Game of chicken

Is there blackmail over vaccines in threat that never went away?

Knowing the day of your death, as someone said, would certainly focus your mind. So it is with avian flu, the big non catastrophe of the last years. Experts and officials are certain that the pandemic will strike one day – the question is, when.
The effects could be devastating. Based on the 20 percent incidence and 0.5 percent mortality of the Spanish 1918 flu, there could be tens of millions of deaths, mainly in the elderly and vulnerable. Unlike normal seasonal flu, this will also strike the tropics – Africa, South-East Asia. And these countries are woefully underprepared. There has been an enormous expansion of scientific research into bird flu vaccines in the last few years: 70 percent of patents being applied for in the last year alone. But there are matters of production capacity and cost that severely question the ability of the developing world to pay for it. Rich countries have advanced purchase guarantees with the large drugs firms to buy the so called pre-pandemic drug in the event of a outbreak. Poor countries have to make do with charity, and reduced prices. GlaxoSmithKline has just announced a donation to the World Health Organization of 50m doses of their vaccine, with promises of an arrangement of tiered pricing for the rest of developing country needs. This is all well and good, but Asian health officials are sceptical as to whether help will always be forthcoming or effective.
For a start, a 50 million dose earmarked war chest will only go so far in the developing world; and though intelligent targeting of key workers and the vulnerable (perhaps less the vulnerable in callous Africa) is inevitable, there will be huge political problems in decisions to distribute the drugs: In a pandemic that can cross the world at the speed of a jumbo jet, delays due to squabbles are fatal. As for tiered prices, will they be low enough to be affordable? The example of tamiflu, the anti viral drug taken after any outbreak, is not encouraging: a dose sells in the west for $16, in India, where wages are $1 a day, for $14. GSK have not yet set out a price but promise that their vaccines will be affordable.
Officials from one Asian country badly hit with avian flu have hinted that they are prepared to use their biggest means of leverage:: the genetic material necessary for the production of vaccines culled from the millions of poultry slaughtered in their countries where avian flu in birds is endemic. At the moment, this information has been given freely to the WHO’s reference laboratories on the same basis as seasonal mutating flu virus information has been given for the last fifty years.
But now Asian officials are contemplating starting to “sell” the virus information. The legal situation is a bit unclear, says one UK patent official, but under the international biodiversity convention which says a country’s plants are its “ownership”, viruses could fall into that category. Even if international patent court cases ruled against Asian countries’ legal right to knowledge of constantly mutating virus varieties, their officials can just withhold them. And without virus information, there can be no vaccines.
This is a drastic step, but Asian officials say that there is a lack of trust between their government and he WHO as to whether they will get something back. Current global production capacity is 600m units, enough for rich countries, way short of global population needs.
Because WHO bureaucracy works slowly and by consensus, such “blackmail” may not be effective on an international political scene. Another way forward is where countries affected by avian flu cut deals directly with the vaccine manufacturers. The drugs firm Baxter already has good relations with Indonesia, having promised to donate 2m vaccines. Officials refuse to say there’s any quid pro quo for Baxter’s generosity, that they give virus information on an exclusive basis, but it’s also known that Baxter is one of the few drugs firms with the advanced drugs facilities that can take the wild version of the virus directly from the source, avoiding the need to have the virus’s safety risks genetically modified through the WHO’s reference laboratories. This opens the way to an interesting possibility: While Indonesia gets its drugs guaranteed, there are also certain commercial advantages for Baxter: bypassing the reference labs speeds up the process of bringing to market the most up-to-date vaccines by several weeks, giving the firm an edge over its rivals.
Leverage exercised in such a way, while it might be some good news for the Asian countries where the precious avian flu viruses are present, is likely to leave Africa even more marginalised. Even if Africa were to get its fair share of vaccine, no one has even talked about delivery systems. One African expert said: “We are not well prepared.” Africa’s death toll could be the equivalent of a decade’s worth of AIDS deaths.
One “consolation”, if you could call it that, is that the current vaccines, against the H5N1 species of the virus, will only work if the mutation that causes the pandemic is within the H5 family: Health experts say the disease which may break out anywhere on the planet tomorrow may well not be H5; in that case, an effective vaccine against a new strain will take months to develop while the pandemic rages. For that period at least, rich and poor would be affected equally.