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Global solidarity needed in preparing for pandemic influenza
Editorial
The death of the US academic medical centre?
Empics
The printed journal includes an image merely for illustration
Academic medical centres are the jewels in the crown of American medicine. As centres for education, training, and research, academic medical institutions have been engines driving improved patient outcomes and new knowledge. But they now face a threatened future. Last week, budget proposals from President Bush concealed a hidden bomb: hundreds of millions of dollars are being taken away from teaching hospitals. One distinguished epicentre of American medicine, New York, will be hit especially hard. A New York Senator, Charles Schumer, called the Bush plan “an all-out assault on graduate medical education”, according to the New York Times. These forces are echoing around the USA. Many academic centres are seeing declining revenues from their major source of income—patients. Smaller, private hospitals are springing up to capture money from highreimbursement specialties, such as cardiology. The foundation stone of academic hospitals is being severely eroded. Worse still, research is now coming to be seen as an expensive luxury. The days when science was supported as a goal in itself are long gone. A research
ethos is being replaced by a much sharper attitude to financial stringency. Academic centres are fighting back. To attract patients, they are realising that an exclusive focus on clinical outcomes will not be enough to ensure their survival. They are now concentrating on the patient’s experience, or as one chief executive of a leading US institution recently put it: they are now in the business of selling empathy. Academic leaders are also brushing up their business skills to identify new revenue streams. Biotechnology and the creation of spin-off enterprises remain a popular approach. An alternative income stream may come from globalising the brand of academic centres—offering lucrative consultancy services at the same time—to emerging economies, such as those in the Middle East. What is clear is that biomedicine’s most prestigious institutions are not guaranteed to thrive. A dangerous fault line is being created across one of the most successful sectors of American medicine. It is a surprise to us that so few academic leaders are not signalling their concerns more publicly. ■ The Lancet
Global solidarity needed in preparing for pandemic influenza
Science Photo Library
The printed journal includes an image merely for illustration
532
Vaccines will be one of the most important medical interventions for reducing morbidity and mortality in an influenza pandemic. The development of H5N1 vaccines to protect people in a pandemic is underway in several countries. But two disturbing problems about vaccine availability and accessibility exist. To protect the global population, 6·2 billion doses of pandemic vaccine will be needed, but under current manufacturing capacity the world can only produce 500 million doses. And, in a pandemic, it is industrialised countries that will have access to available vaccines, whereas developing countries—where a pandemic is likely to emerge—will be left wanting. In November, 2004, a WHO consultation reached the depressing conclusion that most developing countries would have no access to vaccine during the first wave of a pandemic and possibly throughout its duration. In this context, Indonesia’s move last week to try and secure an affordable vaccine supply for its population
is understandable. Since the beginning of this year, the country has made a controversial decision not to share its H5N1 virus samples with WHO. Indonesia is instead planning to provide a US pharmaceutical company with the strains in exchange for technology to manufacture a pandemic vaccine. This strategy is a marked departure from the existing WHO virus-sharing system, in which influenza viruses are donated by countries and flow freely to the global community for vaccine development. Indonesia fears that vaccines produced from their viruses via the WHO system will not be affordable to them. Their concerns are forcing the world to address this inequity problem. The fairest way forward would be for WHO to seek an international agreement that would ensure that developing countries have equal access to a pandemic vaccine, at an affordable price. Such a move would demonstrate global solidarity in preparing for the next pandemic. ■ The Lancet www.thelancet.com Vol 369 February 17, 2007
The death of the US academic medical centre?
Empics
The printed journal includes an image merely for illustration
Academic medical centres are the jewels in the crown of American medicine. As centres for education, training, and research, academic medical institutions have been engines driving improved patient outcomes and new knowledge. But they now face a threatened future. Last week, budget proposals from President Bush concealed a hidden bomb: hundreds of millions of dollars are being taken away from teaching hospitals. One distinguished epicentre of American medicine, New York, will be hit especially hard. A New York Senator, Charles Schumer, called the Bush plan “an all-out assault on graduate medical education”, according to the New York Times. These forces are echoing around the USA. Many academic centres are seeing declining revenues from their major source of income—patients. Smaller, private hospitals are springing up to capture money from highreimbursement specialties, such as cardiology. The foundation stone of academic hospitals is being severely eroded. Worse still, research is now coming to be seen as an expensive luxury. The days when science was supported as a goal in itself are long gone. A research
ethos is being replaced by a much sharper attitude to financial stringency. Academic centres are fighting back. To attract patients, they are realising that an exclusive focus on clinical outcomes will not be enough to ensure their survival. They are now concentrating on the patient’s experience, or as one chief executive of a leading US institution recently put it: they are now in the business of selling empathy. Academic leaders are also brushing up their business skills to identify new revenue streams. Biotechnology and the creation of spin-off enterprises remain a popular approach. An alternative income stream may come from globalising the brand of academic centres—offering lucrative consultancy services at the same time—to emerging economies, such as those in the Middle East. What is clear is that biomedicine’s most prestigious institutions are not guaranteed to thrive. A dangerous fault line is being created across one of the most successful sectors of American medicine. It is a surprise to us that so few academic leaders are not signalling their concerns more publicly. ■ The Lancet
Global solidarity needed in preparing for pandemic influenza
Science Photo Library
The printed journal includes an image merely for illustration
532
Vaccines will be one of the most important medical interventions for reducing morbidity and mortality in an influenza pandemic. The development of H5N1 vaccines to protect people in a pandemic is underway in several countries. But two disturbing problems about vaccine availability and accessibility exist. To protect the global population, 6·2 billion doses of pandemic vaccine will be needed, but under current manufacturing capacity the world can only produce 500 million doses. And, in a pandemic, it is industrialised countries that will have access to available vaccines, whereas developing countries—where a pandemic is likely to emerge—will be left wanting. In November, 2004, a WHO consultation reached the depressing conclusion that most developing countries would have no access to vaccine during the first wave of a pandemic and possibly throughout its duration. In this context, Indonesia’s move last week to try and secure an affordable vaccine supply for its population
is understandable. Since the beginning of this year, the country has made a controversial decision not to share its H5N1 virus samples with WHO. Indonesia is instead planning to provide a US pharmaceutical company with the strains in exchange for technology to manufacture a pandemic vaccine. This strategy is a marked departure from the existing WHO virus-sharing system, in which influenza viruses are donated by countries and flow freely to the global community for vaccine development. Indonesia fears that vaccines produced from their viruses via the WHO system will not be affordable to them. Their concerns are forcing the world to address this inequity problem. The fairest way forward would be for WHO to seek an international agreement that would ensure that developing countries have equal access to a pandemic vaccine, at an affordable price. Such a move would demonstrate global solidarity in preparing for the next pandemic. ■ The Lancet www.thelancet.com Vol 369 February 17, 2007