PHM-Exch> Global Goal for H1N1 vaccine Quest

[Claudio Schuftan]

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> *Global Goal for Vaccine Quest*
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> *Lawrence O*. Gostin

University of Sydney and Georgetown University


*http://www.theaustralian.news.com.au/story/0,25197,25896462-23289,00.html


The rapid global transmission of Influenza (A) H1N1 (swine flu) has
sparked a worldwide race to develop an effective vaccine. Finding a
technological solution to swine flu will be a major scientific advance,
but vital questions of scarcity and fairness loom large.

The swine flu vaccine will almost certainly be scarce, with
manufacturers unable to meet the huge global demand. Governments face
hard choices on how to ethically ration this scarce life-saving
resource. Children and their caretakers should certainly be a high
priority for swine flu vaccine because they rapidly spread the infection
in day care and school. Yet privileging the elderly would be a mistake
because they have contracted the new strain at the lowest rate and
appear to have some immunity.

Instead, government should assign top priority to the most vulnerable
who have died at a disproportionate rate—those who have poor health such
as heart disease, asthma, or diabetes. This is also the fairest way to
allocate scarce vaccines because people with multiple health conditions
also tend to be the most disadvantaged in society.

It is vital that government makes allocation decisions fairly and
transparently. The public has a right to know which groups will have
priority access and why. One key problem, however, is that the private
market is still likely to privilege the rich and politically connected
in gaining access. Business culture is geared toward satisfying consumer
demand, so the industry will charge what the market will bear for a
scarce, valuable vaccine.

Rich countries will face scarcity, but they will have much more ample
supplies than poor countries. The pressure on governments to protect
their own citizens will be intense during a pandemic. The vaccine
industry is likely to supply markets that can afford to pay and in
countries where they are located. More than 90% of the world’s capacity
to manufacture influenza vaccines is concentrated in Europe and North
America. This leaves poor countries in Africa, Asia, and Latin America
much more vulnerable as the rich stockpile vaccines.

Europe, and the United States are spending a fortune on vaccines and
antiviral medication, but virtually none of these resources will benefit
poor countries. Serious questions of global social justice arise when
wealth, rather than need, becomes the primary allocation criterion. The
mal-distribution of vaccines in the face of a global financial crisis
will only widen the already yawning health gaps between the rich and the
poor. Rich countries hoarding vaccines is also is a bad public health
strategy because it allows the virus to circulate unchecked in highly
populated developing countries.

Even if it is not politically expedient, justice requires that scarce
vaccines go to the most disadvantaged. Equitable access to a vaccine
against swine influenza is not merely a moral imperative. It is also
critically necessary to safeguard global health.
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