Re: WHO: Global pandemic influenza action plan to increase vaccine supply
Concerning the three WHO action proposals:
In the document itself there is some analysis about how rapidly some of the proposals might take effect-- for example, as far as (1) increasing seasonal vaccine use is concerned, the authors observe that increased consumption of vaccines in Group 1 and Group 2 countries could
"generate demand and thereby promote expansion of the production capacity for influenza vaccines." They also note that recent and ongoing increases in flu vaccination in the Group 2 America's are already headed in the right direction. I believe,however, that a more careful analysis of the three WHO proposals are called for as they are rightfully, the guide we all must follow to protect ourselves in a world-without-borders.
The FIRST proposed approach is essentially an economic one-- by increasing seasonal vaccine consumption, a solid demand for vaccines would be created which in turn would stimulate increases in production capacity by the vaccine industry. This approach groups countries into:
Group 1. Countries that already use seasonal flu vaccination and that could increase global seasonal demand by 60% while increasing flu vaccination of their populations;
Group 2. High or middle income countries that currently don't use seasonal flu vaccines but whose introduction of internationally funded vaccination programs would have a modest effect (about 10 % increase in global demand) and;
Group 3. ?Low-income countries? where the $3-7.00 per dose price of current flu vaccines is expected to be a price barrier to the successful application of this approach.
The authors call for development of national and regional plans and mobilization of resources to assist countries to purchase seasonal and pandemic vaccines. There is a notable absences of discussion about the potential role of supply-side actions in preparing for the pandemic. The demand-side prescriptions of this first approach explicitly aim to improve the business of the vaccine industry which it is hoped will respond by increasing investment in production capacity. However, crucial details of if, how, when and where these capacity increases would be deployed are left to the industry to decide.
Influenza is a poorly understood disease even after a century of scientific research. Even less is known about how the disease behaves in the tropics where most Group 3 countries are located. The seasonal nature of flu epidemics in temperate latitudes on which the global influenza management strategy is based, is not manifested in tropical regions. There is a high background of influenza activity throughout the year with epidemics occurring at intermediate months between the 'official' influenza seasons of the Northern and Southern hemispheres[1]. This suggests that low-income countries located in tropical regions might potentially generate twice the per capita demand of temperate countries where demand for flu vaccines only exists for six months of the year-- one of the key economic challenges faced by the vaccine manufacturers.
The SECOND WHO approach calls for direct increase in production-capacity for pandemic vaccines. Recognising that vaccination of the 6.7 billion population of the world is probably not feasible, the short-term focus is on developing surge-capacity-- ability to ramp up production quickly in response to an outbreak. It also identifies improving production yields; building new plants in developed and developing countries; improving vaccine technologies and alternative vaccination methods as the most promising strategies for this approach.
The THIRD approach proposes to build on existing research and development into new or better vaccines that either require less dosage for effect or induce a wider spectrum of protection against both seasonal and pandemic influenza.
A key element in the success of all three approaches is the need for surveillance and implicitly, a significant economic engine that can contribute to the realizations of the goals set out in the plan. Better surveillance will cost money to put in place but will benefit the stability of the supply side by giving better information with which to operate seasonal business. The human capacity and manufacturing associated with surveillance needs can offer an important stepping stone toward development of globally distributed vaccine production.
For this reason I believe that improving production yields; building new plants in developed and developing countries; improving vaccine technologies and alternative vaccination methods should be the area of highest priority. Elsewhere on the site is
a discussion of the threat to the exisiting vaccine manufacturing capacity itself. Wider geo-politico-economic distribution of production, and indeed of ALL the activities associated with pandemic preparedness will determine how well we survive a possible pandemic.
