Inequality in a Global Pandemic Response

In Uncategorized on January 13, 2010 at 8:50 am

Justin Banerdt, Staff Writer

As the flu season arrives in the northern hemisphere, governments are preparing for a resurgence of the H1N1 pandemic as they rush to produce vaccines. Questions remain though as to whether there will be enough vaccine stock, whether will it arrive in time, and if there is a shortage, who will have access. These questions are even more disconcerting for developing countries that likely will not have the resources to vaccinate the majority, and in some cases even minority, of their population.

In what is a sobering take on history, the last time the United States government dealt with the H1N1 flu in 1976 resulted in an immunization campaign riddled with difficulties. The most fundamental of these was a striking disconnect in communication between the general populace and high-ranking health officials when a handful of vaccinated patients developed Guillain-Barré syndrome. This led to widespread panic about the safety of the vaccine. These incidences of Guillain-Barré syndrome would later prove to be unrelated to the vaccine.1

Recently several representatives from the Centers for Disease Control (CDC) have publicly affirmed the safety of the vaccine. Dr. Melinda Wharton MD, Acting Director for the National Center for Immunization and Respiratory Diseases, commented in an interview with the HCGHR that “the new H1N1 vaccine that is just now being distributed is being made exactly same way as the seasonal influenza vaccine that we use more than a 100 million doses of each year and that vaccine has an excellent safety record.”14

This reassurance has not stopped several advocacy groups and concerned parents from continuing to raise questions.7 There still appears to be a notable divide in the public knowledge and opinion on the matter.

By now, the southern hemisphere has already experienced its flu season, and our best way to understand the dynamics of such antiviral campaigns lies in the experiences of these countries such as Australia, Argentina, Chile, and New Zealand. Recent data shows that the viral strains and at risk populations were similar to that of the US.

Dr. Stephanie Bailey MD, the Chief of Public Health Practice at the CDC, who has been involved in state and local preparedness to the pandemic, confirmed to the HCGHR that the CDC’s “vigilance takes into account the whole world.”13

It is now evident that their flu season was of comparable length to previous seasons and that, although health care centers experienced additional stress, this was neither prolonged nor overwhelming. Additionally, the virus seems to have mutated little, bolstering hope that the current vaccine in development will be effective.4

Dr. Wharton predicts that “If the virus evolved I would expect that that evolved strain could be included in our seasonal vaccine for next year.”14

With new H1N1 cases spreading rapidly throughout the States, some are beginning to raise concerns that the vaccine is yet to be available to the general public.5 The US has purchased 250 million doses of the vaccine, enough for most of the populace, but distribution is not set to begin until October, already well into the flu season.8

Several other countries such as China, Australia, France, and Britain have been independently working on vaccines, with the world production capacity estimated at roughly 3 billion doses per year—less than half of the world’s total population global health review and 1.9 billion less than previous estimates. A total of nine countries so far including the United States have pledged to share their vaccine stocks with developing countries that have little to no access.9

While White House spokesmen Reid Cherlin promised that there would be enough vaccine for every US citizen that wanted to be vaccinated, the reality is that in a global context there exists a significant disparity between those in developing nations that have access to vaccination and those in developed areas.10

According to a recently proposed United Nations plan, only 5-10% of the population in poor countries will be vaccinated in the coming season, with an additional $1.48 billion in aid for antiviral drugs such as Tamiflu that can slow the spread of the virus. Eighty-five of the 195 member states of the WHO have stated they have no vaccine supplies.11

Dr. Wharton points out, however, that “that the burdens associated with seasonal and pandemic influenza certainly need to be considered in the context of other health issues some of which in a global context may be a higher priority in other countries than this one is.”14

Director-general of the World Health Organization Margaret Chan has raised concerns about the likelihood of regions with endemic disease being especially hard hit by the virus.11 While the virus is rarely fatal in healthy populations, immuno-compromised individuals could experience vastly higher mortality rates.

This has already become apparent in countries such as Australia where the aboriginal community’s infection rates are higher than that of the general population.12 While the aboriginal population is small, other wealthy nations have significantly larger low-income and disadvantaged populations with unequal access to health care services.

