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INFLUENZA PANDEMIC (H1N1) (12): VACCINE DISTRIBUTION, WHO UPDATE
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
In this update:
[1] Vaccine distribution
[2] WHO pandemic update 85
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[1} Vaccine distribution
Date: Mon 1 Feb 2010
Source: The New York Times [edited]
<http://www.nytimes.com/2010/02/02/health/02flu.html>
Progress Is Slow on Moving Surplus Vaccine to Countries In Need
---------------------------------------------------------------
There is now so much unused swine flu [influenza pandemic (H1N1) 2009
virus] vaccine in the world that rich nations, including the United
States, are trying to get rid of their surpluses. But the world's
poorest countries -- a few still facing the brunt of the pandemic --
are receiving very little of it. Of the 95 countries that told the
World Health Organization (WHO) last year that they had no means of
getting vaccine, only 2, Azerbaijan and Mongolia, have received any so
far. Afghanistan is expected to be next. Early last month {January
2010], WHO officials said they hoped to have shipped vaccine to 14
countries by now, and even then it would have been only enough to
protect 2 percent of the countries' populations.
While the [pandemic (H1N1) 2009 virus epidemic] has waned in North
America, it is still affecting North Africa, Central Asia and parts of
Eastern Europe [see part [2] below]. This imbalance between rich and
poor countries, and the inefficiency of global vaccine transfers,
frustrate many experts. "If we'd been confronted with H5N1, we'd be
completely caught with our pants down," Dr. David S. Fedson, a former
medical director for Aventis-Pasteur vaccines and an expert on
pandemics, said, referring to the avian influenza, which has a 60
percent mortality rate. "I don't think any nation got it right."
But the WHO is stuck with the world as it is: countries that can
afford vaccines save themselves 1st and, when the worst has passed,
transfer their leftovers to the poor, using the WHO as a
clearinghouse. That transfer "turns out to be an incredibly difficult
logistical action," said Dr. Keiji Fukuda, the WHO's chief of pandemic
influenza. "It's a mammoth effort by an awful lot of people and
organizations and countries but it is a very complex operation." Each
country must submit a plan proving it can store refrigerated vaccine,
give it to those who need it most, inject it safely and do medical
follow-up. It must also sign letters exempting donors from legal
liability, and the WHO has to certify the vaccine as safe if the
country has no regulatory agency. Even shipping adds delays. By
December [2009], Dr. Fukuda said, only 5 countries had even received
syringes.
Not everyone says shifting swine flu vaccine to poor countries makes
sense. Bill Gates, who just pledged USD 10 billion, the largest
charitable donation in history, to getting other vaccines to the poor,
dismissed [pandemic influenza virus] vaccine shipments as "a pipe
dream." "It's not practical; they have no infrastructure to deliver
it," he said. "And you don't want to distract them away from measles
vaccine, for example. That could cost lives."
Although 190 million doses have been pledged to the WHO, it is not
ready to use them. So rich countries are frantically trying to cancel
orders. The surplus built up because they put in orders when it was
assumed that 2 doses would be needed to provide protection. For most
people, only one was [sufficient]. Also, as the virus proved less
lethal, many countries lost interest. France, for example, ordered 94
million doses for its 65 million people. At 1st, there was deep
skepticism; 80 percent of French residents polled said they would
refuse. But after a few deaths were reported, such huge lines formed
that, in Lyon, the riot police were called. Then interest faded;
France has been trying to sell 50 million doses.
Other nations faced similar waves of scepticism, panic and yawns. In
Britain, government experts predicted 65 000 deaths, then revised that
to 1000; fewer than 400 died. The government is renegotiating
contracts for 90 million doses.
The chairman of the Swiss pharmaceutical company Novartis, Daniel
Vasella, recently warned that governments breaking their contracts
might not be 1st in line in the next pandemic. "Reliable partners will
be treated preferentially," Mr. Vasella said.
Canada recently lent Mexico 5 million doses because Mexico's 1st
shipments were not due to arrive until this month. Similar bilateral
deals took place between Western and Eastern Europe, a WHO spokesman
said.
