An editorial in The Lancet: Pandemic influenza—(some) reasons to be cheerful? Excerpt:
WHO and the UN Secretary General worked tirelessly to ensure vaccine delivery to low-income and middle-income countries, but from the outset were dogged by a lack of vaccine-producing capacity, recalcitrant politicians, and inadequate plans. Even if vaccines reached developing countries, a lack of infrastructure hampered deployment.
There was a stark contrast between countries rich enough to stockpile vaccines, and others (eg, Laos and Cambodia) who for many months had none.
Ironically, people in high-income countries used their vaccine stockpiles reluctantly. Around 80% of people in the UK chose not to be vaccinated, many because they doubted they were at serious risk. They were correct, but we know this only after the fact.
Despite the fairly mild course in most infected individuals, more than 18 449 people died and hundreds of thousands were severely affected around the world. It is a testament to global health-care systems that many were successfully treated.
However, the pandemic largely caught the research community unawares. Although anecdotes and observational data have been gathered, few patients were entered into randomised trials, and thus solid data to inform treatment decisions for future pandemics are lacking.
Where they existed, countrywide plans for handling a pandemic were predicated on an outbreak of severe H5N1 influenza, but were too draconian for the milder H1N1 strain, while many countries carried on with business as usual.
Questions are rightly being asked about the influence of the drug industry on WHO’s decision-making process, but to focus on this alone would be foolish. Now is not the time to apportion blame, but to ask: how can we do better next time?
First, we need to be better prepared. There needs to be global investment in responsive vaccine production systems, which allow production to track demand. Plans are also required to ensure equitable distribution of vaccines and antiviral drugs. Developed countries should not be able to stockpile unused vaccines, while people in the developing world go without.
Planning for equitable worldwide vaccination will require the development of a political framework to ensure adequate funding, procurement agreements, and worldwide distribution strategies well before the next outbreak.
Such plans will help to ensure that poorer countries have enough incentives to share information about emerging virus strains, and do not feel that they are giving their wealthier counterparts information, for no benefit.
Preparedness plans also need to have the flexibility to be able to cope with a range of pandemic severity.
