The World Health Organisation plans to start sending H1N1 flu vaccines to poorer countries as early as next month, the United Nations agency’s head of vaccine research said on Monday.  Marie-Paule Kieny said about 100 low- and middle-income nations would receive the vaccines donated by companies such as GlaxoSmithKline and Sanofi , as well as related supplies such as syringes.  “We are trying to have a first delivery starting in November,” she told journalists in Geneva. “The idea is to start with northern hemisphere countries first.”

via Reuters AlertNet – Poorer countries to get donated H1N1 vaccines – WHO.

A majority in the Dutch lower house wants Health Minister Ab Klink to donate A(H1N1) vaccine to the World Health Organisation.

Two of the government coalition parties, Labour and the Christian Union, as well as the opposition Socialist Party and Green Left told Radio Netherlands Worldwide that Mr Klink should act immediately to enable the WHO to supply developing countries with the vaccine.

The Netherlands ordered 34 million doses of flu vaccine when the current pandemic developed, with a view to immunising the entire population. Because of a later decision that only vulnerable groups within the population will be inoculated, a sizeable quantity of the vaccine is surplus to requirements.

via MPs want to give surplus flu vaccine to WHO | Radio Netherlands Worldwide.

Gov. Jon Corzine announced a plan yesterday to immunize all uninsured New Jersey residents against swine flu — and possibly to waive the cost for those with insurance — as health officials get ready for the influenza season. “There has been a tremendous amount of planning and preparation so that we can respond to any kind of circumstance,” Corzine said on the first day of classes at the new Park Street Elementary School in Newark.

via Protecting uninsured against swine flu – NJ.com.

From an excellent piece in the NEJM, by Dr. Nicole Lurie, that nicely links healthcare reform, infection prevention and the public health:

“Early detection of a new infectious disease—and potentially the survival of those who are infected—requires that sick people have access to the health care system and receive early treatment. Delays in seeking care can lead to delays in the recognition and control of an epidemic and in the treatment of patients. Indeed, experts have hypothesized that one reason the mortality associated with the current epidemic of swine-origin influenza A (H1N1) virus (S-OIV) was so high in Mexico is that many people delayed seeking care, in part because of its cost. In the United States, lack of health insurance is a key reason for delays in seeking care; health care reform that results in universal coverage would facilitate earlier detection of new diseases, enable disease-control efforts to be instituted, and alleviate the population’s vulnerability that is attributable to delayed care.”

Read the whole thing here.

via Controversies in Hospital Infection Prevention: Healthcare reform and infection prevention.

With HIV/AIDS, TB, malaria, and a host of other diseases competing for attention, influenza has never been high on most African countries’ priority lists, and getting a handle on the spread of influenza viruses in Africa has long been problematic because laboratories and surveillance have been lacking. But a 2002 outbreak in Madagascar and a similar one in the Democratic Republic of the Congo in 2003 suggest that, with its myriad of problems, Africa—especially south of the Sahara—might be harder hit by the 2009 H1N1 pandemic virus than any other continent. The virus has so far been detected in 16 African countries, and experts fear that the high HIV infection rates in many African countries could worsen the pandemic’s impact.

via Worries About Africa as Pandemic Marches On — Enserink 325 (5941): 662 — Science.

July 31 (Bloomberg) — A U.S. plan to rely on swine flu vaccines without ingredients to boost effectiveness would reduce the global supply just when other countries need it most, according to an editorial by the British journal Lancet.

The ingredients, called adjuvants, have never been approved for flu vaccines in the U.S. and are controversial because some studies show they cause immune disorders in mice. The World Health Organization recommended on July 7 that adjuvants be used to pump up the global vaccine supply, and the Lancet criticized the U.S. for plans to rely exclusively on standard formulations.

The U.S. Health and Human Services Department declared a public health emergency over swine flu in April, and the Food and Drug Administration has the power to allow the use of unapproved medical products including adjuvants. The health department agreed to purchase more than $415 million of the vaccine additives, while saying it may not use them if enough shots are available for U.S. residents.

“The USA must support the use of dose-sparing strategies to avoid depletion of an already short vaccine supply,” said the authors of the Lancet’s editorial. “All countries will require the vaccine, but current manufacturing capacity will not be able to meet this demand.”

via Pandemic Information News: Flu Vaccine Plan in U.S. May Shortchange Nations, Lancet Says.

