IMPORTANT

Important decisions before production

There is also concern that should a second, deadlier wave of a new H1N1 strain reappear during the Northern autumn of 2009, producing pandemic vaccines now as a precaution may turn out to be a huge waste of resources with serious results, as the vaccine may not be as effective, and there would also be a shortage of seasonal flu vaccine available. Seasonal flu vaccine is being made now, according to WebMD News. But the news site adds that although vaccine makers will be ready to switch to making a swine flu vaccine, many questions remain unanswered, including the following: "Should we really make a swine flu vaccine? Should we base a vaccine on the current virus, since flu viruses change rapidly? Vaccine against the current virus might be far less effective against a changed virus - should we wait to see if the virus changes? If vaccine production doesn't start soon, swine flu vaccine won't be ready when it's needed."

The costs of producing a vaccine have also become an issue, with some U.S. lawmakers questioning whether a vaccine is worth the unknown benefits. Representatives Phil Gingrey and Paul Broun, for instance, are not convinced that the U.S. should spend up to $2 billion to produce one, with Gingrey stating "We can’t let all of our spending and our reaction be media-driven in responding to a panic so that we don’t get Katrina-ed. ... It’s important because what we are talking about as we discuss the appropriateness of spending $2 billion to produce a vaccine that may never be used — that is a very important decision that our country has to make."

Moreover, should a pandemic be declared and a vaccine produced, the WHO will attempt to make sure that a substantial amount is available for the benefit of developing countries. Vaccine makers and countries with standing orders, such as the U.S. and a number of European countries, will be asked, according to WHO officials, "to share with developing countries from the moment the first batches are ready if an H1N1 vaccine is made." The global body stated that it wants companies to donate at least 10 percent of their production or offer reduced prices for poor countries that could otherwise be left without vaccines if there is a sudden surge in demand.

Production timelines

After a meeting with the WHO on May 14, 2009, pharmaceutical companies said they were ready to begin making a swine flu vaccine. According to news reports, the WHO's experts will present recommendations to WHO Director-General Margaret Chan, who is expected to issue advice to vaccine manufacturers and the World Health Assembly next week. WHO's Keiji Fukuda told reporters "These are enormously complicated questions, and they are not something that anyone can make in a single meeting." Most flu vaccine companies can only make one vaccine at a time: seasonal flu vaccine or pandemic vaccine. Production takes months and it is impossible to switch halfway through if health officials make a mistake. . . . if the swine flu mutates, scientists aren't sure how effective a vaccine made now from the current strain will remain." Rather than wait on the WHO decision, however, some countries in Europe have decided to go ahead with early vaccine orders.

A May 20th AP article reported: “Manufacturers won't be able to start making the vaccine until mid-July at the earliest, weeks later than previous predictions, according to an expert panel convened by WHO. It will then take months to produce the vaccine in large quantities. The swine flu virus is not growing very fast in laboratories, making it difficult for scientists to get the key ingredient they need for a vaccine, the "seed stock" from the virus, WHO said. . . . In any case, mass producing a pandemic vaccine would be a gamble, as it would take away manufacturing capacity for the seasonal flu vaccine that kills up to 500,000 people each year. Some experts have wondered whether the world really needs a vaccine for an illness that so far appears mild.”

Another option proposed by the CDC is an "earlier rollout of seasonal vaccine," according to the CDCs Dr. Daniel Jernigan. He said the CDC would work with vaccine manufacturers and experts to see if that would be possible and desirable. Flu vaccination usually starts in September in the United States and peaks in November. Some vaccine experts agree it would be better to launch a second round of vaccinations against the new H1N1 strain instead of trying to add it to the seasonal flu vaccine or replacing one of its three components with the new H1N1 virus.

As of early May, only a few more weeks were needed for the WHO and CDC to develop a "seed strain" of the pandemic virus, but producers would then need four to six months before they could create large volumes of vaccin

Containment

On April 28, WHO's Dr. Keiji Fukuda pointed out that it is too late to contain the swine flu. "Containment is not a feasible operation. Countries should now focus on mitigating the effect of the virus," he said. He therefore did not recommend closing borders or restricting travel, stating that "with the virus being widespread... closing borders or restricting travel really has very little effects in stopping the movement of this virus." However, on April 28, the U.S. CDC began "recommending that people avoid non-essential travel to Mexico." Many other countries confirmed that inbound international passengers will be screened. Typical airport health screening involves asking passengers which countries they have visited and checking whether they feel or appear particularly unwell. Thermographic equipment was put into use at a number of airports to screen passengers. A number of countries also advised against travel to known affected regions while experts have suggested that if those infected stay at home or seek medical care, public meeting places are closed, and anti-flu medications are made widely available, then in simulations the sickness is reduced by nearly two-thirds.