully developed or used, and the strain has mutated since then. In interviews over recent days, [Anthony S. Fauci] has said that tests so far have shown that the new vaccine produced a strong immune response among the small group of healthy adults under age 65 who volunteered to receive it, although the doses needed were higher than in the standard influenza vaccine offered each year. The vaccine, developed with genetic engineering techniques, is intended to protect against infection, not to treat those who are sick

In recent interviews, [Anthony Fauci] has said that tests so far have shown that the new vaccine produced a strong immune response among the small group of healthy adults under age 65 who volunteered to receive it, although the doses needed were higher than in the standard influenza vaccine offered each year. The vaccine, developed with genetic engineering techniques, is intended to protect against infection, not to treat those who are sick

Tens of millions of birds have died from infection with the virus and culling to prevent the spread of the virus. About 100 people have been infected, and about 50 have died from this strain of the avian influenza virus, called A(H5N1). So far there has been no sustained human-to-human transmission, but that is what health officials fear, because it could cause a pandemic. And that fear has driven the intense research to develop a vaccine. An earlier human vaccine against the A(H5N1) avian influenza virus was prepared after it first appeared in the world, in Hong Kong in 1997. That vaccine was never fully developed or used, and the strain has mutated since then. In interviews over recent days, Dr. [Anthony S. Fauci] has said that tests so far had shown that the new vaccine produced a strong immune response among the small group of healthy adults under age 65 who volunteered to receive it, although the doses needed were higher than in the standard influenza vaccine offered each year. The vaccine, developed with genetic engineering techniques, is intended to protect against infection, not to treat those who are sick

Because the A(H5N1) strain of avian flu is lethal for chickens and so could not be grown in eggs, Dr. [Robert G. Webster] had to use a technique known as reverse genetics to remove the gene that made the virus deadly. This altered virus was used by Sanofi-Pasteur, a French vaccine company, to produce the vaccine in chicken eggs. Dr. [Anthony S. Fauci] said he was encouraged by the findings because ''many other experimental vaccines have produced flat dose-response curves,'' meaning that the vaccines were ineffective because they did not stimulate the necessary immune response. An immunologically potent vaccine produces ''a good dose-response curve,'' he said, ''and unquestionably we got one with this vaccine.''

He cautioned: 'We don't have all the vaccine we need to meet the possible demand. The critical issue now is, `Can we make enough vaccine, given the well-known inability of the vaccine industry to make enough vaccine?' '