Pandemic Vaccine Politics and Posturings

Indonesia has been playing tough on the virus samples front for awhile now.  One of the clades used in the current vaccine formulation testing and pre-pandemic stock-piles is the Indonesian Clade.  They have claimed ownership to this virus Clade as it is their citizens catching it and in over 70% of the cases dying from it. 

Do they have the “right” to withhold the virus samples from the rest of the world?  Sure.  It occurs within the boarders of their country.  China denies the world H5N1 samples regularly and has a very long history of doing so, why should we be shook and shaken when another country realizes that it is within their “rights” to do so as well?  We’ll not worry about the fact that should the pandemic happen it will effect the entire world, not just the “Rich Selfish Western” portions of it.

Reuters Wednesday, March 21, 2007; 4:22 AM

JAKARTA (Reuters) – The inability of poor countries to get vaccines in the event of an influenza pandemic could threaten world peace, Indonesia’s health minister said on Wednesday.

Siti Fadilah Supari said the virus-sharing scheme under the World Health Organization system did not guarantee poor countries access to vaccines and urged developed countries to help the developing world with the technology to produce them.

“If the rule is not changed there will be a huge gap between rich and poor countries and this will perhaps threaten world peace,” Supari told reporters.

“If we want the world to be a harmonious place, the poor should be helped with the technology. If the situation remains like this poor nations will become poorer, sicker and more helpless.” Indonesia, the nation worst hit by avian influenza with 66 deaths, has created a controversy by saying it will only share samples of the H5N1 avian influenza virus if it has guarantees they will not be used to make vaccines that will profit a company or another country.

Some health and aid agencies criticized Indonesia for refusing to share samples, while others defended the stance because developing countries often struggle to get access to life-saving drugs due to patent laws and high costs.

“Do poor and developing countries have to be sacrificed just because they don’t have the technology because of ignorance and poverty?” Supari asked.

Sharing of virus samples is crucial as it allows experts to study their make-up and map the evolution and geographical spread of any particular strain. Samples are also used to make vaccines.

WHO and health ministers from the Asia-Pacific region are due to meet in the Indonesian capital, Jakarta, from March 26-27 to sort out the best ways of making sure companies can make more vaccines against influenza, and that these vaccines will be available to all who need them.

The H5N1 avian flu virus has swept through poultry across Asia to Africa and Europe. Experts believe it could mutate into a form that would easily pass from one person to another, killing tens of millions in months.

Few companies make vaccines, and total world capacity is only about 300 million to 400 million doses of vaccine a year — far below what would be needed in a pandemic.

And that’s vaccines at the normal dosage of antigen.  The H5N1 vaccines are proving to need eighteen times the antigen as a yearly influenza vaccine without adjuvants to even approach acceptable success levels of immune system response.  This means that however much the antigen needs to be increased is however much the world’s yearly capacity is reduced.  Even with the adjuvant, we are back to roughly the amount of antigen that a seasonal vaccine requires, meaning there is no increase from the baseline in supply.  Since there are over six billion humans facing a possible pandemic, it is easy to see that not just the poor countries, and their citizens, will be facing the viral tsunami without benefit of vaccination.


17 February 2007 From New Scientist Print Edition.

Editorial: Self defence over bird flu is no crime


Everyone in the vaccine business knows that when a pandemic appears, countries with vaccine factories will ensure their own citizens are catered for before any vaccine gets exported. That is what happened in the swine flu scare in the US in 1976. If a pandemic does begin, countries without factories will probably not receive vaccine in time for the first wave.

That means even the citizens of the United States.  Until 2009 we have a grand total of ONE vaccine manufacturing plant.  Our vaccine plan consists of purchasing it from companies with plants in other countries, France, Germany, Canada, Britain.


From the World Health Organization (WHO)

H5N1 avian influenza – first steps towards development of a human vaccine

12 August 2005

On 6 August, government scientists at the US National Institute of Allergy and Infectious Diseases announced results from initial clinical trials of a vaccine being developed to protect humans against infection with H5N1 avian influenza. Preliminary data indicate that the experimental vaccine evoked an immune response in a small group of healthy adults.

Although more trials are needed, the new findings reconfirm the feasibility of developing an H5N1-specific vaccine.

H5N1 is presently considered the most likely virus to ignite the next pandemic. The increasing spread and evolution of H5N1 viruses in Asia have brought the world closer to another pandemic than at any time since 1968, when the last of the previous century’s three pandemics began.

Vaccines are the principal medical intervention for protecting individuals against pandemic influenza. If available rapidly and in sufficient quantities, they can reduce the morbidity and mortality that have traditionally made pandemics such socially disruptive as well as deadly events.

However, many problems need to be resolved before vaccines can assume such a role in mitigating the effects of the next pandemic. The most important need is to find vaccine formulations that make the best use of limited antigen supplies.

Antigen is the component of the vaccine that elicits an immune response. The US trial provides important insight into possible vaccine formulations. It used doses that are higher than the amount of virus antigen contained in influenza vaccines produced yearly for normal seasonal epidemics.

Strategies for stretching limited antigen supplies – by adding an adjuvant to the vaccine formulation or injecting the vaccine into the skin rather than into muscle – have been proposed. Adjuvants are chemicals that can be added to the vaccine formulation to boost the immune response, theoretically allowing the use of smaller doses of antigen to achieve an immune response. Such antigen-sparing strategies using adjuvants are currently being tested by several manufacturers, and preliminary results are expected within the next three months.

At present, 90% of production capacity for all influenza vaccines is concentrated in Europe and North America in countries that account for only 10% of the world’s population. Current global manufacturing capacity (estimated at 300 million doses of regular trivalent influenza vaccine per year) is inadequate to meet the expected global needs during a pandemic and cannot be rapidly augmented.

Influenza pandemics are unique infectious disease events that can spread to every country in the world within months, resulting in a high and universal demand for preventive and treatment measures. Pandemics thus throw into sharp relief inequities in global access to vaccines and other medical interventions during an emergency. Based on past experience,countries with local manufacturing capacity are likely to meet domestic demand for vaccines and other critical resources fully before freeing supplies for the export market.

Because the present total global manufacturing capacity for influenza vaccine is limited, any decision to manufacture a pandemic vaccine in large quantities prior to the start of a pandemic would, of necessity, compromise the capacity to produce vaccines for seasonal influenza. Seasonal epidemics of influenza predictably cause an estimated 250,000 to 500,000 deaths each year. In the current situation, the capacity to respond to seasonal influenza must be balanced against preparations for pandemic influenza. However, once a pandemic has been declared, all manufacturers would stop production of seasonal vaccines and produce only the pandemic vaccine.

WHO has produced advice on a broad range of preparedness measures that can be undertaken by countries, taking into consideration that adequate supplies of vaccine will not be available at the start of a pandemic in any country.


So whether Indonesia, Thailand, and this just in, ten other Asian countries realize it, there are a whole lot of people, roughly six billion of us, who will not see a PanFlu vaccine any time soon.  Of course, there is hardly anyone around who says it better than Revere at EffectMeasure :


Everyone is arguing about a vaccine that doesn’t exist and won’t exist in enough quantity to supply more than a tiny fraction of the world’s population — or even a tiny fraction of Indonesia’s population — for years to come. Indonesia is playing a very dangerous game. Either technical develops or a shift to a pandemic strain outside of Indonesia could make their bargaining chip worthless at any time. Then their current negotiating stance would be tremendous weakness, putting them far down the line for any vaccine supplies that might exist.

SZ (As vaccineless as your average Indonesian)

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