Dr. Bailey told the HCGHR that “the risk factors from chronic disease to STDs, to poverty, to environmental factors are all part of our surveillance so that when we give our vaccine information cautions and our protocol it takes that into mind.”13 The fact that agencies such as the CDC are directingattention to these risk groups creates hope that impoverished and diseased populations will gain better access to healthcare, especially during a pandemic.

In developed countries, priority will be given to pregnant women, health care workers, people under the age of 24, and to those who are older and have chronic health issues.8

This list does not, however, include several impoverished groups that should be deemed as risk groups based on experiences of nations in the southern hemisphere.

Dr. Wharton informed us that the WHO “is working to ensure the donated vaccine are distributed where they are most needed.”14

The H1N1 virus is predicted to stay in a relatively mild form that will not significantly increase the mortality rates of this year’s flu season.3 Nevertheless, the WHO has classified this as a global pandemic, and the world’s response must be viewed in this context.

With delayed production schedules and disparities in global access to the vaccine, the H1N1 virus provides governments with a valuable chance to reconsider and better control pandemic policy and health systems before another more deadly virus arises.

As Dr. Bailey concluded, it is important to realize “what we can control and what we cannot control.”13


1 Neustadt, Richard and Fineberg, Harvey. The Swine Flu Affair: Decision-Making on a Slippery Disease. Department of Health, Education, and Welfare Report: 1976. <http://www.nap.edu/catalog.php?record_id=12660&gt;

2 Haskell, Meg. “Officials tout safety, efficacy of H1N1 vaccine.” Bangordailynews.com.25th Sept. 2009. <http://www.bangordailynews.com/detail/122422.html&gt;

3 “H1N1 virus not mutated, vaccine still works.” The Med Guru. 26th Sept. 2009. <http://www.themedguru.com/20090926/news/h1n1-virus-not-mutated-vaccine-stillworks-86128351.html&gt;

4 “Assessment of the 2009 Influenza A (H1N1) Outbreak on Selected Countries in the Southern Hemisphere.” Flu.gov. Aug. 2009. <http://www.flu.gov/professional/global/southhemisphere.html&gt;

5 Simmins, Charles. “Swine Flu Continues to Spread in United States.” Examiner.com. 26th Sept. 2009. <http://www.examiner.com/x-18444-Rochester-Infectious-Disease-Examiner~y2009m9d26-Swine-Flu-continues-to-spread-in-United-States&gt;

6 Alan, Reed. “Vaccine concerns increase.” Willston Herald. 21st Sept. 2009. <http://www.willistonherald.com/articles/2009/09/21/news/doc4ab7a9547a040396298984.txt&gt;

7 Boyd, Leah. “Vaccine Raises Safety Concerns.” Livingston Daily.com. 27th Sept. 2009. <http://www.livingstondaily.com/article/20090927/NEWS01/909270323/-1/NEWSFRONT2&gt;

8 Sweet, Lynn. “Free H1N1 Flu Vaccine for Everyone in the Country.” Politics Daily. 25th Sept. 2009. <http://www.politicsdaily.com/2009/09/25/free-h1n1-flu-vaccinesfor-everyone-in-the-country/&gt;

9 “H1N1 vaccine production far less than forecast: WHO.” Reuters. 18th Sept. 2009. <http://www.reuters.com/article/health-News/idUSTRE58H1N120090918?pageNumber=2&virtualBrandChannel=11604&gt;

10 “UPDATE 1-Rich countries to share some swine flu vaccine.” Reuters. 17th Sept. 2009. <http://www.reuters.com/article/marketsNews/idUSN1756571620090917&gt;

11 “A(H1N1) may have ‘damaging consequences’ for poor.” Business Mirror. 21st
Sept. 2009. <http://businessmirror.com.ph/home/world/16301-ah1n1-may-havedamaging-

12 “Aborigines at high H1N1 flu risk.” The Associated Press. 24th June 2009. <http://

13 Bailey, Stephanie B. Coursey. Telephone INTERVIEW. 29th Sept. 2009.

14 Wharton, Melinda. Telephone INTERVIEW. 6th Oct. 2009.


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