By Cheryl Pellerin
Washington File Staff Writer

Washington - With the release of a new World Health Organization (WHO) report on a plan for increasing the supply of vaccines to fight pandemic influenza around the world, the United States has announced a $10 million contribution to support flu vaccine development and manufacturing in other countries.

The WHO report, Global Pandemic Influenza Action Plan to Increase Vaccine Supply, released October 23, identifies a set of activities required for immediate and sustained action and funding if the world is to be prepared for an influenza pandemic. (See related article.)

“In developing this plan through a consensus of the world’s experts in influenza, immunization, vaccine research, and manufacturing,” Mike Leavitt, U.S. secretary of health and human services, said in an October 23 statement, “the WHO has set the world’s sights on the decisive path forward to increase the global capacity to produce pandemic influenza vaccine.”

Since 2003, some 256 people have become victims of human avian influenza, and 151 have died. Hundreds of millions of birds have died or been killed to limit the spread of bird flu, a primarily animal disease.

If the virus mutates into a form that is easily spread among people, a global pandemic could result.

REDUCING VACCINE SUPPLY GAPS

According to the WHO report, the major flu vaccine producers operate and supply almost exclusively in Australia, Europe, North America and some countries in Asia and Latin America. (See related article.)

The global flu vaccine manufacturing capacity is 350 million doses per year in a world of 6.7 billion people, none of whom would have natural immunity to a new, potentially deadly viral mutation.

"Immunization is a critical control strategy for limiting the impact of an influenza pandemic,” Dr. David Heymann, acting assistant director-general for communicable diseases at WHO, said in a statement. “Immediate, collaborative action to increase vaccine supply could have a massive payoff."

In May, WHO invited more than 120 experts from national immunization programs, natural regulatory authorities, vaccine manufacturers and the research community to identify and prioritize practical solutions for reducing anticipated vaccine supply gaps.

Participants identified three approaches:

• Increase seasonal flu vaccine use protect against seasonal flu and use the increased demand to stimulate industry to produce more.

• Increase production capacity by improving vaccine production yields and building new plants.

• Invest in research and development to design more potent and effective vaccines that induce protection after one dose or broad spectrum and long-lasting immunity, and produce vaccines more efficiently and quickly.

Because the anticipated flu-vaccine shortage is based on the expectation that each person will need a two-dose course of vaccine, new technologies will play an important role in developing the best possible pandemic influenza vaccine.

The ideal vaccine would be safe and highly protective in all groups (including babies and the elderly) for at least one year with a single dose. It would require a small amount of virus antigen, could be stored without refrigeration and would be produced easily and inexpensively on a large scale.

SEEKING A GLOBAL SOLUTION

Implementing the global action plan will require sustained, joint efforts of affected countries, industry and the global health community, and substantial funding, according to WHO. Capital investment alone for establishing new production facilities is an estimated $1 per vaccine dose.

"The Global Action Plan sets the course for what needs to be done, starting now, to increase vaccine production capacity and close the gap,” said Dr. Marie-Paule Kieny, director of the WHO Initiative for Vaccine Research. “In just three to five years we could begin to see results that could save many lives in case of a pandemic."

Investments made in relation to the action plan will benefit the production and use of vaccines for seasonal flu, which causes 3 million to 5 million cases of severe illness and 250,000 to 500,000 deaths a year worldwide.

Assistance to developing countries is critical, according to the report. Such countries will need help to assess the impact of flu on their populations and to develop and implement seasonal flu vaccination programs. This includes the purchase of seasonal flu vaccine, which now costs $3 to $7 per dose.

“If a country is to protect its own people, it must work together with other nations to protect the people of the world,” Leavitt said.

“In that spirit,” he added, “the United States has provided $10 million to the WHO to support influenza vaccine development and manufacturing infrastructure by institutions in other countries as they develop sustainable programs for vaccines to prevent avian H5N1 or other novel influenza viruses in humans.”

The full text of the report (PDF, 24 pages) is available at the WHO Web site.

For ongoing coverage of this issue, see Bird Flu (Avian Influenza).