Critical U.S Support will Help Mitigate the Global Impact of H1N1 (Swine) Flu
September 25, 2009
Last week’s important decision by the Obama administration to take a global leadership position in sharing a significant proportion of the U.S. H1N1 (swine) influenza vaccine supply with the people of developing countries is likely to help save many lives. However, its longer term importance may well be the major shift in U.S. global health policy suggested by the decision.
In brief, the United States has agreed to donate 10% of its hundreds of millions of contracted doses of H1N1 flu vaccine to the World Health Organization (W.H.O.) for distribution to various developing countries. The U.S. vaccine donations will be made on a rolling basis so that resource poor-countries can begin receiving and administering vaccine relatively soon. A number of other industrialized countries (Australia, Brazil, France, Italy, New Zealand, Norway, United Kingdom) also announced similar vaccine donations nearly simultaneously. (The Swiss government had already committed in June 2009 to donate US$4.8 million directly to W.H.O. for the latter to purchase H1N1 vaccine at concessionary prices.) GlaxoSmithKline and Sanofi-Aventis, two large vaccine manufacturers, had also committed earlier to donations of more than 100 million H1N1 vaccine doses to W.H.O.
The ability of the United States and other countries to make these vaccine donations was helped by several factors. First, it has become clear within the last week that a single dose of the new H1N1 vaccine will provide satisfactory protection for adults and older children with normal immune systems, making a second (booster) dose unnecessary except for children under 10 years old. Since the U.S. H1N1 vaccine supply had been planned and requested to include the possible need for a two-dose series for most people, U.S. swine flu vaccine supplies will be more ample than it appeared earlier.
Second, infection with the new H1N1 influenza virus continues to cause a relatively mild illness for the great majority of people, among whom the risk of severe illness, hospitalization or death, although not zero, remains exceedingly low. The risk factors identified so far for severe illness and death after H1N1 infection include pregnancy, obesity, diabetes mellitus, a suppressed immune system (caused by radiation treatments, certain medications and/or by HIV/AIDS, some types of cancers and certain other illnesses) and various other chronic illnesses of the lungs (including asthma), heart, kidneys and other organ systems. Compared to the United States and other industrialized countries, a larger proportion of the population in many developing countries is likely to have one or more of these or underlying conditions (including malnutrition) that put them at risk of severe illness or death from H1N1. Recommendations for priority use of H1N1 vaccine in all countries include each of these high risk groups as well as health care workers and others who care for sick people and young infants.
Last month, a Presidential advisory group, the President’s Council on Advisors in Science and Technology, had recommended (See pages 42-44) to the White House that H1N1 vaccine and other materials be purchased for or redirected to developing countries by the United States. In addition, Dr. Tachi Yamada, President of the Global Health Program at the Bill and Melinda Gates Foundation had recently written in the New England Journal of Medicine that the global community should “take steps to protect all populations, including those without resources to protect themselves.” Other motivations behind these vaccine donation decisions by the United States and other industrialized countries include:
- the new foreign policy tone being set by the Obama administration;
- the growing awareness in many industrialized countries of the importance of global health as a legitimate foreign policy concern;
- the magnitude of the growing H1N1 pandemic and the lack of preparedness for it in many developing countries.
In the past, one other influenza-related concern has been a resistance in some quarters to the sharing of avian (H5N1) influenza virus specimens across national borders for analysis in other countries without some certainty of reciprocal access to any of the benefits (e.g., vaccines, anti-viral drugs) that might accrue from the study of these specimens. Presumably, the demonstration of global solidarity represented by these vaccine donation steps can help re-start the discussion about a resolution of that specimen sharing issue.
Not only does this vaccine donation by the United States appear to signal a new attitude toward overall global solidarity, but the U.S. participation in this multilateral approach coordinated through W.H.O. seems to signal a new level of trust in both multilateral approaches to global health and in the institution of W.H.O., at least for this particular crisis.
However, the donation of these many millions of H1N1 vaccine doses, while ground-breaking and important for saving lives, does not go very far toward addressing the long term need to improve health systems in developing countries. One especially critical issue is the need for better preparedness for pandemics and other health crises (e.g., natural disasters) in either developing countries or in the larger global community. A general consensus is that faster identification in developing countries of new disease outbreaks could benefit the entire global community by giving all countries more time to prepare for subsequent disease spread.
Beyond vaccine doses, H1N1 influenza preparedness in the United States and other industrialized countries includes adequate systems for influenza surveillance and laboratory diagnosis; anti-viral drugs and other antibiotics; sufficient hospital bed capacity; specific training of public health workers; masks, respirators, and other personal protective equipment for health workers; etc. Most of these preparedness systems and materials are still lacking in most developing countries. The resolution of these and other global health inequities will not be easy and will not happen quickly.
This H1N1 vaccine donation by the United States and other countries hopefully represents only an initial step of a new commitment, a first step on a long road toward improving overall health systems in developing countries, and thereby improving global health equity.
Image courtesy Samantha Celera