South Africa, the country with the most resources in Africa, has two suspected cases of swine flu, but does not have adequate supplies of the antiviral drugs known to be effective in treating the rapidly spreading disease that has so far claimed more than 150 lives in Mexico, according to an expert.
"I know for a fact we haven’t stockpiled. If you don’t have a national stockpile, that’s it – you’re not going to get the drugs in time," said Ed Rybicki, a virologist who teaches at the University of Cape Town.
In the absence of a vaccine for swine flu, antiviral medicines such as oseltamivir (Tamiflu) and zanamivir (Relenza) have been used to treat the disease.
Dr Lucille Blumberg, of the South African National Institute for Communicable Diseases, confirmed on 29 April that two suspected cases of swine flu were being investigated. South Africa is a major transit hub for the continent and a destination of migrants.
The World Health Organization (WHO) has allocated a Phase 4 alert level to the flu, which is two steps away from the pandemic phase but signals the need for response and mitigation efforts.
Dorothy Mwangu, a spokeswoman for Roche, the global pharmaceutical company that manufactures Tamiflu, confirmed that the South African government had a stockpile of the drug and said the company also kept its own reserve of drugs to handle seasonal flu outbreaks at country level, but could not comment on the specific quantities on hand in South Africa.
The company had set aside key ingredients of the drug, but it would take time to respond to any sudden major upsurges in demand. She said the country’s best bet was to maintain an adequate stockpile.
All eyes on South Africa
Neighbours such as Namibia have pinned their hopes on South Africa to meet their drug requirements, should there be an outbreak. Mozambique’s national deputy director of health, Leonardo Antonio Chavane, said his country did not have the antiviral drugs. "We use what we have."
Tamiflu is sold at a discounted price to developing countries, and a box of 75 pills retails for about US$24 in South Africa. The government had not responded to queries on the quantity of antiviral drugs stockpiled at the time this story went online.
Rybicki, who is working on a flu vaccine, said if swine flu hit Africa it might be nearly unstoppable because the continent’s poor surveillance capacity, higher disease burden than more developed regions, and lack of drugs were a deadly combination.
"I think picking it up - outside of sophisticated centres - all over the world is going to be difficult," he said. "Surveillance at airports is almost nil - I reckon you can count the number of thermal scanners in South Africa on one hand."
Screening a problem
Screening for the disease in Africa would mean locating it in a population that already suffered from many fever-producing ailments, like malaria, and could result in higher mortality rates, Rybicki said.
Developed countries often have standing orders with pharmaceutical companies for vital drugs, so developing countries like those in southern Africa may be out of luck when placing emergency orders for medicines in high demand.
Swine flu is a respiratory disease in pigs, caused by type A influenza viruses. According to the US Centers for Disease Control and Prevention, people do not normally get swine flu, however, "swine flu viruses have been reported to spread from person-to-person, but in the past this transmission was limited and not sustained beyond three people."