The great exception is Poland, the only Western country known to have
rejected swine flu vaccine and to have spent nothing to stop the
pandemic, according to The Associated Press (AP). Poland had fewer
than 150 confirmed deaths, and the government's decision proved very
popular, The AP said.
The United States has contracts to buy 251 million doses from 5
companies. With one exception -- the cancellation of 22 million doses
out of 36 million ordered from CSL Ltd., an Australian manufacturer
that fell behind on deliveries anyway -- those orders are going ahead.
Although critics have called that wasteful, since only about 62
million doses have been given, federal health officials are gambling
that it is better to have a surplus in case a 3rd wave emerges. The
country also promised 25 million doses to the WHO.
Dr. Bruce G. Gellin, director of the National Vaccine Program Office
at the Department of Health and Human Services, defended the decision,
noting that not all the vaccine would be put into vials, an extra step
that involves a separate payment. Instead, it can remain in "bulk
antigen" form. Bulk antigen is not normally saved because flu mutates
[i.e., degrades]. [Non-replicating influenza virus does not mutate. -
Mod.CP]. But Dr. Gellin said tests on a stockpile of experimental
vaccine against the H5N1 avian [influenza virus] that the government
began building in 2004 showed that it slowly loses potency but is
still strong enough to be used. The unused pandemic (H1N1) 2009
vaccine antigen, he argued, could be quickly put in vials if a 3rd
wave emerged; shifted to the Southern Hemisphere, where the flu season
starts in June; or saved for next year's seasonal flu shots.
[Byline: Donal G. McNeil Jr.]
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[The preceding article provides an interesting analysis of the current
situation regarding the availability and distribution of pandemic
(H1N1) 2009 virus vaccine and the associated problems. The following
extract from the most recent WHO Pandemic Update summarises the
current global disease situation. - Mod.CP]
******
[2] WHO pandemic update 85
Date: 29 Jan 2010
Source: World Health Organisation, CSR, Disease Outbreak News
[abbreviated and edited]
<http://www.who.int/csr/don/2010_01_29/en/index.html>
Pandemic (H1N1) 2009 - update 85
--------------------------------
As of 24 Jan 2010, worldwide more than 209 countries and overseas
territories or communities have reported laboratory confirmed cases of
pandemic influenza H1N1 2009, including at least 14 711 deaths. The
WHO is actively monitoring the progress of the pandemic through
frequent consultations with the WHO Regional Offices and member states
and through monitoring of multiple sources of information.
Situation update: Although much of the temperate northern hemisphere
passed a peak of fall and wintertime pandemic influenza activity
between late October and late November 2009, virus transmission remain
active in several later affected areas, particularly in North Africa,
limited areas of eastern and southeastern Europe, and in parts of
South and East Asia.
In North Africa, limited data suggests that pandemic influenza virus
transmission remains active and geographically widespread,
particularly in Morocco, Algeria, Libyan Arab Jamahiriya, and in
Egypt, although most countries in the region appeared to have recently
passed a peak of activity during December 2009 or January 2010. In
west Asia, pandemic influenza activity continues be geographically
regional to widespread, however activity levels have continued to
decline or remain low since December 2009.
In South Asia, pandemic influenza activity remains active but
geographically variable. Recent peaks in activity were noted during
late December and early January 2010 in northern India, Nepal, and Sri
Lanka. Influenza activity remained stable but elevated in western
India, continued to decline substantially in northern India, and
remained low overall in southern and eastern India. In Bangladesh,
regional spread influenza activity and a low intensity of respiratory
diseases activity was reported.
In East Asia, transmission of pandemic influenza virus remains active,
however, overall activity continued to decline in most countries. An
increasing trend in respiratory diseases with localized spread was
reported for DPR Korea. In the Republic of Korea, transmission of
pandemic influenza virus remains active (>20 percent respiratory
specimens tested positive for pandemic H1N1), however, overall
activity continue to decline since peaking during November 2009. In
Japan, influenza activity continues to decline, however high levels of
transmission persist on the southern island of Okinawa. In northern
and southern China, pandemic virus isolations have declined
substantially since peaking early to mid November 2009, however, in
recent weeks detections of influenza type B viruses have increased.
