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Cheap, widely-available generic drugs that alter people's immune response could save millions of lives in developing countries without access to a vaccine or antivirals, says a leading vaccine expert.

In a paper published last week in Influenza and other Respiratory Diseases, David Fedson suggests that focusing on the host (the human), rather than the virus, in attempts to tackle the swine flu — influenza A(H1N1) — pandemic could lead to fruitful new drug approaches such as this.

Fedson suggests more research should be done into using statins, fibrates and glitazones — agents normally used by doctors for treating diabetes and high cholesterol — to see if they could help manage an influenza pandemic.

He adds that while influenza researchers are aware of this hypothesis, few resources have been invested in pursuing it.

"If they could be shown to be effective in treating severe influenza, they could be made available to people in all countries on the first pandemic day. The studies would not be very expensive, and the important ones could probably be completed in less than six months," he told SciDev.Net.

WHO director-general Margaret Chan is continuing negotiations with pharmaceutical companies to make antivirals and vaccines available to the developing world. GlaxoSmithKline has already pledged 50 million doses of vaccine and Sanofi-Pasteur announced a donation of 100 million doses yesterday (17 June), while smaller companies have promised a percentage of their production. 

But the Financial Times reported that Swiss pharmaceutical giant Novartis said it would not donate swine flu vaccine to the developing world. The newspaper said this was "a rebuff to Chan" who had hoped for "solidarity" in fighting the pandemic.

Daniel Vasella, Novartis chief executive, told the Financial Times: "If you want to make production sustainable, you have to create financial incentives."

In an editorial following Novartis' announcement, the Financial Times pointed out that 85 per cent of the burden of chronic disease falls in low- and middle-income countries — suggesting that more deaths from influenza A(H1N1) would occur there.

The newspaper called on rich nations to stand ready "not only to pay for other people's drugs" but, if the WHO thinks it necessary, "to give up some of their own vaccine stocks".

The scale and impact of swine flu was outlined in a set of maps this week by the risk specialist company Maplecroft. Science Daily reported that the Influenza Pandemic Risk Index consists of three categories: risk of emergence, risk of spread and capacity to contain.

For many Sub-Saharan African countries the capacity to contain is "extreme" — not good — as is the risk of spread. Algeria, China, Egypt and South Africa are all listed as "medium" in their ability to contain the virus.

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