Gustavo Capdevila

GENEVA, May 5 2009 (IPS) – Poor countries facing the greatest threat from the spread of the H1N1 flu virus popularly known as swine flu will begin to receive shipments of Tamiflu, the World Health Organisation (WHO) announced.
The global health agency, which reported last week that it planned to provide poor nations with 2.4 million doses of the flu medicine, said Tuesday that it had dispatched Tamiflu from the United Arab Emirates, the United States and Switzerland.

So far, most of the cases of the new H1N1 flu have been reported in North America, although the epidemic is still in a very early stage, said acting WHO assistant director-general Keiji Fukuda.

We have concerns about the infection traveling to the southern hemisphere, because that part of the world will be heading into the winter months, and the winter months are when influenza viruses usually thrive, he told a news briefing in Geneva.

If a deadly pandemic were to develop, there would be a desperate fight over limited supplies of anti-viral treatments and vaccines, said Sangeeta Shashikant, a researcher with the Malaysia-based Third World Network, an independent non-profit international network of organisations involved in development issues.

In that fight, developing countries will be at a vast disadvantage, Shashikant told IPS, adding that an urgent matter is the adoption of a framework establishing a fair and equitable global system for the sharing of the flu vaccines as well as anti-viral treatments.
Related IPS Articles

Developing countries, which face a broad range of public health challenges, don t have the financial resources to purchase costly flu medicines and vaccines, she said.

Transnational pharmaceutical companies are offering anti-viral drugs like oseltamivir patented under the Tamiflu brand name by Switzerland s Roche at 16 dollars per treatment.

To treat millions, that cost is really quite high for a poor country, said Shashikant, who works at the Third World Network offices in Geneva.

By contrast, generic anti-viral medicines produced in countries like Brazil, China and India can be purchased for 10 dollars per treatment.

None of these three countries are on the list of 72 nations to receive Tamiflu from the WHO.

But Mexico, the country hit hardest by the outbreak, is on the list, even though it is a member of the Organisation for Economic Cooperation and Development (OECD), known as the rich nations club .

The adoption of a distribution system will be discussed by WHO at its May 15-16 intergovernmental meeting on pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits .

The question of the sharing of flu viruses came to the forefront in 2003, when Asian countries hit by outbreaks of avian flu became embroiled in a controversy over the sharing of bird and human flu virus samples with drug companies.

At that time, Indonesia discovered that its viruses had been used to produce vaccines without its permission, and temporarily suspended sending flu samples to WHO collaborating centres, until an agreement on setting up a more equitable system was reached.

In the case of a swine flu vaccine, once it has been developed, the distribution system should recognise the principle of free access for developing countries, said Shashikant.

The reference to other benefits in the name of next week s WHO meeting alludes to technology and the know-how on its appropriate use, said the expert.

Today, many of these scientific resources are protected by laboratories by means of patents and trade secrets, she added.

The incidence of the H1N1 flu virus is highest among adults under the age of 60. The average age seems to be people in their mid-20s, said Fukuda.

By Tuesday, there were a total of 1,490 laboratory-confirmed cases, including 822 in Mexico, where 29 deaths have been confirmed so far. There have also been two deaths in the United States.

Fukuda said it was not yet clear why there was a higher incidence among young people, and said that perhaps it was because younger people travelled more and were thus more exposed to the virus, or because older people had developed greater resistance than young people. With influenza, oftentimes we see the infections go to younger people first and then go to older people later, said the WHO expert.

But he clarified that males and females have been infected at the same rate, and said the viral samples taken in different regions are still very similar.

And the diarrhea suffered by some patients in Mexico was also a symptom seen in patients in the United States, Fukuda added.

He said that although a number of countries in Europe have reported cases, there is no evidence yet of community-level transmission of the virus there, and that in the two European countries with the largest number of cases Britain and Spain the virus was not apparently spreading beyond institutions like schools to the community at large.

We don t believe we are seeing community transmission in the same way we re seeing it in the U.S. and Mexico, he said, noting that most of the cases in Spain were travel-related, and that in Britain transmission was occurring in schools and related to travel.

That is an important aspect because the highest level on WHO s six-phase influenza pandemic alert system is triggered by sustained community-level outbreaks in at least one other country in another WHO region, on top of the criteria for phase five (human-to-human spread of the virus in at least two countries in one WHO region), which have already been met.

A declaration of a phase six alert would indicate that a global pandemic was under way.

But, Fukuda added, I don t believe that all travel-related cases are related to travel just to Mexico. He said WHO had learned of one such case related to travel to the United States, and stated that If people are moving around, of course we will expect to see travel-related cases from different countries.

He concluded, as other WHO officials have in the last few days, that we don t know how this will evolve.