Developing countries face unique difficulties in preparing for an influenza pandemic. Our current top-down approach will not provide these countries with adequate supplies of vaccines and antiviral agents. Consequently, they will have to use a bottom-up approach based on inexpensive generic agents that either modify the host response to influenza virus or act as antiviral agents. Several of these agents have shown promise and many are currently produced in developing countries. Investigators must primarily identify agents for managing infection in populations, and not simply seek explanations for how they work. They must determine in which countries these agents are produced and define patterns of distribution and costs. Because prepandemic research cannot establish whether these agents will be effective in a pandemic, randomized controlled trials must begin immediately after a new pandemic virus has emerged. Without this research, industrialized and developing countries could face an unprecedented health crisis.

via A TIME’S MEMORY: Abstract. Meeting the Challenge of Influenza Pandemic Preparedness in Developing Countries (EID, edited).

Some may wonder where the figure of 300 million dead that some are quoting might come from. The story below suggest one factor.

THE United Nations has raised the prospect that the swine flu pandemic could hit countries undermined by poverty, conflicts or famine and trigger a “major” new crisis in those areas. “This is something we are concerned about and planning for,” UN humanitarian chief John Holmes said. The bulk of the planning focuses on either relief staff being affected by flu or the prospect of a pandemic infecting people already in need of aid. Mr Holmes noted that many were “crowded into camp situations and therefore particularly vulnerable” to the fast spreading virus. But Mr Holmes, the UN under secretary general for humanitarian affairs, also raised more serious concerns about disruption to health care, education, as well as food and water distribution in such strife-torn settings.

“There’s a wider concern that if a pandemic, for example the current H1N1 pandemic, spreads into a very poor and vulnerable country, and has a much more dramatic effect there than on the countries where it has been present so far, then we would have a major new humanitarian crisis on our hands,” he explained.

via Pandemic Information News: Swine flu could hit famine countries – UN.

Some of the blame for the growth of novel H1N1 could be laid at the door of the agricultural policies of the rich countries of the West, The disease then released kills the poor but the rich protect their own……..

Imminent decisions on a strategy for H1N1 pandemic flu vaccination in the United States could leave other countries short of vital doses if it elects not to follow World Health Organization (WHO) advice on vaccine formulation.

The United States is the biggest buyer among a group of rich countries whose combined orders for vaccine against the H1N1 2009 virus could potentially tie up most of the world’s pandemic vaccine production capacity for 6 months or longer, so depriving other countries of vaccine.

To counter this prospect, the WHO recommended on 13 July that countries use shots that contain adjuvants, chemicals that boost the immune system’s response to a vaccine. This allows smaller amounts of antigen — the molecule that stimulates the immune response — to be used in each dose, boosting the overall amount of vaccine available from existing production capacity and allowing orders to be filled more quickly.

The United States’ global responsibility to consider dose-sparing strategies is briefly alluded to in the minutes of a mid-June US National Bio­defense Science Board meeting, released on 17 July: “Federal decision-making will affect not only the 300 million Americans who depend on the government to support the public health system but also people all around the world.”

The United States has certainly kept open the option of using adjuvants. It has already allocated almost US$2 billion for antigen and adjuvant to provide every American with up to two doses of vaccine. That sum includes orders of $483 million for Novartis’s MF59 adjuvant, and $215 million for GlaxoSmithKline’s AS03 adjuvant.

But although Canada and many European countries are set to use adjuvanted pandemic flu vaccines, the United States may do so only as a last resort. “All things being equal, an unadjuvanted vaccine is often just fine in terms of giving protection against influenza virus,”

via Regulators face tough flu-jab choices : Nature News.

Pharmaceutical maker Roche Holding AG said Wednesday a new initiative will ensure that poor countries get its antiviral drug against swine flu at a lower price. Under the Tamiflu Reserves Program, Roche will produce and ship the drug to developing countries upon order at a “significantly reduced price,” it said. A treatment of Tamiflu for a single ill person will cost between C2 euros and 6 euros (US$2.80 and $8.50), depending on the dosage, Roche said in a statement. The price excludes local taxes or tariffs, it added.

Tamiflu sells for as much as $100 per five-day treatment course in countries such as the U.S., but since 2005 the company has offered a discounted price of $16 per treatment to poor nations. Roche has also given approval for two companies – one in China and one in India – to produce Tamiflu generically.

via The Canadian Press: Roche gives poor countries easier access to swine flu drug Tamiflu.