Journal of Public Health Policy

, Volume 28, Issue 3, pp 322–340

Commentary: From Scarcity to Abundance: Pandemic Vaccines and Other Agents for “Have Not” Countries

Commentary

Abstract

The recent impasse between the Indonesian Ministry of Health and the World Health Organization (WHO) over sharing H5N1 viruses in return for access to affordable pandemic vaccines highlights slow progress in defining an antigen sparing vaccine formulation, developing licensing requirements that meet the needs of populations and obtaining government funding for vaccine trials. Currently, vaccine-producing countries would have difficulty producing enough doses for their own people and few doses would be left over for non-producing (“have not”) countries. Yet within a few months of the onset of a new pandemic, several billion doses of live-attenuated and recombinant hemagglutinin H5 vaccines could be produced for “have not” countries, provided a new and disruptive system of “top down” management could be organized. In its absence, a “bottom-up” alternative that uses widely available and inexpensive generic agents like statins must be considered. The “have not” countries must continue to put pressure on WHO and leading countries to ensure that they will have access to the interventions they will need.

References

  1. Reuters. Indonesia says WHO must set rules on H5N1 sharing, 2 February 2007.Google Scholar
  2. MacKenzie D . Poor countries hold out for bird vaccine. New Scientist, 16 February 2007. Available at http://www.newscientist.com/article.ns?id=mg19325914.600&print=true.
  3. World Health Organization. Pandemic Influenza Vaccine: WHO and International Community Make Progress Towards Ensuring Access of Developing Countries, 22 March 2007. Available at http://www.who.int/mediacentre/news/releases/2007/pr21/en/print.html.
  4. World Health Organization. Indonesia to Resume Sharing H5N1 Avian Influenza Virus Samples Following a WHO Meeting in Jakarta, 27 March 2007. Available at http://www.who.int/mediacentre/news/releases/2007/pr09/en/print.html.
  5. Sixtieth World Health Assembly. Pandemic Influenza Preparedness: Sharing of Influenza Viruses and Access to Vaccines and Other Benefits. WHA 60.28, 23 May 2007. Available at http://www.int/csr/don/archive/disease/influenza/A60_28-en.pdf.
  6. Fedson DS . Preparing for pandemic vaccination: an international policy agenda for vaccine development. J Public Health Pol. 2005;26:4–29.CrossRefGoogle Scholar
  7. Fedson DS . Vaccine development for an imminent pandemic: why we should worry, what we must do. Hum Vaccin. 2006;2:38–42.CrossRefGoogle Scholar
  8. Fedson DS, Dunnill P . New approaches to confronting an imminent influenza pandemic. Perm J. 2007;11:63–69.CrossRefGoogle Scholar
  9. UN System Influenza Coordinator & World Bank. Responses to avian and human influenza threats: progress, analysis and recommendations, January–June 2006. Available at http://siteresources.worldbank.org/INTTOPAVIFLUResources/UNSIC_Report_Vienna_Final.pdf.
  10. World Health Organization. WHO Global Programme on Influenza. Vaccine Research and Development, Current Status, November 2005.Google Scholar
  11. Stephenson I, Gust I, Kieny MP, Pervikov Y . Development and evaluation of influenza pandemic vaccines. Lancet Infect Dis. 2006;6:71–72.CrossRefGoogle Scholar
  12. Stephenson I, Gust I, Pervikov Y, Kieny MP . Development of vaccines against influenza H5. Lancet Infect Dis. 2006;6:458–460.CrossRefGoogle Scholar
  13. Kieny MP, Costa A, Hombach J, Carrasco P, Pervikov Y, Salisbury D, et al. A global pandemic influenza vaccine action plan. Vaccine. 2006;24:6367–6370.CrossRefGoogle Scholar
  14. World Health Organization. Antigenic and genetic characteristics of H5N1 viruses and candidate H5N1 vaccine viruses developed for potential use as pre-pandemic vaccines. Wkly Epidemiol Rec. 2007;82:164–167.Google Scholar
  15. Subbarao K, Joseph T . Scientific barriers to developing vaccines against avian influenza viruses. Nat Rev Immunol. 2007;7:267–278.CrossRefGoogle Scholar
  16. Hennessy AV, Davenport FM . Relative merits of aqueous and adjuvant influenza vaccines when used in a two-dose schedule. Public Health Rep. 1961;76:411–419.CrossRefGoogle Scholar
  17. Treanor JJ, Campbell JD, Zangwill KM, Rowe T, Wolff M . Safety and immunogenicity of an inactivated sub-virion influenza A (H5N1) vaccine. N Engl J Med. 2006;354:1343–1351.CrossRefGoogle Scholar
  18. US Department of Health and Human Services. Food and Drug Administration. Guidance for Industry. Clinical Data Needed to Support the Licensure of Pandemic Influenza Vaccines. May 2007. Available at http://www.fda.gov/cber/gdlns/panfluvac.htm.
  19. Stohr K, Kieny MP, Wood D . Influenza pandemic vaccines: how to ensure a low-cost, low-dose option. Nat Rev Immunol. 2006;4:565–566.Google Scholar
