Researcher Eleanor Fish thinks interferon may help people who are hospitalized with the H1N1 virus. Preliminary research points to this but Dr. Fish is scrambling to get resources to test her hypothesis.Peter Power/The Globe and Mail
Eleanor Fish thinks interferon, a drug usually used to treat people with cancer, might help patients with serious cases of H1N1.
The immunologist at the University Health Network in Toronto has preliminary data that suggest the synthetic version of a compound produced by the human immune system might be an effective treatment for swine flu. But she is having trouble securing the money to test it.
"Finding the funds to demonstrate safety and efficacy in patients is a tremendous challenge - remarkable given the concerns about an H1N1 pandemic," she said. "But I am determined to pursue this."
Other Canadian researchers also have urgent questions about H1N1. Are people with acute or chronic infections, like latent tuberculosis or parasites, more at risk of being sent to hospital or dying from it? Is vulnerability to it linked to specific genes?
But perhaps the biggest question is whether they can design experiments, get the ethical approvals and find the funding quickly enough to make a difference in this pandemic.
Dr. Fish is one of many Canadian scientists forming teams to apply for grants from a $1.2-million fund to study H1N1 that the Canadian Institutes of Health Research is offering. The deadline is Aug. 10, but the funds aren't expected until October.
Flu season will be well under way by then, Dr. Fish said. "It is very obvious where attention needs to be focused right now - treatment and patient care. There are individuals in the scientific community who are acutely aware of the urgency of the situation and frustrated at the lack of resources directed at one specific area: antivirals."
She said considerable attention and funding has rightly gone into research on infection control in the community and health-care facilities, research of the transmission of the virus and work on a vaccine.
But it is unlikely a vaccine will be available before flu season, she said, when many more Canadians could become infected. It is also unclear whether there will be enough.
So short-term treatment must focus on antivirals, she said. The virus is already becoming resistant to Tamiflu, one of two antivirals that can keep it in check if taken within days of the first symptoms. That leaves only Relenza, which must be inhaled, making it less useful for patients with lung problems.
Dr. Fish and collaborators are proposing to evaluate several antivirals, including interferon, for treating H1N1, to study lung injury during infection, and the flu's effect on a person who already has a bacterial infection.
The $1.2-million is meant to bring together large teams of researchers, but it is not adequate, she said. It also is not intended for clinical trials, so Dr. Fish will have to look elsewhere for money to study interferon as a treatment.
Interferons are produced by the immune system to combat viruses, but doctors using synthetic versions during the SARS outbreak in 2003 worried they would increase inflammation in the lungs of patients with severe cases.
As other approaches failed, Dr. Fish and colleagues did a small pilot study on 19 patients that had promising results, but the outbreak ended before they could follow up.
Lab work shows interferon might be effective against H1N1, but studies involving seriously ill patients are needed.
Mark Loeb, an infectious diseases expert at McMaster University in Hamilton, agrees on the need for more funding. "Obviously, we have to move fast, and we need existing funds to be bolstered," he said.
He is chairman of a task force set up to advise the CIHR, which funds medical research in Canada, about priorities for pandemic research. He said many areas are important, including fundamental research on the virus and how the human body responds to it, as well as vaccines and antivirals.
Bhagirath Singh, scientific director of the CIHR's Institute of Infection and Immunity, said he understands the urgency, with flu season only six to eight weeks away.
Dr. Singh said he is hoping for more money from the government and that will try to speed up the approvals process so the $1.2-million starts to flow before the fall.
But he said the Canadian research community is far more prepared to work on influenza today than it was in 2006, when concerns over avian flu prompted the federal government to start investing in pandemic research.
At the time, only four teams in the country were working on influenza, he said, but since then, the CIHR has spent $39-million on pandemic research through 71 different proposals.
Work on H1N1 that has already been funded includes a network focused on evaluating vaccines and a project to track the evolution of the virus and evaluate its susceptibility to antiviral drugs.
"There is money out there. There is investment. Do we need more money? Absolutely," Dr. Singh said.
Other countries are stepping up to the plate.
Australia recently announced $ 6.3-million for 41 medical research projects on the evolving threat of H1N1. The peer-review process used to determine which proposals receive funding was reduced from months to a week.
Amir Attaran, who holds a Canada Research Chair in Law, Population Health and Global Development Policy at the University of Ottawa, said Australia has fast-tracked inexpensive, quick research with the potential in improve the public health and clinical care response to the pandemic.
One study, he said, is looking at Australians' attitudes toward vaccination, which could be essential for an effective national program to fight H1N1.