Poverty, Wealth, and Access to Pandemic Influenza Vaccines (New Eng Jour Med)

[pinto]

Poverty, Wealth, and Access to Pandemic Influenza Vaccines
Tadataka Yamada, M.D.

http://content.nejm.org/cgi/content/full/NEJMp0906972?query=TOC

On June 11, 2009, Margaret Chan, director general of the World Health Organization (WHO), declared that the status of the influenza A (H1N1) pandemic had reached phase 6 — active transmission on a global scale. Until now, the case fatality rate of this influenza has been quite low, but history teaches us that the situation could take a turn for the worse during the next wave of the pandemic. If a 1918-like pandemic were to occur today, tens of millions of people could die, the vast majority of them in the world's poorest countries.

Fortunately, the prospects for developing an effective vaccine to prevent infection with the current H1N1 virus are excellent, and the world's pharmaceutical companies are working diligently at this task. In contemplating equal access to such a vaccine, it is important to consider three key issues: manufacturing capacity, cost, and delivery.

Only a few countries in the world have plants for manufacturing influenza vaccine, and three companies — GlaxoSmithKline, Sanofi-Aventis, and Novartis — account for most of the world's manufacturing capacity. The number of doses of vaccine against H1N1 influenza that could be produced with the existing capacity is very large, but the sobering truth is that even if production were switched over completely from seasonal influenza vaccine to pandemic influenza vaccine, there would not be nearly enough for everyone in the world. The size of the gap in potential supply depends greatly on the dose that is required, and it may be possible to reduce the necessary dose by as much as 75% with the use of an adjuvant. The challenging problem is that much, if not most, of the manufacturing capacity is already spoken for through purchasing contracts held by many of the world's wealthy countries.

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The WHO has provided strong leadership as the world has contemplated the prospect of an influenza pandemic. We are counting on the organization to guide us, wisely and fairly, through the complex challenges that lie ahead.

The prospect of a worsening global influenza pandemic is real and will not go away anytime soon. I cannot imagine standing by and watching if, at the time of crisis, the rich live and the poor die. It will take collective commitment and action by all of us to prevent this from happening.

Principles to Guide Global Allocation of Pandemic Vaccine.

1. The global community should take steps to protect all populations, including those without resources to protect themselves.

2. Vaccination should be considered in the context of comprehensive pandemic preparedness and response efforts in all nations.

3. Developed countries and vaccine manufacturers should urgently agree upon a mechanism to ensure access to vaccine by developing countries.

4. Influenza vaccine manufacturers should identify strategies such as tiered pricing and donations to make pandemic vaccine more accessible to developing nations.

5. Pandemic vaccines allocated to developing nations should become available in the same time frame as vaccines for developed nations.

6. The global community should obtain data to help establish a consensus on the safety and efficacy of adjuvants, and efforts should be made to ensure the fullest use of this and other dose-sparing strategies.

7. All countries obtaining pandemic vaccine should ensure that mechanisms are in place to provide the vaccine to their populations, to ensure that this scarce resource is not wasted, and donors should be prepared to provide resources and technical assistance to help countries bolster these mechanisms.

8. The World Health Organization is uniquely positioned to lead the global response to a pandemic virus and should support governments and industry in their efforts to implement these principles.

* From the Pneumonia and Flu Web site of the Bill and Melinda Gates Foundation (www.gatesfoundation.org/topics/Pages/pneumonia-flu.aspx).

Dr. Yamada reports holding equity in GlaxoSmithKline. No other potential conflict of interest relevant to this article was reported.

Source Information

From the Global Health Program, Bill and Melinda Gates Foundation, Seattle.

The New England Journal of Medicine is owned, published, and copyrighted © 2009 Massachusetts Medical Society. All rights reserved.

http://content.nejm.org/cgi/content/full/NEJMp0906972?query=TOC

[hlthe2b]

1. Well, since we have so many wealthy anti-vaccine protesters,

perhaps we should send their doses to the 3rd world... Quite frankly, with most of our staff having no option for a vacation or even a day off since last spring and going forward through December-- so that we can get vaccine out to those most at risk and then to all who want to take it-- I would cheerfully pack up the doses from those who accuse me and other PH and health care providers of plotting genocide on them....

Oh, and you know what? Those crazies who scream about public option being "evil and socialism" don't know the difference between a public option for health care reform and PUBLIC HEALTH..... SO we are starting to get nasty ass anonymous phone calls--some becoming increasingly threatening.

Some days I don't know why I get up in the morning.... :shrug:

[pinto]

2. I work in Public Health as well, and hear you. Some of the fear about flu vaccines is so overblown.

It's disheartening. Yet we routinely have a line, come standard flu season vaccine availability.

:hi:

[hlthe2b]

3. Glad to have the company....

and appreciation for the challenges.... Back at ya... :fistbump:

[pinto]

4. Cool.

:hi: