By Marty Logan
MONTREAL, Jan 8 2004 (IPS)

To the list of killer diseases that threaten millions of people in the developing world, add one more – influenza, commonly known as the flu.

The disease, whose early, lightning attack on northern nations is making headlines this winter, is not unknown in the South. In 2002-03 the flu killed more than 2,000 people in the Democratic Republic of the Congo, for example.

But the emerging threat of a worldwide flu epidemic or pandemic has spotlighted the lack of resources and preparations in developing nations to fight the disease – in part because such resources are dominated by the North, say experts.

"Our concern is that during an influenza pandemic, first, influenza vaccines will not reach developing countries until developed countries would have set aside their demand because (vaccine-producing) companies are there," says Klaus Stohr, head of the World Health Organisation’s Global Influenza Programme, in Geneva.

"Secondly, developing countries have not yet started with the other items that belong to pandemic preparedness", which includes deciding whom to vaccinate first, how governments will allocate hospital and other medical resources, and developing treatment guidelines, he adds.

While the Fujian strain of the flu is getting most attention in this northern winter – primarily because researchers were unable to develop a vaccine designed to combat it specifically – it is the emergence of two avian (bird) flu strains that have experts worried.

"The only thing that has stood between us and what could happen – a catastrophe – is the fact that the virus has not learned to transmit human to human," said Dr. Robert Webster of the U.S.-based St. Jude Children’s Research Hospital, in a teleconference with journalists Nov. 26.

"In 2003, the bird flu killed humans, but didn’t transmit human to human. That’s the only remaining step to be achieved," added Webster, who co-authored an article on a possible flu pandemic in November’s ‘Science’ magazine.

Usually, flu viruses are transmitted through the atmosphere, especially through coughing and sneezing. Any person can be infected by simply being near or next to a flu-ridden person.

The last pandemic, the 1968-1969 Hong Kong Flu, killed an estimated 700,000 people worldwide, according to the Pan American Health Organisation (PAHO). The next one could produce 650,000 deaths in less than two years – in the industrialised countries alone, the organisation predicted in September.

Developing nations are increasingly vaccinating their populations against the flu.

Countries outside of North America, Europe, Australia and New Zealand accounted for 35 percent of the almost 233 million doses of influenza vaccine used in 2000, according to a paper by Dr. David S. Fedson published in the website version of the journal ‘Clinical Infectious Diseases’ in June 2003.

The main users included Russia, Japan, South Korea, Brazil, Argentina, Chile and Uruguay. Almost overwhelmingly, they purchased the vaccine from companies in northern nations, which in 2000 produced 85 percent of the global vaccine supply.

Those production figures have really not changed, said Stohr in an interview. "China produces currently around four million vaccine doses. There are more companies that have applied for licences . but it’s a drop in the bucket."

But when a pandemic hits, that "bucket" might be the only supply immediately available in the South, as all experts agree that developed countries will hoard – "nationalise" – flu vaccine until they have treated their own citizens.

With just over 250 million doses now being produced worldwide, vaccinating the populations of industrialised nations could take a long time.

Developing countries "are going to be plenty pissed off if they’re faced with a pandemic and can’t get any supply of vaccine, or can’t get them rapidly enough", said Fedson in an interview.

"A mechanism needs to be developed so that the inequities that will arise with the nationalisation of vaccine supply can be in some way overcome," added the France-based researcher, who formerly worked at Aventis Pasteur MSD, a western European vaccine company.

That supply issue aside, many experts – Fedson included – are also now pushing for regulatory authorities to accept a new technique, called reverse genetics, to produce vaccine strains. Currently they are developed in hens’ eggs, a process that can take months.

Acceptance of reverse genetics faces two main hurdles – what it produces is considered a genetically modified organism (GMO), which the European Union (EU) does not permit; and the patent for the technique is held by one company: U.S.-based MedImmune.

Stohr says the company is willing to discuss how it will be compensated if reverse genetics is accepted for producing the virus strain in normal years – and to take a huge cut in compensation in the event of a pandemic – while EU officials are also open to talks on dealing with the GMO that reverse genetics would produce.

All sides will meet at the WHO in February, when plans are made for next season’s flu vaccine.

According to Fedson, "the issues of public perception – getting advocacy groups onboard, getting the regulatory officials to feel comfortable – all of these things need to be done before the pandemic ever appears".

"And that means that we have to introduce reverse genetics into the process of preparing seed strains for routine vaccine production every year."

Regardless of the technology to be used, developing countries face more basic issues before they can produce adequate vaccine. Few companies in the South now make flu vaccine; they could switch production but that would take about a year, says Stohr.

"In a pandemic situation, the judgement would also have to be made by these countries on whether or not it’s preferential to spend their funds for influenza vaccine or perhaps for malaria, or tuberculosis or HIV."

"These decisions can be clearly made in favour of the other diseases, which are much more burning for the time being. But what (developing nations) have to do is use the models that we have prepared and then come up with a prioritised decision on where they’re going to allocate the resources now and in the future," he added.

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