Trying to solve the pandemic vaccine problem: too little, too late

One of the big issues over sharing of viral isolates from Indonesia was the contention, probably well justified, that the poor nations would be last in lie for any vaccine that might be available in the event of a pandemic. While a well matched vaccine has to await the emergence of a pandemic strain, there are good reasons to think vaccines made from pre-pandemic strains would provide some cross-protection, and such vaccines are already in production, although in small quantities.

The choke point is the clearly inadequate global production capacity for influenza vaccine. Even if there were a vaccine that was sufficiently protective, it wouldn't be possible to ramp up production sufficient to meet global needs in a pandemic. As a result of promises and some general agreements made in the wake of the contentious World Health Assembly recently, some vaccine manufacturers are "voluntarily" pledging to contribute to WHO tens of millions of doses of their pre-pandemic H5N1 vaccines. WHO, in turn, would use them judiciously where the need was greatest and earliest. Most experts believe this will be in the developing world. If something started in a rich nation, WHO might or might not make some of the stockpile available. However much stockpile there is, that is.

Because the pledges, while not insignificant, will take years to be fulfilled:

The British firm GlaxoSmithKline said it will contribute enough vaccine for 25 million people to WHO over three years. French drug maker Sanofi-Aventis, American firm Baxter International Inc., and Omnivest of Hungary also said they were willing to make some of their H5N1 vaccine available.

[snip]

More work is needed to clarify under what conditions the stockpile will be used, said the agency, which intends to use the supply to try to stamp out cases at the source of a pandemic, and to help developing countries protect health-care workers, police and military during a pandemic. (Helen Branswell, Canadian Press)

Vaccine manufacturers have to do this. The demands of Indonesia would have scuttled a well established system of influenza virus surveillance, a system that made it possible to manufacture a flu vaccine prior to the flu season, not after it was over. But the amount being made available and the time frame for fulfilling the pledge suggest this isn't going to save poor countries in a pandemic. The only solution -- and it is more a mid or long term one -- is to use better and faster technologies for making vaccines. In addition, if the object is to prepare for a possible pandemic, there will have to be some kind of system for scaling up quickly to meet a sudden demand that isn't there prior to a pandemic. The only other alternative would be to routinely and vastly overproduce and destroy much of the inventory each year.

There is a lot of activity on the vaccine technology front, but little solution to the surge capacity problem. If we started now it would be a race between the virus and vaccine development.

But we haven't started.