around the world are preparing for a surge in the number of H1N1 flu cases,
also known as swine flu. But while rich
nations may have the resources to produce or acquire adequate doses of vaccine,
developing countries could fall far short.
In June, the World
Health Organization announced that an H1N1 global pandemic was underway. The action was taken not because of the
severity of the illness, but the extent to which to new virus had traveled
around the world.
Potentially a big problem
Dr. Ruth Karron,
director of the Center for Immunization Research and the Johns Hopkins Vaccine
Initiative, says the disease should be taken "very seriously."
"I don't think that
anybody can absolutely predict at this point what the final impact of this new
virus is going to be…. Because we know
that this virus is a really highly infectious virus," she says.
don't know at this time how ill those infected will become.
"So far a lot of
this illness that it's caused is mild….
If the virus starts causing worse illness, then I think the fact that
it's so infectious and readily transmitted is really a problem," she says.
Also she says H1N1
flu has the potential of being more severe in poor countries simply because
there is more underlying disease there overall.
Not enough to go around
In the United
States, health officials are debating whether 600 million doses of vaccine will
beneeded to deal with the pandemic.
"The assumption has
been for this new vaccine we would need to give two doses. So, if there are 300 million people in the
United States, and everybody needs two doses, that's how you get to the number
of 600 million," she says.
Some have posed the
question that if the United States and European nations are looking to produce
or procure huge amounts of H1N1 vaccine, should they also help poor nations do
"I think wealthier
nations are looking at protecting their population and then they're also
considering the needs of other countries.
I know that some of the pharmaceutical companies have pledged some doses
to a WHO (World Health Organization) stockpile of vaccine. How many doses and in what time frame I think
is probably the difficult question," she says.
Poor countries may
have to wait until the pharmaceutical companies fulfill their obligations to
the wealthy nations. Karron says she
expects the goal will be to make the vaccine available as soon as possible to
afford the best protection.
Not like HIV/AIDS
In the earlier
years of the HIV/AIDS pandemic, many accused the pharmaceutical companies of
not doing enough to help poor countries.
Legal battles erupted over the availability of ARVs, or anti-retroviral
Dr. Karron says
conditions are different in this case.
When we were
talking around ARVs, we were not talking about scarcity…. That if you provided anti-retroviral drugs in
resource-poor settings, it wasn't an issue that somebody in a wealthy country
might not get the ARV that they needed.
Here we're dealing with …scarcity," she says.
says the debate over how much to help poor countries will heat up if the
pandemic grows more severe. And it's
possible pharmaceutical companies could again face criticism.
Karron says the
last major flu pandemic occurred in 1968, but she says much has improved in
responding to illnesses.
"We can track viral
spread in real time. We can understand
the genetic composition of the viruses that are spreading in real time. We can make vaccine more rapidly and
anti-virals. And we have more options
for the kinds of vaccines that we make," she says.
She says because
all these tools are now available, there is a responsibility to use them to
combat the H1N1 pandemic.
Dr. Karron has
conducted research for or consulted with pharmaceutical companies that produce
In late August, the World Health Organization
had confirmed over 209,000 cases of the so-called swine flu, with nearly 2200