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The WHO says it is discussing with vaccine manufacturers how to ensure that developing countries receive supplies of any vaccine made to combat the potential swine flu — influenza A (H1N1) — pandemic.

There have been concerns that developing countries will have little access to vaccines because many developed countries already have 'dormant' orders lodged with pharmaceutical companies, to be triggered in the event of a pandemic (see Poor may lose out in swine flu vaccine production).

But Marie-Paule Kieny, director of the WHO Initiative for Vaccine Research said: "We are discussing with manufacturers to make sure that the WHO and the international community will have access to the vaccine for the benefit of the poorest people in developing countries".

She said that although the books of some manufacturers are "already pretty full", all of them "have expressed their willingness, over and above these commitments, to work with WHO to identify what part of production can be used and devoted to this public health mission".

Funding to purchase the vaccines for developing countries will come from large donors, said Kieny. The WHO is currently in discussions with "some of the big funders which hold finances for public health intervention in developing countries" she told a press conference last week (1 May).

"We are confident that the cost of the vaccine will not be that high and that it will be possible to find the finances for them."

Not all production will come from developed countries. Although Kieny acknowledged that most vaccine production capacity is in Europe and North America, she said that there are "serious" manufacturers in other parts of the world — in Asia in particular.

Six developing country manufacturers have received funding and technical assistance from the WHO over the last two years to acquire the technology to make seasonal vaccines, she said, adding that the WHO would discuss with them whether they are ready to start producing an influenza A (H1N1) vaccine.

The WHO is talking to manufacturers that are part of the International Federation of Pharmaceutical Manufacturers and Associations, the Developing Country Vaccine Manufacturers Network and also to independent manufacturers.

Although an official decision about the need to make a pandemic vaccine is yet to be made, manufacturers are envisaging they will start making the vaccine as soon as possible. "Unless very soon there is a signal that this [outbreak] will not continue it seems most likely that manufacturers will proceed and we will support them".

Kieny said that there are many tests to be done and decisions to be made before any vaccine is used in humans. For example, one way of improving the efficiency of delivery of a pandemic vaccine would be to combine it with a seasonal flu vaccine, as a tetravalent vaccine.

But such an approach "will not cover the total population" she said. "Many many people, especially in poor countries, do not receive a seasonal influenza vaccine. So for those populations, availability of a monovalent vaccine would be crucial. It may well be that in the coming months we will see both a monovalent and a tetravalent vaccine on the market."

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