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Tuesday, November 20, 2007

Stockpiling Influenza Vaccine in Hong Kong

In light of the importance of virus monitoring for pandemic influenza preparedness and response, Indonesia’s refusal to share samples of avian flu (H5N1) virus with the World Health Organization for most of 2007 is "distressing and potentially dangerous for global public health," say two leading global health experts in an essay in this week's PLoS Medicine.

Laurie Garrett (Senior Fellow for Global Health at the Council on Foreign Relations, New York) and David Fidler (Professor of Law and Director of the Center on American and Global Security at Indiana University) say that Indonesia repeatedly refused to share H5N1 samples unless significant changes were made to allow it greater access to vaccine derived from samples it shared with WHO.

Typically some 250-300 million influenza vaccine doses are made each year, based primarily on samples of flu viruses circulating in Asia, yet most of those vaccinated are residents of rich countries. Some developing countries, say the authors, have challenged this strategy by asking “What’s in it for us? We share virus samples, and pharmaceutical companies make vaccines from them that primarily benefit rich countries. Without better access to vaccine, why should we share virus samples?”

Garrett and Fidler offer a novel proposal to overcome the virus sharing impasse. They propose that annually updated supplies of more than 500 million doses of highly specific influenza vaccine, plus antiviral medicines, protective masks and gloves, and germicide washes be stockpiled in Hong Kong. They select Hong Kong, they say, because it has shown "absolute transparency regarding disease emergences going back several decades," it is a dynamic center of virus research and response, and it sits in the middle of the ecological zone that has spawned the bulk of all flu strains known to have emerged over the last three decades.

"We advocate that the strategic stockpile be fed continuously and its specificity updated based on circulating forms of viruses," say the authors. "These objectives would be accomplished through an Advance Market Commitment (AMC) mechanism in which the G-8 nations and Asian powerhouses China, India, Singapore, South Korea, and Japan set aside a fund to guarantee purchase of stockpiled products. The Asia-Pacific Economic Cooperation forum (APEC) should manage the AMC fund and the stockpiled materials in Hong Kong. APEC has proven to be one of the most dynamic and effective of the world’s regional organizations."

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