David Fedson

Sergy Haut, France

This section highlights opportunities and obstacles presented by two key issues in pandemic preparedness: the development and registration of a “pandemic-like” vaccine, and the use of reverse genetics to prepare seed strains for vaccine development. These issues are introduced with an overview of global vaccine production and distribution and followed by an exploration of the idea that prophylaxis and/or treatment with certain commonly available therapeutic agents such as statins could possibly have beneficial effects on the clinical course of human influenza. If these effects could be confirmed, they could potentially mitigate the morbidity and mortality of pandemic influenza when there are limited supplies of vaccines and antiviral drugs.

According to a recent report by the Influenza Vaccine Supply (IVS) Task Force, 230 million doses of influenza vaccine were distributed worldwide in 2000, of which 162 million (70 percent) were distributed in Canada, the United States, Western Europe, Australasia, and Japan (Table 3-1). In 2003, vaccine distribution increased to 292 million doses, of which 207 million (71 percent) were distributed in the same countries. During this 4-year period, vaccine distribution increased 20 percent in Canada and the United States, 18 percent in Western Europe, 25 percent in Australasia, and 134 percent in Japan. For the rest of the world, vaccine distribution increased from 69 million doses to 85 million doses, a 23 percent increase. For these other countries, the use of influenza vaccine was largely limited to four countries in South America (Argentina, Brazil, Chile, and Uruguay), several countries in Central Europe (especially Hungary and Poland), Russia, and South Korea. When individual countries were compared according to per capita vaccine distribution levels in 2003, the leading countries (doses distributed/1,000 total population) were Canada (344), South Korea (311), the United States (286), and Japan (230) (Macroepidemiology of Influenza Vaccination Study Group, unpublished observations).

Nearly all of the world’s influenza vaccine is produced in nine countries: Australia, Canada, France, Germany, Italy, Japan, Netherlands, United Kingdom, and United States. In 2003, these countries had only 12 percent of the world’s population, yet they produced 95 percent of the world’s influenza vaccine. Almost none of the doses produced in Canada, Japan,

Front Matter (R1-R18)

Summary and Assessment (1-56)

1 The Story of Influenza (57-114)

2 Today (115-140)

3 Toward Preparedness: Opportunities and Obstacles (141-221)

4 Strategies for Controlling Avian Influenza Birds and Mammals (222-253)

5 Emerging Technical Tools (254-314)

6 Beyond Biomedical Response (315-372)

Appendix A: Pandemic Influenza: Assessing Capabilities for Prevention and Response (373-380)

Appendix B: Selected Bibliography (381-387)

Appendix C: The Critical Path to New Medical Products (388-389)

Appendix D: Forum Members, Speakers, and Staff Biographies (390-412)