Biology Reference
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license to sell flu vaccine. 269 Although the corporation claimed that a portion of the vaccine was uncon-
taminated, FDA investigators determined that the entire stock was spoiled.
As a result, the United States lost half of its seasonal vaccine and was forced to ration the rest. Al-
though the CDC and local health officials worked miracles in shifting vaccine to areas of greatest need,
the crazy quiltwork of the U.S. vaccine distribution system—with literally thousands of independent gov-
ernment and private agents involved—gave a disturbing foretaste of the chaos that a pandemic would cre-
ate. The Chiron disaster easily risked killing as many Americans through lack of vaccination as the 9/11
attacks, but Thompson, Crawford, and their underlings continued to breezily disclaim any responsibility
for errors of oversight. Amazingly they also let Chiron keep its contracts for manufacturing avian flu vac-
cines.
As public anger grew over the fiasco, which was soon followed by shocking exposes of the FDA's
failure to monitor drug safety in a variety of cases, even the mainstream media was forced to acknowledge
structural contradictions in the system. Thus, the New York Times, in a moment of almost Marxist rev-
elation, identified the underlying problem as the “chronic mismatch of public health needs and private
control of the production of vaccines and drugs.” 270 (In August, the HHS's draft National Pandemic In-
fluenza Preparedness Plan had made a similar point in more cautious language, noting that the United
States's “primarily private vaccine purchase and delivery system may not be optimal in a pandemic.”) 271
The vaccine crisis also prompted closer scrutiny of other major components of the pandemic plan
which in its snail's pace evolution since 1993 had finally arrived at the final comment and discussion
phase in fall 2004. The New York Times —the only major newspaper that seemed to take avian flu seri-
ously—published an editorial on 12 October chastising HHS for proposing to add only 2 million courses
of oseltamivir (Tamiflu) to the Strategic National Stockpile. The editors pointed out that while Japan had
purchased enough Tamiflu for 20 percent of its population, and Australia for 5 percent, the Bush admin-
istration's order would cover less than 1 percent of Americans. “Ten times that amount,” said the Times,
“would seem more reasonable. The drug favored in this country is made by a single manufacturer whose
capacity is limited, but a contract for massive quantities would presumably energize the industry to ramp
up production.” 272
In fact, there was gridlock in Switzerland, where Roche had failed to expand capacity to keep pace
with its overflowing order topic. The manufacturer recommended that governments stockpile enough
Tamiflu to cover one-quarter of their populations, the estimated infection rate of an influenza pandem-
ic; this rule of thumb would mandate 1.6 billion courses globally, with 74 million for the United States.
Roche's recommendations might have been self-serving, but they were not far-fetched: Dr. Julie Gerberd-
ing, the head of the CDC, told the New York Times that she would like to see a U.S. stockpile closer to 100
million courses than 1 million. But in fall 2004 Roche, although it was trying to add a new production line,
was only producing 8 million courses per year. “Some public health experts,” the Times reported, “are
strongly critical of Roche for not increasing production of Tamiflu sooner, saying that the company should
have expanded production this year, when avian influenza started becoming a problem across much of
Asia.” 273
The obvious solution to both the Tamiflu shortage and the vaccine fiasco is for the federal government
itself to undertake the nonprofit development and manufacture of lifeline medications. But in a political
system where almost everyone dances to the tune of the drug industry's political contributions, the “lib-
eral” alternative to the Bush administration's negligence was the proposal, supported by presidential can-
didate John Kerry and other Democrats, to raise market demand with larger government purchases. Mean-
while, for the foreseeable future Americans would be trapped in precisely the dilemma that Robert Web-
ster had warned about: How should the scarce supply of Tamiflu, the only antiviral known to be effective
against avian influenza, be rationed? Americans would be faced with a veritable “Sophie's choice”: who
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