GHF2006 – PS13 – Access to Health at a Time of Pandemics

Session Outline

Parallel session, Thursday, August 31 2006, 16:00-17:30
Chair(s): Claire-Anne Siegrist, Switzerland, Flavio Del Ponte, Switzerland
Global Response in Case of Crisis 
Keiji Fukuda, Coordinator, Global Influenza Program, World Health Organization, Switzerland 
Can Global Vaccine Needs Be Covered?
Jean R. Stephenne, General Management, GlaxoSmithKline Biologicals, Rixensart, Belgium 
Ressource Management on a Worldwide Scale
Mike Ryan, Director, Epidemic and Pandemic Alert and Response, WHO, Switzerland 

Session Report

Submitted by: Brooke Bishara (ICVolunteers); Contributors: Milena Lawrence-Samuel (ICVolunteers)

Image: Photograph taken in 2005 at the Center for Disease Control and Prevention in Atlanta. Doctor examining reconstructed 1918 Pandemic Influenza Virus inside a specimen vial containing an orange-colored supernatant culture medium. Image courtesy http://phil.cdc.gov/Phil/

A flu pandemic is inevitable, scientists say. Yet we are the first humans ever to have had fore-knowledge of a pandemic, which gives us a unique opportunity to act to address the crisis before it occurs. Sustained political attention and collaboration between the public and private sector hold our greatest hope of effectively managing this disastrous event.

Dr. Keiji Fukuda, of the Global Influenza Program of the World Health Organization (WHO), led the symposium with an overview of the pandemic threat. Historical evidence (three pandemics in the last century), the abundance of viruses among wild birds and substantial levels of contact between humans and animals all point to the inevitability of a flu pandemic. The H5N1 virus is the most lethal flu virus discovered to date, but Dr. Fukuda pointed out that it is only one of many that could spread to humans. Therefore, we do not know of which form of flu virus the pandemic will comprise, so there is a high degree of uncertainty which preparedness plans must take into account. For example, it is difficult to predict the degree of capacity needed in hospitals, but Dr. Fukuda pointed out that our current system operates at about 95% of its full capacity, so there is very little room for the surge that would come from a pandemic. Health care systems will suffer from staff absences, increased deaths and little to no help from other countries, because all will be dealing with the crisis. Ethical dilemmas (whom should we vaccinate?) and technical obstacles (how can we produce a vaccine more quickly?) are also challenging to preparedness planners.  The recent passage of the new International Health Regulations by the WHO is an encouraging development, as it provides countries with a standard framework for responding to and reporting health crises. The WHO's strategic plan for Pandemic Influenza includes reduction of human exposure to H5N1 through education about animal contact; intensification of early identification and rapid response to outbreaks; and coordination of global scientific research efforts. Dr. Fukuda concluded that 1) the threat is real; 2) we must focus on our preparedness rather than the threat itself and 3) we must balance our preparedness between specific preparations for the flu pandemic and building infrastructure to address all future infectious diseases.

Jean Stephenne, President and General Manager of GlaxoSmithKline Biologicals (the pre-eminent flu vaccine producer), spoke about the company's efforts to address the pandemic threat. He first stressed that with current technology, there is not enough vaccine capacity to protect the world from such a pandemic. A vaccine for a newly discovered virus can be produced in about four to five months, but current predictions show that by then the pandemic would be close to reaching its peak.  In addition the number of doses available would be woefully inadequate to protect all those at risk.  Instead, Mr. Stephenne suggests two solutions: 1) a Pre-pandemic flu vaccine which includes the H5N1 strain giving a safe vaccine with a broad immune response; 2) by adding adjuvants boosting the immunogenicity, the existing capacity could yield a ten-fold of vaccine doses. In 2008 he predicted the global capacity to reach 600 million doses which by adding adjuvants would translate into 6 billion doses, enough to cover the world-wide demand.  Mr. Stephenne stressed the need for such a vaccine to be made available more widely than to just those countries that can afford to pay for it, especially because there is a high probability that the pandemic will start in a developing country.  Innovative thinking and vaccines are only part of the solution, he stated. The vaccine has to get to the right people and our health systems must be prepared.

Finally, Dr. Michael Ryan, Director of Epidemic and Pandemic Alert and Response of the WHO in Switzerland, presented a sobering picture of our current health infrastructure's ability to handle disease outbreaks and stressed the need for permanent collaboration between the public and private sectors. New pathogens are emerging, like avian influenza, but "old" diseases like cholera, yellow fever, and dengue fever are also resurging in Africa, despite the fact that we have plenty of well-established, readily available, low-cost cures. A population that is increasingly urban, while also coming in close contact with intensively farmed animals, runs a greater risk of infectious disease.  Dr. Ryan also stressed that the complexity of our health systems can actually prove to be a hindrance in a crisis, as simple systems are easier to fix when they fail. He echoed Dr. Fukuda's call for greater capacity in our health systems in order to deal with the surges in demand created by epidemics. But no single institution has enough capacity to deal with the threats, he noted, and so the looming flu pandemic is driving us to professionalize and collaborate on all levels. He added his enthusiastic endorsement of the new International Health Regulations mentioned earlier.

After a few questions from participants, Chairwoman Siergrist closed the session by noting that during the SARS outbreak, news of it filled the airwaves in Switzerland. Yet there was not one reported case in the country.  Meanwhile, 671 people suffered from measles, a disease with a well-developed vaccine. How can we expect to handle pandemics when we are so lax about those diseases we can control? She urged attendees to work to change public perception of common vaccines and to work against our greatest enemies: ignorance and complacency.

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