Pandemic flu would outrun vaccine, global health officials say
350 million doses produced annually are not enough
WASHINGTON -- Eight years after first drawing attention to a global shortage of flu vaccines, the World Health Organization yesterday said the failure to increase vaccine production means that billions of people would be unnecessarily vulnerable to a pandemic flu outbreak.
The WHO, citing the threat of avian flu crossing over to humans on widescale basis, urged that countries step up vaccination for seasonal flu. Their hope is that if more factories produce vaccines to meet increased demand for seasonal flu vaccinations, pharmaceutical companies could more quickly produce a vaccine to fight a pandemic flu if there were an outbreak.
Today, drug companies are producing about 350 million seasonal flu vaccines every year -- roughly the same number as in 1998, when the WHO drew attention to the shortage of flu vaccines in a report on how the world should respond to a global pandemic influenza. Many other global health specialists, including those at the US Centers for Disease Control and Prevention, also have recommended in the past that the world's supply of influenza vaccines should be increased dramatically.
In the event of a pandemic influenza, the world's entire population -- more than 6.5 billion people -- theoretically would need to immunized.
"The world is unprepared," David Heymann , the WHO's acting assistant director-general for communicable diseases , told reporters in Geneva. " We are calling urgent attention to the fact that we need to start now to increase that [vaccine] capacity in the event of a pandemic in the next five, 10, or 30 years. The process must begin immediately."
Heymann said in an interview that he was especially concerned now because the "pandemic in the chickens does not go away, it continues to spread throughout Asia, and this is the beginning of another influenza season."
So far, all but a handful of human cases of bird flu have resulted from contact with infected birds. Should the virus mutate to permit easier human-to-human transmission, a pandemic could occur.
US Health and Human Services Secretary Mike Leavitt immediately supported the WHO recommendation, noting the fast spread of the avian flu to 40 additional countries in the past year, leading to the deaths of millions of birds. More than 250 people have been infected with avian flu in 10 countries.
"Equally alarming is the fact that global influenza vaccine manufacturing capacity of 350 million doses per year is far short of the manufacturing capacity needed to protect the world's 6 billion people," Leavitt said in a statement.
The United States is now spending roughly $1 billion in influenza vaccine research. Now, a number of vaccines against avian flu are in scientific trials, but officials predict that none will be approved for at least another year.
In the United States, manufacturers have stepped up production of seasonal flu vaccine this year, and US officials predict that between 110 million and 115 million people will receive a flu shot or a protective nasal spray. The previous high was 83 million doses in 2003.
In past two years, the CDC has recommended that those at high risk receive a seasonal flu shot, including those with chronic diseases, people over the age of 65, children ages six months to 24 months, women who are pregnant, and healthcare workers. They had asked those not at high risk voluntarily step aside and not receive the vaccinations.
This year, the CDC is recommending that everyone receive a flu vaccination because of the increase in supply.
WHO officials yesterday said they believed countries could give seasonal flu vaccines annually to 600 million people in the next few years. To increase rates further, especially in poorer countries, donors would need to subsidize the vaccine cost, which is between $3 and $7 per dose. The WHO estimates its plan could cost up to $10 billion. Still, under a best-case scenario, health officials acknowledged that it would take years before enough vaccines could be made to protect everyone.
John Donnelly can be reached at donnelly@globe.com 
