Tamiflu - will it get to all who need it?

07-05-2009

The World Health Organisation (WHO) has begun distributing 2.4 million treatment courses of Tamiflu. The virus inhibitor will be given to 72 countries in order to combat the threatened Mexican (swine) flu pandemic. However, the chance that the millions of people living in developing countries will ever get the antiviral medication is extremely small.

Professor Ivan Wolffers (pictured) of Amsterdam's Free University Medical Centre (VUMC) says the WHO's efforts are "a stopgap measure". According to Professor Wolffers, who specialises in health care in developing countries, a mountain of problems will arise if the feared influenza pandemic does indeed break out. The professor says that if there is a pandemic, the majority of influenza victims will be in southern Africa:

"Samples will have to be sent abroad for analysis, it is impossible to isolate patients, there are no distribution networks for the necessary drugs and there are no specially trained doctors to explain to patients how to take the medication."

Stockpiles

The authorities in Vietnam and Indonesia are slightly better prepared as they learned a great deal from the 2004 avian influenza outbreak. The World Health Organisation trained doctors and hospitals are prepared for infectious diseases. Despite that, neither country has sufficient supplies of antivirals.

The huge supplies of Tamiflu that Vietnam and Indonesia stockpiled as a precaution against the bird flu epidemic have now passed their expiry 28.

"Do these countries have to spend even more money?" asks Professor Wolffers. The authorities in several countries in the region, such as Bangladesh, are just as ill-prepared as their African colleagues".

Power factor

In recent years, numerous developing countries privatised health care in order to reduce government spending and concentrate on economic growth. Professor Wolffers believes that the successful middle classes in those countries could prove to have significant political clout:

"If the middle classes are afraid and demand government measures, then the government will have to act ".

However, government action will ultimately prove fruitless says Wilbert Bannenberg, director of Medicine Transparency Alliance (MeTA):

"The world has neither the resources nor capacity to provide everyone with antiviral medication or a vaccine. Even though China and India have been licensed to produce antivirals, the demand is still far greater than supply. That also applies to the raw materials needed to produce antivirals and vaccines".

Distribution of a limited amount of Tamiflu will not help says Professor Wolffers, adding, "manufacturing a drug isn't the biggest problem, quality control and distribution are far greater problems".

Scarcity

Tamiflu reduces the severity of the influenza infection but only a vaccine can offer complete protection. Western countries, driven by the scarcity of antiviral medication, will distribute the drugs to their own populations first. MeTA's director says,

"The Dutch government has already reserved production time with the vaccine manufacturer Solvay. Only when that order has been filled, will other countries get their orders filled".

The only way to get a large amount of vaccine on the market is to develop an extremely strong medication, that way a very small dose will be sufficient to protect people.

Western countries can do very little to improve preparedness in developing countries. The WHO emergency protocols are freely available and the most basic measures such as hand washing and staying at home do not cost anything. Non-governmental aid organisations are not doing anything about Mexican flu either; Jules van Os from Oxfam-Novib, the largest aid organisation in the Netherlands, says,

"We concentrate on long-term projects. Our emergency aid division has no plans to tackle Mexican flu".

Whooping cough

It is questionable whether extra help would actually be effective. Mr Bannenberg sums it up:

"Under normal circumstances, some 2 billion people across the globe have no access to antibiotics. Measles and whooping cough kill 14 million children annually and both diseases are preventable".

They are distressing statistics. Western countries appear unable to meet the Millennium Goals, including good affordable health care for all.

"Everybody knows it, but nobody wants to be the one with such a negative message".

Crime

All hope is now centred on reports from US scientists that the virus causing Mexican flu is not as aggressive as earlier feared. The number of infections has not risen exponentially and it hasn't killed very many people.

Professor Wolffers believes that the outbreak won't be as bad as previously feared and a global action programme won't be necessary:

"Spending millions on a pandemic that doesn't happen is also a crime. With that amount of money you could save the 500,000 women who die from complications during pregnancy in developing countries every year".

On Wednesday, the WHO announced that UN Secretary-General Ban Ki-moon will meet with major drug manufacturers on 19 May to ensure that any Mexican flu vaccine will be made available to developing countries.
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