An expert advisory group, convened by the European Centre for Disease Prevention and Control (ECDC), has concluded that it would be inadvisable to embark on a widespread pre-pandemic H5N1 vaccination programme in European countries at the present time. Pre-pandemic vaccines, currently being developed by several pharmaceutical companies, can be made ahead of the emergence of pandemic inﬂuenza virus, unlike “true” pandemic vaccines. However, experts have concluded that there remains too much uncertainty as to whether the H5N1 avian inﬂuenza virus, on which pre-pandemic vaccines currently under development are based, will ever be responsible for a pandemic. According to Johan Giesecke (ECDC, Stockholm, Sweden), “If there is an H5N1-based pandemic, the strategy of having stockpiled pre-pandemic H5N1 vaccines, even if the vaccines incompletely match the pandemic virus, may prevent more infections and deaths than waiting for speciﬁc “true” pandemic vaccines…however, there is no guarantee that the next human
inﬂuenza pandemic will evolve from the current H5N1 avian inﬂuenza virus”. Several countries have placed orders for small batches of H5N1 vaccines with a view to using them for health-care workers. Switzerland and Finland have, say the ECDC, placed substantial orders with a view to enabling widespread vaccination of their populations. But, said Giesecke, “there seems to be little reason for any European country to start immunising large population groups at present”. He added: “this assessment may well not apply to a country where the H5N1 virus is presently circulating”. The ﬁndings from the expert advisory group concluded that there may be particular beneﬁts in early vaccination of—for example—poultry workers and health-care staﬀ; the trigger points for vaccination should be deﬁned as far in advance as possible. However, diﬀerent views were expressed by experts as to whether pre-pandemic vaccines would be best used in WHO phase 5 or phase 6 of a pandemic. Giesecke told TLID: “Costs will vary from country to country…some UK and US estimates point to a cost of a
future pandemic to be in the order of 0·5–1% of the gross domestic product for a country, so the economic beneﬁt from a major investment could be considerable if—and this is a big if—the pandemic strain matches the vaccine”. The ECDC calls for further research, in particular for better systems to gather and share epidemiological information. “The obvious reservation is that we just don’t know how eﬀective a pre-pandemic vaccine will be against a pandemic virus, although the data from animal challenge studies are so far very encouraging”, commented Jonathan Van Tam (Health Protection Agency, London, UK). Additionally, he told TLID that countries’ responses to a future pandemic still showed considerable variations: “In general terms the international community has truly woken up to the threat of an inﬂuenza pandemic. But the general state of preparedness in countries across the globe ranges from very high (eg, France) to almost nothing in very resource-poor settings”.
Uncertainties remain over pre-pandemic ﬂu vaccine beneﬁts
For more information on Pandemic inﬂuenza: scientiﬁc and technical guidance see http://ecdc.europa.eu/Health_ topics/Pandemic_Inﬂuenza/ Guidance.html
Increase funding to ensure universal access, warns UNAIDS According to UNAIDS, at current global funding levels, only two-thirds of HIV-positive people requiring antiretroviral drugs will receive them by 2010. A recent UNAIDS report (Sept 26), which has estimated the ﬁnancial resources required for the AIDS response, calls for donors to quadruple their spending on HIV/AIDS, an increase in spending of US$42 billion by 2010, in order to meet the goal of universal access to treatment. “If the scale-up of HIV services continues at the same pace as in the recent past, the necessary funding is projected to reach $15·4 billion in 2010 and $22·5 billion in 2015”, said a UNAIDS spokesperson. Although ﬁnancing for AIDS has risen http://infection.thelancet.com Vol 7 November 2007
exponentially from less than $300 million in 1996 to $10 billion in 2007, “…even with such increases, the world will not reach universal access by either 2010 or 2015. If current trends continue, only 4·6 million people would receive antiretrovirals in 2010; two-thirds of the number of people who needed antiretrovirals in 2006”, she added. The international community has committed to scaling-up universal access to HIV treatment; by June this year 93 countries had set ambitious national targets and 60 had developed and costed strategic plans. The estimates provided in the report, developed for 132 low and middleincome countries, were based on
national target data, and included costs associated with HIV prevention (including responses to gender inequality and violence against women, male circumcision services, and costs associated with health systems strengthening), treatment, and care. “The $10 billion available in 2007 represents a serious shortfall in funding and will hamper many countries’ eﬀorts in achieving their universal access goals”, said UNAIDS. They highlight that the lack of investment 10–20 years ago in the AIDS response, particularly in strengthening health systems, has resulted in the higher levels of funding now required.
For more information on the UNAIDS report Financial resources required to achieve universal access to HIV prevention, treatment, care and support see http://www.unaids. org/en/MediaCentre/ PressMaterials/ FeatureStory/20070925_ Resources_needs.asp
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