By Cheryl Pellerin
USINFO Staff Writer

Washington – Progress is being made in establishing a global stockpile for developing nations of a vaccine to protect against avian influenza, which has caused 190 deaths in 312 human cases identified since 2003.

The World Health Organization (WHO) announced June 14 that it is working with vaccine manufacturers to create a global stockpile of vaccine for the H5N1 avian influenza virus that it can distribute to the world’s poorest nations on short notice in the event of an H5N1 pandemic.

On the same day, pharmaceutical firm GlaxoSmithKline said it would donate 50 million doses of a “pre-pandemic” flu vaccine that could help 25 million people (two injections per person) through the first several months of a worldwide outbreak while a pandemic-specific vaccine is being produced. (See related article.)

Three other manufacturers – Omninvest of Hungary, Baxter International and Sanofi Pasteur, the vaccine division of the French Sanofi-Aventis Group – also have offered unspecified amounts of H5N1 vaccine for the stockpile.

“The United States is committed to working with member states and the WHO to explore other avenues to meet the near-term need for greater access to influenza vaccines, including pre-pandemic vaccines,” U.S. Health and Human Services Secretary Michael Leavitt said in a May 23 statement.

GLOBAL STOCKPILE

Details about the stockpile have yet to be worked out, said WHO spokesperson Christine McNab during a June 14 USINFO interview.

“There will probably be a meeting or series of meetings to look at the operational use of [the stockpile],” she said, “and there are still lots of questions – is it a virtual stockpile; if not, where will it be stored; how and when would it be used; and which countries would use it?”

The announcement follows a request by the World Health Assembly – WHO’s supreme decisionmaking body – in May that WHO establish such a stockpile.

"WHO welcomes this contribution from the vaccines industry,” said WHO Director-General Dr. Margaret Chan in a June 14 statement, “and is also working with countries to develop capacity for the production of influenza vaccines."

WHO is preparing for a potential flu pandemic with rapid containment plans to stop a pandemic by using public health measures (isolation, quarantine, personal hygiene and social distancing) and anti-virals, helping countries increase vaccine-production capacity and promoting vaccine technology transfer to developing countries.

The stockpiled vaccines will be useful only if the H5N1 flu strain initiates the next flu pandemic, McNab said, but added that even if an entirely different strain of flu produces a global outbreak, the experience gained in establishing the stockpile will be valuable.

INTERNATIONAL HEALTH REGULATIONS

The revised International Health Regulations become effective June 15, bringing a comprehensive, tested set of rules and procedures into force for WHO and member states. The rules are intended to limit the international spread of pandemics, epidemics and other public health emergencies and minimize disruption to travel, trade and economies. (See related article.)

The revisions, approved in 2005, updated 1969 regulations that addressed only four diseases – cholera, plague, yellow fever and smallpox, a disease now eradicated.

The regulations are adopted by most countries as legally binding rules to contain disease threats that could spread rapidly from country to country. Threats include emerging infections like a new human flu virus or severe acute respiratory syndrome (SARS), which caused a major epidemic between November 2002 and July 2003 with more than 8,000 known cases and 774 deaths.

"SARS was a wake-up call for all of us,” Chan said. “It spread faster than we had predicted and was only contained through intensive cooperation between countries which prevented this new disease from gaining a foothold."

Threats also could come from chemical spills, leaks and dumping, contaminated food and nuclear accidents.

TESTING THE SYSTEM

On June 15, WHO will hold the first of a series of exercises to sharpen its preparedness under the revised rules.

The exercise will verify new procedures for receiving, analyzing and responding to information about potential public health emergencies, and test and improve mechanisms in place in and between member states and at different WHO levels.

A unexpected test of the fledgling system occurred in May, when a U.S. citizen with extensively drug-resistant tuberculosis, an airborne infectious disease, boarded commercial flights to and from Europe, and crossed the border from Canada into the United States despite an international alert about his condition. (See related article.)

In testimony June 4 before a U.S. Senate Appropriations subcommittee, Centers for Disease Control and Prevention (CDC) Director Dr. Julie Gerberding described the process of contacting WHO about the traveler, and said that CDC’s notification process could be improved.

The International Health Regulations “are wonderful,” she told the subcommittee, “but there’s no operational planning around them. This is going to be the perfect case study for us to sit down with affected health ministries and the TB officials at WHO [to discuss] how we are going to create operational and tactical plans.

“Every country is going to have to come to grips with the same thing CDC did,” Gerberding added. “How do we keep people from [traveling internationally], how do we find out where they are, how do we handle them when we need to isolate them in someone else’s country, and who pays?”

More information about the International Health Regulations is available on the WHO Web site.

For more information on U.S. and international efforts to combat avian influenza, see Bird Flu.