Got your flu shot but still worried sick about a global pandemic? Fear not. In The Flu Pandemic and You: A Canadian Guide, Vincent Lam and Colin Lee offer practical, clear-headed and thorough advice on preparing for what they argue is an inevitable influenza pandemic. Here, the Toronto-based emergency physicians and writers—Lam’s the author of the Giller-winning Bloodletting & Miraculous Cures—talk about the media’s role in pandemic preparation, the complexities of vaccine development, and your (pretty good) chances of survival.

Did someone ask you to write this book?

CL: Margaret Atwood, who’s a mutual friend, approached us with the idea and we thought it was great.

VL: There was a lot of media interest in the issue of pandemic influenza and avian or “bird” flu. What we saw was that although much of the media wrote and talked about avian influenza, it was hard for the individual to understand and put it all into context. We felt this was an important issue, and so we wrote this book to give people some perspective.

Does the media have a positive or negative impact on the public perception of pandemics, including seasonal influenza and avian flu?

CL: I think it’s both. Sometimes the media can cause a more fearful response, and it’s out of misunderstanding a very complicated situation or issue. We have seasonal influenza every year. There’s also pandemic influenza and avian influenza, but there are differences between them. It’s up to the media to specify what those differences are. This is a major example of how the media can help in terms of providing details on what the most up to date information is. So it can go both ways.

Going into more detail about bird flu, does the H5N1 strain only exist in birds?

CL: The current H5N1 strain we are concerned about is an avian strain. We’re concerned because it has two of the three characteristics a strain needs to become an influenza pandemic. The first characteristic is that it has not been seen in humans before. The second is that it can cause quite a serious illness. The third characteristic, which it doesn’t have right now, is the ability to transmit or be very contagious from human to human. Most (if not all of the cases) have been from bird to human, but there are some cases where we are unsure, hence all the surveillance and worry.

Is it possible for this strain, or any strain, to develop the ability to be contagious between people?

CL: Absolutely—that’s part of the evolution of the virus. A virus goes through genetic mutations. Some mutations stick and some don’t. With regards to developing the ability to go from human to human, it’s almost impossible to predict if that’s going to occur. It could easily be the case that another influenza strain we know nothing about becomes the next pandemic strain.

In the book you discuss major pandemics. There have been severe cases of pandemic influenza in the past, and it’s very likely that a pandemic will happen again and unfortunately hundreds or thousands of people will die. Is there any way to prevent a severe pandemic happening, or is it something that’s inevitable?

VL: Pandemics do reoccur, and we can expect another one. However, what we understand now about pandemics is much greater than what we understood at the beginning of the century. Now we have many more potential strategies in terms of slowing the progression and limiting the damage. Our core strategies, such as immunizations, public health measures and general medical care of the older population, are much more advanced than they were during previous pandemics and should serve us well when we have another one.

Do you think that taking minimal precautions—washing your hands frequently, eating healthy and exercising—is enough to stave off a bigger pandemic?

CL: I think many of the strategies we provide in the book are not only to stave off a pandemic but also to stave off sickness in general. The more healthy you are to start off with, the greater your chance of surviving a pandemic. A pandemic is not going to kill off civilization as we know it, but it will unfortunately kill more people than seasonal influenza. One of the facts many people don’t know is that in the 1918 to 1919 pandemic (arguably one of the most lethal pandemics in history), you still had a 95 per cent chance of surviving. During the last two pandemics (in 1957 and 1968), the survival rate was over 99 per cent. The best thing you can do to prepare for a pandemic is to be as healthy as you can. There’s nothing you can do to prevent it entirely, but you can do things to decrease the likelihood that you’ll be affected.

You discuss the formulation of a vaccine for a big pandemic. But is it worth it for drug companies to invest money into research and formulation of a vaccine?

CL: It’s very difficult to predict when the next pandemic will occur, so it is hard for drug companies to see the benefit of putting money into vaccines. Part of the problem is that the influenza virus mutates and scientists have difficulty predicting what the next pandemic strain will be. If a pandemic were to arrive today, it would take four to six months before the start of vaccine production. The world capacity for production is not enough to make enough vaccine for everyone in such a short time period. In Canada, we are very lucky as our government has had the foresight to have a private contract with a vaccine company. The company would be able to make about eight million doses of vaccine per month once production started. So you’re looking at about four months before these vaccines could get to people.

Isn’t that too late?

CL: No, it’s definitely not too late for a lot of people. We know that influenza pandemics generally last about one to two years. And they come in waves of about six to eight weeks, followed by a lull for a few weeks. But the idea is that when a pandemic does arrive, we hope that we would be able to delay as many people getting sick until the vaccine is available.