Several emerging industrial nations, including India, Brazil, Mexico and South Africa, are working on producing their own vaccine against pandemic influenza A (H1N1), known in the Netherlands as Mexican flu. They want to be independent of vaccine donations and the World Health Organisation (WHO). However, the project appears to be a bit too ambitious.

A warning issued by the WHO earlier this year is now a fact: poor countries are at the back of the queue waiting for vaccines against pandemic influenza. The huge global demand for the A(H1N1) vaccine means that only those countries whose governments placed orders immediately after the virus became a pandemic have been able to obtain the vaccine. However, the demand is so great that even countries that have managed to secure the vaccine do not have enough to inoculate their entire populations.

Priorities
A number of developing countries have decided to take control of the situation and their own flu vaccine, just like their own AIDS vaccine, will make them independent of the West. "It's a sound initiative," says health expert Remco Van de Pas of the aid organisation Wemos. He continues:

"The question remains for each country whether the flu is a public health priority or not. Is this the priority they need to focus on and invest money and knowledge in or are there other problems in the country that need attention as well?"

In countries where more people die from AIDS, malaria and tuberculosis than the flu, development of an A(H1N1) vaccine could be considered wasteful. It's money that could be better spent on treating curable diseases. The vast majority of the population is poor and there is a general lack of proper nutrition and health care. Solving basic problems will contribute to improving resistance to influenza and similar diseases.

Safety standards
One of the largest problems is the knowledge deficit in the countries involved. Even India, which is a pharmaceutical giant in the developing world, has never developed a flu vaccine. Developing and producing a flu vaccine will require an enormous investment in laboratory facilities in order to meet the highest safety standards. Most vaccines are created using live viruses and if a virus escaped, the consequences could be disastrous.

Mr van de Pas says after care has received far too little attention and doubts whether developing countries have sufficient capability to test whether a vaccine is safe or not. The knowledge and the networks for reliable quality control just aren’t there. Nor are there any facilities to register side effects.

The Wemos health expert says, "in essence, it is positive that they are able to do something themselves. But are they really capable of controlling and monitoring the entire process? I do question that, especially considering that pharmaceutical companies might not be led by public health concerns but by profit. And they don't care that much about how the vaccine will be distributed."

Another concern is that of timing; countries that are just beginning to develop an A(H1N1) vaccine are starting well behind events. It is entirely possible that when the first delivery of South African A(H1N1) vaccine is ready in 2010 or 2011, the virus will have disappeared or already mutated.

Care                                                                                                                                         
Once the production problems have been solved, the distribution problems start; the vaccine has to be delivered to those who need it most, such as healthcare workers, children and poor people in rural areas. The entire vaccination campaign - from development to production and distribution - has to be affordable. Its problems seem insurmountable. Remco van der Pas says:

"What we see is that subsidies for those schemes are very limited. Sometimes the middle classes or the lower-middle classes in the cities are able to access those vaccines through existing health centres but access is limited in rural areas where there is no infrastructure and no money. Equitable access to vaccines is a problem."

The emerging industrial countries' plans appear to be in response to the growing numbers of middle classes in cities who are increasingly able to pay for decent health care and modern medicines.

Photo: alvi2047 at Flickr