In southeast Asia, transmission of pandemic influenza virus persists,
but current activity levels are low. In Viet Nam, influenza activity
has declined substantially since peaking during October and November
2009. In Thailand, focal outbreaks of influenza were reported from a
few provinces in northern and central parts of the country, however,
overall ILI [influenza-like illness] activity remains low.
In Europe, transmission of pandemic influenza virus remains
geographically regional to widespread in the central, eastern, and
southeastern parts of the continent, however, overall activity
continues to decline in most places. Several countries (Austria,
Albania, Bulgaria, Slovakia, and the Russian Federation) reported
slight increases in the levels of ARI [acute respiratory infection] or
ILI activity, however in most, levels remain well below recent peaks
in activity. The overall rate of respiratory specimens testing
positive for influenza (16 percent) continued to fall since peaking
(45 percent) during early November 2009.
In the Americas, both in the tropical and northern temperate zones,
overall pandemic influenza activity continued to decline or remain low
in most places. Of note, detections of RSV [respiratory syncytial
virus] have increased in a few countries in the Americas, which may
partially account for elevated ILI activity in those areas,
particularly among young children. In the US and Canada, pandemic
influenza virus detections and the numbers of severe and fatal cases
have decline substantially as rates of ILI have fallen below seasonal
baselines. In Central America and Caribbean, pandemic influenza virus
transmission persists but overall activity remains low or unchanged in
most places.
In temperate regions of the southern hemisphere, sporadic cases of
pandemic influenza continued to be reported without evidence of
sustained community transmission.
Pandemic influenza (H1N1) 2009 virus continues to be the predominant
virus circulating worldwide. Seasonal H3N2 and type B viruses are
circulating at low levels in parts of Africa, east and Southeast Asia
and are being detected only sporadically on other continents.
The countries and overseas territories/communities that have newly
reported their 1st pandemic (H1N1) 2009 confirmed cases since the last
web update (No. 84): none.
The countries and overseas territories/communities that have newly
reported their first deaths among pandemic (H1N1) 2009 confirmed cases
since the last web update (No. 84): Cyprus and Nigeria.
Region / Deaths
----------------
WHO Regional Office for Africa (AFRO) / 133
WHO Regional Office for the Americas (AMRO) / At least 7166
WHO Regional Office for the Eastern Mediterranean (EMRO) / 1002
WHO Regional Office for Europe (EURO) / At least 3429
WHO Regional Office for South-East Asia (SEARO) / 1426
WHO Regional Office for the Western Pacific (WPRO) / 1555
Total / At least 14 711 (The reported number of fatal cases is an
under representation of the actual numbers as many deaths are never
tested or recognized as influenza related.)
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
[The full text of this Update should be accessed via the URL at the
top of the report to provide access to the series of maps and
tabulated data accompanyng this report. - Mod.CP]
[see also:
2009
----
Influenza pandemic (H1N1) 2009 (123): vaccine safety 20091205.4152
Influenza pandemic (H1N1) 2009 (112): Canada (MB), vaccine reaction
20091121.4009
Influenza pandemic (H1N1) 2009 (67): vaccine delivery 20091011.3515
Influenza pandemic (H1N1) 2009 (63): USA military vaccine 20091002.3437
Influenza pandemic (H1N1) 2009 (55): vaccine formulation 20090925.3359
Influenza pandemic (H1N1) 2009 (54): vaccine availability 20090921.3325
Influenza pandemic (H1N1) 2009 (53): vaccine donation 20090919.3290
Influenza pandemic (H1N1) 2009 (49): FDA vaccine update 20090917.3254
Influenza pandemic (H1N1) 2009 (21): vaccine prioriities 20090730.2669
Influenza pandemic (H1N1) 2009 (11): vaccine issues 20090722.2595
Influenza pandemic (H1N1) 2009 (10): vaccine 20090720.2577
Influenza pandemic (H1N1) 2009 (05): vaccine 20090716.2540
Influenza pandemic (H1N1) 2009 (03): vaccine 20090713.2505]
.................cp/ejp/jw
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