# 1277
Laurie Garrett, author of The Coming Plague, and a senior fellow for Global Health at the Council on Foreign Relations has long been one of the leading voices warning of the threat of a pandemic. She has teamed up with David P. Fidler, Professor of Law and Director of the Center on American and Global Security at Indiana University, to produce an essay entitled Sharing H5N1 Viruses to Stop a Global Influenza Pandemic, which you can read in this week's edition of PLoS (Public Library of Science).
Here is an excerpt from their press release:
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."
Ms. Garrett and Mr. Fidler are well credentialed and have obviously given this proposal a lot of thought. This is an ambitious plan, but whether it would satisfy nations such as Indonesia is unknown.
The biggest hurdle, aside from gaining the commitment from a number of nations to commit billions of dollars each year to maintain this stockpile, is getting the vaccine industry to triple its current manufacturing output of influenza vaccine.
The authors apparently are relying on an AMC (advance market commitment) mechanism to induce manufacturers to gear up to these new levels. By guaranteeing a market for the excess vaccine, it is hoped that the supply capacity will rapidly be increased.
While it might take several years, I suspect the global manufacturing capacity could be ramped up to meet this demand.
This would be, of course, an expensive program. And even a commitment such as this won't completely `solve' the vaccine problem should we see a pandemic.
Still, this is the first proposal with any specificity I've seen. It will be interesting to see how it is received by the international community.
