Global Goal for Vaccine Quest

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News Article

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Lawrence Gostin, Visiting Professor of Global Health Law at the University of Sydney and the O’Neill Professor of Global Health Law at Georgetown University argues in The Australian that scarce swine flu immunization must go to the needy:

The rapid global transmission of Influenza (A) H1N1 (swine flu) has sparked a worldwide race to develop an effective vaccine. Finding a technological solution to swine flu will be a major scientific advance, but vital questions of scarcity and fairness loom large.

The swine flu vaccine will almost certainly be scarce, with manufacturers unable to meet the huge global demand. Governments face hard choices on how to ethically ration this scarce life-saving resource. Children and their caretakers should certainly be a high priority for swine flu vaccine because they rapidly spread the infection in day care and school. Yet privileging the elderly would be a mistake because they have contracted the new strain at the lowest rate and appear to have some immunity.

Instead, government should assign top priority to the most vulnerable who have died at a disproportionate rate—those who have poor health such as heart disease, asthma, or diabetes. This is also the fairest way to allocate scarce vaccines because people with multiple health conditions also tend to be the most disadvantaged in society.

It is vital that government makes allocation decisions fairly and transparently. The public has a right to know which groups will have priority access and why. One key problem, however, is that the private market is still likely to privilege the rich and politically connected in gaining access. Business culture is geared toward satisfying consumer demand, so the industry will charge what the market will bear for a scarce, valuable vaccine.

Rich countries will face scarcity, but they will have much more ample supplies than poor countries. The pressure on governments to protect their own citizens will be intense during a pandemic. The vaccine industry is likely to supply markets that can afford to pay and in countries where they are located. More than 90% of the world’s capacity to manufacture influenza vaccines is concentrated in Europe and North America. This leaves poor countries in Africa, Asia, and Latin America much more vulnerable as the rich stockpile vaccines.

Europe, and the United States are spending a fortune on vaccines and antiviral medication, but virtually none of these resources will benefit poor countries. Serious questions of global social justice arise when wealth, rather than need, becomes the primary allocation criterion. The mal-distribution of vaccines in the face of a global financial crisis will only widen the already yawning health gaps between the rich and the poor. Rich countries hoarding vaccines is also is a bad public health strategy because it allows the virus to circulate unchecked in highly populated developing countries.

Even if it is not politically expedient, justice requires that scarce vaccines go to the most disadvantaged. Equitable access to a vaccine against swine influenza is not merely a moral imperative. It is also critically necessary to safeguard global health.


The Weekend Australian, August 8-9, 2009, available here.