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Rich and developing countries—and vaccine manufacturers—have backed calls by the World Health Organization to try to establish a stockpile of vaccine against the H5N1 strain of influenza in humans. They also want to see a mechanism to ensure wider access to a vaccine by poor nations in the event of a flu pandemic.
At a one day meeting at WHO headquarters in Geneva last week, stakeholders also agreed to the setting up of expert groups to focus on how to create, maintain, fund, and use an H5N1 vaccine stockpile. WHO said that it should continue to consult with appropriate partners and member states on developing a mechanism for access to a vaccine.
“I think it is a very important step in the process towards shoring [up] better access for poorer countries to vaccines that will be required in the event that they are affected by or at risk of an influenza pandemic,” said David Nabarro, the UN's global coordinator for pandemic preparedness.
Although no target figure for the stockpile of H5N1 vaccine has so far been agreed, during a WHO meeting in Indonesia in March officials from developing countries said that they were looking at coverage of roughly 1% of their populations—enough to cover health workers, police, and other essential staff.
Margaret Chan, WHO's director general, noted: “We have taken another crucial step forward in ensuring that all countries have access to the benefits of international influenza virus sharing and pandemic vaccine production.”
But Dr Chan earlier warned delegates at the meeting that current vaccine manufacturing capacity “is woefully inadequate to meet worldwide demand.” She added: “The issue of access to vaccines has acquired an urgency that we cannot fail to address.
“For a trivalent pandemic vaccine, annual manufacturing capacity is about 500 million doses. For a monovalent vaccine this figure increases to 1.5 billion doses. This is still not enough for a world of over six billion.”
Drug industry representatives said that they plan to increase manufacturing capacity over the next three to five years. Fifteen manufacturers in Australia, Europe, North America, and Japan are presently working on avian or pandemic flu vaccines, says the umbrella organisation the International Federation of Pharmaceutical Manufacturers & Associations.
The participants also agreed that new international health regulations coming into force this June must be the basis for any work ahead on virus sharing, H5N1 vaccine stockpiling, ensuring access to vaccines against pandemic flu, and other measures to boost pandemic preparedness.
However, David Heymann, WHO's assistant director general for communicable diseases, told the BMJ that achieving the necessary support from donors and the participation of vaccine manufacturers will be a “long process.”
So far 87 low income and middle income countries have conveyed to WHO that they want financial support for increasing access to a pandemic vaccine.
Moreover, on 24 April WHO approved initial grants of $2.5m (£1.3m; €1.8m) each to six manufacturers from Brazil, India, Indonesia, Mexico, Thailand, and Vietnam to establish production capacity for flu vaccines.
WHO is expected to present a “road map” to health ministers at this year's World Health Assembly (14-23 May) of how to proceed to reach the proposed objectives.
Besides looking at the feasibility of developing stockpiles of H5N1 vaccines for the current period, the expert meeting also looked into setting up advance purchases of vaccines for a pandemic situation and enabling access for developing countries, WHO officials said.
WHO's efforts were boosted by recommendations in mid-April by its strategic advisory group of experts on immunisation that “recent scientific studies on H5 vaccines had shown them to be safe and immunogenic and that it was realistic to expect that vaccines offering cross protection (against immunologically related but different viruses not contained in the vaccine) could be developed.”