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[OUDTSHOORN] As the WHO declared the end of the swine flu pandemic earlier this month, the high financial cost incurred in preparing defences against the disease has left many countries wondering whether it was money that could have been better spent, given that the disease failed to spread as widely as feared.

But experts say that while the cost of vaccines and anti-virals was high, the lessons learned and the monitoring systems put in place will protect humanity from inevitable future virus outbreaks.

Frew Benson, South Africa's chief director of communicable diseases, said the country spent 115 million rand (US$15.6 million) on vaccine but has only used about US$3.4 million worth. The remaining vaccine will, until it expires, remain part of the country's strategic stock against the epidemic, Benson said.

There also remains a huge stockpile of antivirals. Benson said 100,000 courses were imported for South Africa but only 25,000 have been used so far. The cost of wasted expired vaccine and antivirals will be shouldered by purchasing governments.

"This country was lucky, for some reason this epidemic didn't hit us as hard as other countries in Africa. West Africa is battling far more with A(H1N1) than we are here," said Benson.

Lucille Blumberg, head of epidemiology at South Africa's National Institute for Communicable Diseases, said it was not all wasted — laboratories had been upgraded and skills improved across Africa to cope with the epidemic.

"Yes, there was excessive use of resources in South Africa during the epidemic," she told SciDev.Net. "But this was inevitable."

"There was a time, at the height of the epidemic, when laboratories couldn't cope," she said. "In hindsight we didn't need to test and treat every case, but at that stage we didn't know what we were dealing with — or how dangerous it was."

Rick Bright, scientific director of the global vaccine development programme at Seattle-based nongovernmental organisation PATH, said that a network of influenza centres around the world had been strengthened and regional labs expanded, including in Africa where there are now major laboratories in Madagascar, Senegal and South Africa.

This is particularly important for flu, which does not display specific external symptoms and can be diagnosed only through laboratory testing.

"H1N1 taught us a lot by intensifying attention without the occurrence of fatalities. It was a dry-run for a larger more lethal flu pandemic," said Bright, who has been reviewing the needs of low-income countries for the Influenza VII conference, to be held in Hong Kong in September.

He said the pandemic scare highlighted the global shortage of vaccine, and the need for countries to be able to manufacture antivirals and vaccines within their own countries.

"Stockpiling is not a solution, because no one knows what the next mutation of the influenza virus will be," Bright said.

"Maintaining a stockpile has major costs and you have to continually test the vaccine for potency and that also has costs," said Kathleen Neuzil, Senior Advisor for Immunizations at PATH. The H5N1 vaccine, for example, is more stable in bulk form, but once it is in syringes and vials it can lose its potency within a year.

"The emergence of H1N1 showed the limitations of a stockpile concept, particularly for low-income countries," said Katherine Neuzil, director of PATH's global vaccine work. "You don't have time to put in place a stockpile if the virus mutates."

"In terms of preparedness, we are in much better shape than ten, five, or even two years ago, especially in terms of the degree of surveillance, and the number of countries involved in surveillance," Neuzil said.

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