As billions of dollars are mustered for vaccines, Tamiflu and face masks to combat swine flu, a bitter debate about equity is starting to swirl.
Some critics say the spending is so imbalanced that it amounts to health apartheid, protecting rich countries against A(H1N1), but leaving poor nations to fend for themselves.
Others argue gargantuan sums are being spent on a disease that is no more lethal than seasonal flu, which is grotesquely disproportionate when thousands die each day of less media-friendly diseases.
“It’s another example of the gap between the north and south,” said Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “In the [wealthy countries of the] north, vaccines are being stockpiled, antiviral drugs are being stockpiled, all with the risk that these things will not be effective. In the [poor countries of the] south, there are neither diagnostics nor treatment.”
Vaccines and antiviral drugs are being allocated for poor countries under strategies espoused by the UN, through gifts by countries at the bilateral level and as donations by pharmaceutical giants.
UN Secretary-General Ban Ki-moon and WHO chief Margaret Chan (陳馮富珍) say there is a shortfall.
They are pounding the drum for US$1 billion to help poor countries shore up their defenses.
“Manufacturing capacity for influenza vaccines is finite and woefully inadequate for a world of 6.8 billion people, nearly all of whom are susceptible to infection by this entirely new and highly contagious virus,” Chan said on July 14. “The lion’s share of these limited supplies will go to wealthy countries. Again, we see the advantage of affluence. Again, we see access denied by an inability to pay.”
Another question is whether huge spending on swine flu is morally right.
Each day, around 11,500 people are killed from the long-running, entrenched pandemics of AIDS, malaria and tuberculosis. Swine flu has killed 816 people since the disease was notified in April, a WHO toll issued last Monday.
Marc Gentilini, a professor of infectious disease and former head of the French Red Cross, scathingly calls swine flu “a pandemic of indecency,” in which rich-world politicians opened the financial spigots to forestall accusations of not doing enough.
He gave the example of France, which is spending a 1 billion euros (US$1.4 billion) to buy enough vaccines to inoculate its population of 60 million.
The vaccine is currently being tested for safety and effectiveness. It should be ready in the next two to four months, although the precise date is unclear.
Just as uncertain is whether the vaccine, formulated against the current strain of A(H1N1), will provide a shield if the virus mutates into a more lethal form.
“A billion euros for a vaccine with so many unknowns, it’s pure haste,” Gentilini said. “This is money that can be better used elsewhere. It’s ethically unacceptable.”
Defenders of the big-spending strategies say three influenza pandemics in the 20th century, especially the “Spanish flu” of 1918-1919 that slew tens of millions of people, point to the need for preparedness.
A day after the WHO had declared the new flu to be a pandemic, New York microbiologists Taia Wang and Peter Palese wrote to the US journal Cell to urge a sense of proportion.
There was little sign that the circulating virus would cause a pandemic on the scale of the past, while vaccines, antivirals and antibiotics are all weapons today that doctors did not have in 1918, they said.
“Around 80,000 children die from malaria and more than twice that number of diarrhoeal diseases worldwide in any four-week period,” they said. “On a scale of global health crises, the current H1N1 swine influenza outbreak would seem to rank low on the list. Why, then, has this outbreak caused such alarm?”
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