Biology Reference
In-Depth Information
haran Africa, where 100,000 trained medical workers were lost during the 1990s to AIDS or emigration,
it is estimated that the region desperately needs at least 1 million more personnel, especially nurses and
assistants, to ensure even the most rudimentary public-health coverage to the entire population. 294
In the face of the peril of avian influenza, as with HIV/AIDS earlier, world public health resources are
organized rather like the lifeboats were on the Titanic: many of the first-class passengers and even some
of the crew will drown because of the company's skinflint lack of foresight; the poor Paddies in steerage,
however, do not even have a single lifeboat between them, and thus, they are all doomed to swim in the
icy waters. In September 2004, with H5N1 resuming its murderous course in Vietnam, local authorities
and the WHO were desperate to vaccinate exposed populations to prevent a possible reassortment of avian
and human influenzas. But as WHO influenza chief Klaus Stohr bitterly complained to the New Scientist,
“There is no excess. There is no vaccine available for Vietnam.” Thailand, although much wealthier than
Vietnam, faced the same problem. “We do not have sufficient vaccine to prevent co-circulation,” com-
plained Prasert Thongcharoen, a prominent representative to the WHO. What little surplus was available
in Europe and Canada had been bought up by New York City and other local U.S. health authorities in the
wake of the Chiron fiasco. 295
Only twelve drug companies make influenza vaccines, and fully 95 percent of their output (about 260
million doses) is consumed in the world's wealthiest countries. Current production is limited by the sup-
ply of fertile eggs, and even a switch to cell culture—as all experts advocate—would face the problem
that “there are surprisingly few suitable accredited cell lines and cell banks available, and many of those
are the property of pharmaceutical companies.” 296 Despite the WHO's urgent Geneva summit in October
to lobby governments to finance (and drug companies to produce) a so-called “world vaccine,” little pro-
gress has been made. “Of the world's major flu vaccine manufacturers,” Science reported during the sum-
mit, “so far only two are willing to tackle the financial, regulatory and patent issues involved in making
a new pandemic vaccine, mainly for the U.S. market.” 297 Previous test vaccines, as we have seen, failed
to keep pace with the evolving virulence of H5N1, and even if current clinical trials are successful, Wash-
ington has ordered only 2 million doses from Aventis-Pasteur. With the exception of Canada (which has
contracted with a Quebec-based firm to gear up production for 6 million doses per month), most wealthy
countries are buying just a few “lifeboats” now in the dubious belief that they will have time to order
more when the crisis arrives. (A recent Johns Hopkins study shows that, unlike the 1968 pandemic, which
took a year to circle the world, air travel would now spread a pandemic much faster than pharmaceutical
factories could be geared up to produce vaccine.) 298
With so little investment in expanded manufacturing capacity, the WHO came up with a desperate
scheme to stretch the vaccine supply by adding a cheap adjuvant like alum. (Unfortunately, some re-
searchers believe that even with adjuvants, two doses may be needed to make an H5N1 vaccine effective,
a possibility that would double the problem.) 299 Stohr urged EU leaders to take the initiative in testing
a low-dose pandemic H5N1 vaccine containing an adjuvant. While he argued that this was the only pos-
sible way to ensure that some vaccine would be available to the Third World, Europe could not find the
money. “The EU,” Stohr caustically observed, “has not the flexibility or the political will.” 300 Nature
echoed Stohr in rebuking the EU for failing to support pandemic planning and accelerated vaccine devel-
opment. 301
Without vaccines, as we have seen, there will be a mad global scramble over Tamiflu: according to
Science “the world's only initial defense against a pandemic that could kill millions.” 302 Back in 1999,
René Snacken, the chair of the European Scientific Working Group on Influenza, warned that “waiting un-
til a pandemic strikes to determine access to prophylactic materials inevitably contributes to inequities in
supply for countries to produce antiviral agents or vaccines or lacking resources to competitively purchase
supplies at a time of scarcity.” 303
The WHO, of course, has stressed the “need for international solidar-
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