  20. Centers for Disease Control and Prevention. Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States – Early, Targeted, Layered Use of Nonpharmaceutical Interventions. Washington, DC: Centers for Disease and Control and Prevention, US Department of Health and Human Services; 2007, February. Available at www.pandemicflu.gov/plan/community/community_mitigation.pdf.
  21. The Macroepidemiology of Influenza Vaccination (MIV) Study Group. The macroepidemiology of influenza vaccination in 56 countries, 1997–2003. Vaccine. 2005;23:5133–5143.Google Scholar
  22. MacInnis L . Shortage of pandemic flu vaccine to last for five years. Reuters, 23 May 2007.Google Scholar
  23. Schnirring L . WHO confirms backlog of 15 Indonesian H5N1 cases, May 16, 2007, CIDRAP News. Available at http://www/cidrap.umn.edu/cidrap/cntent/influenza/panflu/news/may1607indonesia.html.
  24. World Health Organization. Global Health Partners Mobilize to Counter Yellow Fever US $58 million GAVI contribution to prevent highly contagious disease in 12 West African nations. 16 May 2007. Available at http://.www.who.int/mediacentre/news/releases/2007/pr23/en/prit.html.
  25. Peiris JSM, de Jong MD, Guan Y . Avian influenza virus (H5N1): a threat to human health. Crit Microbiol Rev. 2007;20:243–267.CrossRefGoogle Scholar
  26. Suguitan Jr AL, McAuliffe J, Mills KL, Jin H, Duke G, Lu B, et al. Live attenuated influenza A H5N1 candidate vaccine provides broad cross-protection in mice and ferrets. PLoS Medicine. 2006;3:e360. Available at www.plosmedicine.org.CrossRefGoogle Scholar
  27. Karron R, Callahan K, Luke C, Thurman B, Coelingh K, Jin H, et al. Phase I evaluation of live attenuated H9N2 and H5N1 ca reassortant vaccines in healthy adults. 3rd WHO Meeting on Evaluation of Pandemic Influenza Prototype Vaccines in Clinical Trials, Geneva, Switzerland, 15–16 February 2007.Google Scholar
  28. Treanor JJ, Schiff GM, Couch RB, Cate TR, Brady RC, Hay CM, et al. Dose-related safety and immunogenicity of a trivalent baculovirus-expressed influenza virus hemagglutinin vaccine in elderly adults. J Infect Dis. 2006;193:1223–1228.CrossRefGoogle Scholar
  29. Treanor JJ, Schiff GM, Hayden FG, Brady RC, Hay CM, Meyer AL, et al. Safety and immunogenicity of a baculovirus-expressed hemagglutinin influenza vaccine. JAMA. 2007;297:1577–1582.CrossRefGoogle Scholar
  30. Hoyt K . Vaccine innovation: lessons from World War II. J Public Health Pol. 2006;27:38–57.CrossRefGoogle Scholar
  31. Infectious Diseases Society of America. Pandemic and Seasonal Influenza. Principles for U.S. action January 2007. Available at http://www.idsociety.org.
  32. Rhodes R . The Making of the Atomic Bomb. New York: Simon and Schuster; 1986.Google Scholar
  33. Norris RS . Racing for the Bomb. General Leslie R. Groves, the Manhattan Project's Indispensable Man. South Royalton VT: Stepforth Press; 2002, p. 170.Google Scholar
  34. US Department of Energy. Strategic Petroleum Reserve Inventory. Available at http://www.spr.doe.gov/eports/dtr.htm.
  35. Levine R . The cure for Asian flu. Biosecur Bioterror. 2006;4:228–230.CrossRefGoogle Scholar
  36. Fedson DS . Pandemic influenza: a potential role for statins in treatment and prophylaxis. Clin Infect Dis. 2006;43:199–205.CrossRefGoogle Scholar
  37. Liao JK, Laufs U . Pleiotropic effect of statins. Annu Rev Pharmacol Toxicol. 2005;45:89–118.CrossRefGoogle Scholar
  38. Terblanche M, Almog Y, Rosenson RS, Smith TS, Hackam DG . Statins and sepsis: multiple modifications at multiple levels. Lancet Infect Dis. 2007;7:358–368.CrossRefGoogle Scholar
  39. de Jong MD, Simmons CP, Thanh TT, Hien VM, Smith GJ, Chan TN, et al. Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia. Nat Med. 2006;12:1203–1207.CrossRefGoogle Scholar
  40. Kash JC, Tumpey TM, Proll SC, Cartar V, Perwitasari O, Thomas MJ, et al. Genomic analysis of increased host immune and cell death responses induced by 1918 influenza virus. Nature. 2006;443:578–581.Google Scholar
  41. Kobasa D, Jones SM, Shinya K, Kash JC, Copps J, Ebihara H, et al. Aberrant innate immune response in lethal infection of macaques with the 1918 influenza virus. Nature. 2007;445:319–323.CrossRefGoogle Scholar
  42. Weill Cornell Medical College students help change global health policy, 21 May, 2007. Available at http://www.bigmedium.med.cornell.edu/cgi-bin/moxiebin/bm_tools.cgi?print=1196;s=2_14;site=2.
  43. Murray CJL, Lopez AD, Chin B, Feehan D, Hill KH . Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918–20 pandemic: a quantitative analysis. Lancet. 2006;368:2211–2218.CrossRefGoogle Scholar
  44. Reynolds I . Health alert over Tamiflu, bird flu spreads in Myanmar. Reuters, 21 March 2007. Available at http://www.alertnet.org/thenews/newsdesk/SP39628.htm.

Copyright information

© Palgrave Macmillan Ltd 2007

Authors and Affiliations

  1. 1.57, chemin du LavoirSergy HautFrance

Personalised recommendations