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Developing countries need to recognise the long-term benefits of creating the capacity to research and develop flu vaccines.

Influenza researchers are converging on the World Health Organization (WHO) headquarters in Geneva today (4 May) to discuss progress in the race to develop the first human vaccine against the H5N1 bird flu virus.

Unfortunately, there is a clear danger that developing countries will be the last to obtain such a vaccine. Hopefully, therefore, the WHO will use the meeting to start official negotiations on advance-purchasing agreements with vaccine producers for countries that need vaccines most but cannot afford them.

But such agreements, though crucial, would be short-term solutions to a long-term problem. Flu pandemics are recurring events — there were three in the twentieth century. Ultimately, developing countries must realise that the cause of the current flurry of attention is just the tip of the influenza iceberg.

Flu in developing countries

By their very nature, flu viruses are health threats that are here to stay. Because they lack an efficient mechanism for correcting errors in their genetic material when it gets copied, the viruses are particularly prone to changing, thereby causing new epidemics of mild flu in humans almost every year.

By the same token, the threat of entirely new forms of flu virus emerging — with the potential to cause global pandemics — will also remain.

Models of how a pandemic flu virus would spread suggest that it could reach all continents within three months of emerging. Yet the US government estimates that it could take up to eight months to produce the first doses of a pandemic flu vaccine. Faced with the threat of an emerging disease that is heading rapidly towards their borders, rich nations are unlikely to feel charitable as they struggle to protect their own populations. It is therefore essential that developing nations enhance their capacity to research and produce their own flu vaccines.

Influenza statistics are virtually non-existent in poor countries, where the burden of other diseases has so far masked the impacts of flu. The WHO estimates that flu affects 5–15 per cent of the global population each year, causing 250,000–500,000 cases of severe illness.

In the tropics, flu spreads year-round. The threat is compounded in such regions by their under-funded and overburdened health systems, and limited access to antiviral drugs and vaccines. As a result, the economic impact of having a workforce at risk of flu is undoubtedly higher than in industrialised countries. A case in point is Madagascar, where a particularly bad flu epidemic in 2002 affected at least 27,000 people in just three months, and killed 800.

Influenza is therefore a health problem that deserves long-term attention in poor countries. Countries that develop the skills to produce an H5N1 vaccine will not only stand a better chance of protecting their populations if that virus sparks a human pandemic, but will also be better placed to deal with future pandemics (which flu experts insist are inevitable) and with annual epidemics of normal human flu.

Financial benefits

For the pharmaceutically-savvy, namely China and India, the financial attractions of getting involved in flu vaccine production are also considerable. That the US stockpile of seasonal flu vaccine had 86 million doses last year — 25 million more than in 2004 — is testament to the rising demand for flu vaccine.

For pharmaceutical company Roche, the publicity surrounding avian flu has been like gold dust. Its share price rose steadily in 2005, doubling in the space of ten months. Roche has increased the amount of Tamiflu — the main flu drug — it can produce, and has avoided the threat of compulsory licensing by handing out production licenses to selected companies in Asia.

There are signs that successful vaccine producers could enjoy similar rewards. Sanofi-aventis, a key player in flu vaccine manufacturing, reported in March that it had increased its investment in vaccines, "especially influenza" in 2005, following a strong growth in its vaccine sales. Its share price has been on an upward trend since early 2005, as have those of several other flu vaccine manufacturers.

One thing the current media and policy attention surrounding H5N1 has highlighted is that the world's capacity to produce flu vaccines is insufficient. Production methods are also deemed antiquated and in dire need of an update (see Pandemic flu: fighting an enemy yet to exist). Research is under way to find a more efficient way of producing flu vaccines using cell cultures rather than chicken eggs. Vietnam is engaged in this, and others would be wise to use the opportunity to invest in something for which there will be global demand.

China, Brazil and Thailand are also trying to develop an H5N1 vaccine. But Africa has virtually no research or production capacity when it comes to flu vaccines, and is largely a stranger to the seasonal flu vaccine. The continent that will undoubtedly suffer most from a flu pandemic needs to step up to the challenge.

Catherine Brahic
Senior correspondent, SciDev.Net

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