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Feature Pandemic Flu

The problem with flu vaccines

BMJ 2009; 338 doi: (Published 21 May 2009) Cite this as: BMJ 2009;338:b2065
  1. Andrew Jack, pharmaceuticals correspondent
  1. 1Financial Times, London
  1. Andrew.Jack{at}

    With the number of cases of swine flu continuing to rise, Andrew Jack assesses our capability to produce enough vaccine to cope with a pandemic

    As the H1N1 swine flu virus spreads swiftly from Mexico around the world, public health specialists and flu vaccine manufacturers are scrambling to catch up. This week, they are meeting in Geneva, on the margins of the World Health Assembly, to discuss how best to respond.

    They face scientific uncertainties and technical problems alike. The first decision is whether to switch to production to a new vaccine tailored to provide protection against the virus. A second question is how to maximise production if they do. A third is how to distribute and make affordable the still scarce stocks likely to result.

    At best, the different commercial manufacturers can produce a total of about 480 million doses of trivalent seasonal flu vaccine this year. That figure—a small fraction of the world’s population—reflects a history of modest demand that has kept manufacturing relatively small.

    In Europe, vaccination rates remain modest, with wide variations between countries. Where programmes take place, they are concentrated among children, elderly people, and other risk groups with weak immune systems. In the developing world, where most of the estimated annual 500 000 seasonal flu deaths occur, coverage is still more scant.

    The scarcity of vaccine even in normal times was highlighted in 2004, when quality problems halted production in Chiron’s Speke factory near Liverpool. The resulting shortage in meeting US orders for seasonal flu vaccine left Americans struggling to find alternative supplies.

    Since then, a growing realisation of the burden of seasonal flu and fresh concern over a future pandemic have helped stimulate expanding demand. The rise of more lucrative patented vaccines—led by Wyeth’s Prevnar for pneumococcal disease, the first vaccine to generate more …

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