# 4213
A recurring theme in this blog has been that it isn’t enough to have sufficient vaccine manufacturing capacity – you have to have an infrastructure in place to deliver it to the world’s population.
And while most developed countries have systems in place that can, to some degree at least, deliver a vaccine to the public - the same can’t be said for a great many developing nations.
Even something as rudimentary (in the developed world) as keeping vaccines refrigerated can become a tremendous challenge in many regions of the world.
The push to donate vaccines to the World Health Organization for distribution to poorer nations began early last summer, just after the virus was isolated.
And many of you probably remember the hoopla last fall when millions of doses were pledged to the WHO for distribution to poorer nations (see WHO: Deploying Donated Vaccine As Soon As November.
This overly optimistic BBC story is from early October
Poorer nations get swine flu jabs
About 100 developing nations will begin receiving donations of the vaccine against swine flu as early as November, the World Health Organization says.
Millions of doses of the vaccine against H1N1 are being donated by pharmaceutical companies.
Fast forward four months and so far, only two nations have actually received the H1N1 vaccine: Azerbaijan and Mongolia.
But it is not for the lack of trying, as you will see in this report from Donald G. McNeil of the New York Times.
It is a terrific article, so follow the link to read it in its entirety.
Progress Is Slow on Moving Surplus Swine Flu Vaccine to Countries That Need It
Published: February 1, 2010
There is now so much unused swine flu 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 last year that they had no means of getting flu vaccine, only two, Azerbaijan and Mongolia, have received any so far. Afghanistan is expected to be next.
Early last month, W.H.O. 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 flu has waned in North America, it is still affecting North Africa, Central Asia and parts of Eastern Europe. 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 flu, which has a 60 percent mortality rate. “I don’t think any nation got it right.”
But the W.H.O. is stuck with the world as it is: countries that can afford vaccines save themselves first and, when the worst has passed, transfer their leftovers to the poor, using the W.H.O. as a clearinghouse.
That transfer “turns out to be an incredibly difficult logistical action,” said Dr. Keiji Fukuda, the W.H.O.’s chief of pandemic influenza. “It’s a mammoth effort by an awful lot of people and organizations and countries but holy moly, it’s a very complex operation.”
Over the years we’ve seen highly optimistic assessments of how much vaccine could be produced in the face of an H5N1 pandemic, but very little is said about the logistics of delivering it to the arms of the world.
Roughly a year ago – before novel H1N1 had made its appearance – the WHO stated they believed our global pandemic vaccine capacity was at least 2.5 billion doses a year.
At the time I wrote a bleak assessment of the prospects of actually delivering those billions of doses of H5N1 vaccine during the first year of a bird flu pandemic (see Study: Global Bird Flu Production Capacity).
The take away lesson here is the world needs to do a far better job with developing and maintaining its public health infrastructure. Particularly in developing countries.
The blind eye that many richer nations have turned towards these third world deficits (and the ambivalence demonstrated by the rulers of many of these countries) - in this age of rising emerging infectious diseases - is a literal powder keg, waiting for a spark to set it off.
While one would hope that humanitarian reasons would be sufficient to spur action, the truth is a virulent epidemic outbreak in a place like Zimbabwe or Cambodia could be on our doorstep in a matter of days or weeks.
And that is something that no nation, rich or poor, is currently prepared to deal with.
