In early September swine flu was just ramping up in the US and there was no vaccine. CDC envisaged adequate vaccine supplies by end of October but in reality this was too optimistic. For a period of weeks, the news was full of stories of long lines at vaccine clinics and the frustration of worried parents who were anxious about the health of their children in a pandemic where children seemed to be most at risk. The flu struck in North America first, but eventually made its way to over 200 countries on every continent, some of them desperately poor. They didn’t have to worry about too much optimism. They were burdened by too little resources and the rich countries, the US in the lead, were taking up the lion’s share of the world’s productive capacity for flu antigen, but the flu was getting to them later than the US.
Now it has arrived, just as the second wave of this pandemic is easing off in the US. The decline in flu in the US has also brought with it a decline in anxiety and that has prompted a decline in desire for vaccination. The result is that production and demand are out of phase and it is now likely a significant portion of swine flu vaccine originally intended for US citizens will go begging. CDC is saying this is a good time to get vaccinated for people who dodged the flu bullet this fall, but human nature being what it is many people are ignoring this prudent advice. If a third wave starts in January, which is quite plausible and would be a carbon copy of the 1957 pandemic, those with little foresight will again clamor for the vaccine. What I think we should say to them is this. We don’t have it any more. We did the right thing and gave it away to places that wanted it and needed it. Here’s the way we put it in early September:
I am opposed to mandatory vaccination, even though I believe vaccination is an important public health measure that will save millions of lives. But there isn’t enough vaccine for everyone in the world, so if people in the US don’t want it, then any unused stock (keeping a small reserve) should be released by a date certain (say January 15 for the sake of argument) and given to others. I believe this will doom many Americans to severe sickness and some to a fatal illness, but the compensation is that many others, children and adults, in poorer parts of the world will be saved. Their lives are worth no less than American lives. If someone in this country, for whatever reasons, doesn’t wish to receive the vaccine, someone who wants it and needs it will be waiting. (Effect Measure, September 8, 2009)
We aren’t the only ones saying this. To take just one recent example, three public health scholars and practitioners from Johns Hopkins (the School of Public Health and the Berman Institute of Bioethics), Ruth Karron (Center for Immunization Research), Orin Levine (the International Vaccine Access Center) and Ruth Faden (Berman Institute of Bioethics) weighed in two weeks ago in an Op Ed in the San Francisco Chronicle:
In June, the World Health Organization confirmed that a new influenza pandemic was upon us. The United States and other wealthy countries supported a nearly unprecedented effort to develop, test and license H1N1 influenza vaccines, and give their own citizens nearly exclusive access to these vaccines as quickly as possible. Delays in manufacture meant that in October and November, many in these countries had to wait their turn while limited supplies were given to those at greatest risk.
December is already very different.
In the United States, the number of new H1N1 cases is steadily decreasing, while the vaccine supply increases. In the first week of December, we saw an increase of 13 million doses over the previous week, and our supply has roughly doubled over the past month, with more than 76 million doses of vaccine shipped for distribution. Soon, everyone in the United States who wants the vaccine will have it, and there will be more on hand. (San Francisco Chronicle)
Their conclusion? The US should start to give our excess away. The Netherlands, France and Germany have already begun to do this. The US and other wealthy countries had pledged 10% of their vaccine supply to the poorer nations, although they have yet to deliver any of it. Now is the time, as in “immediately,” say Karron, Levine and Fadden. But 10% of our vaccine supply won’t go very far globally. So if our citizens don’t want it, we should give ours away, except for a small emergency reserve and whatever is produced after January 15. And if it turns out a third wave materializes and suddenly people in the US want the vaccine, that’s tough luck. They had their chance and didn’t take it. If we do this, people who aren’t as lucky will get their chance, too.