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Delamothe attacks those working to address the possibility of a flu pandemic.1 There may be rather too many international meetings, and media reports do on occasion amplify the genuine and widespread concerns of many knowledgeable scientists, but—given the general apathy, particularly in Europe—it is necessary for those of us who are preparing affordable plans to find ways to address the public. Otherwise they would have no counter to the complacency which the editorial encourages. With Fedson, I have focused particularly on how new vaccines that are already approved for seasonal flu or are close to approval could be produced in existing vaccine and biopharmaceutical protein facilities.2 This would avoid the capital costs of billions of dollars globally to match the US current pandemic preparedness investment. However, it would require time consuming, though relatively inexpensive, negotiations on intellectual property and technology transfer. The activity has no commercial incentive, so governments would need to enable it. They will not do that if the medical establishment constantly argues it is unnecessary.
Pandemic preparedness is like house insurance: one hopes not to need it, but if a severe pandemic comes then, as things stand, the total global vaccine capacity with the best adjuvant could after six months cover only 700 million of the 6400 million global population, and that will not change in the next 10 years. For the rest, the situation would be essentially the same as in 1918 because antibiotics do not seem to be of great importance. Delamothe may be happy to have that on his conscience, I am not.
Competing interests: None declared.