Are we really ready for a global pandemic?

An Emirates airliner was quarantined at John F. Kennedy International Airport on September 5 after several passengers reported flu-like symptoms. Oxiris Barbot, acting health commissioner for New York City, said the cause of the disease was "probably the flu".

The next day, two other flights, arriving from the Middle East were quarantined at US airports after the passengers reported symptoms similar to those aboard the airliner stranded at JFK airport in New York.

Scenes of passengers being taken to the hospital, wearing masks, have raised concerns around the world. But it was just a good public health practice – isolate the patient, minimize the transmission to others and (hopefully) start the treatment.

But if these events really marked the beginning of a flu pandemic (global spread of a disease), the world is not prepared at all. There is poor public health surveillance in many parts of the world, there are not enough vaccines and the international legal framework designed to ensure that vaccines reach the poorest countries is not enough. not adapted to the needs.

Demand will outstrip supply

Vaccines are the key to responding to an influenza pandemic, but we can not prepare vaccines in advance. We need to know which influenza strain is causing the epidemic before we can make vaccines to protect it.

People usually need two doses of a vaccine to provide immunity against pandemic influenza. At least one-third of the population needs both doses to establish "collective immunity" and slow down the transmission of the virus. This means that during the next pandemic, we will need at least 4.7 billion doses of vaccines.

According to the most recent estimates, the potential global supply would be around six billion doses and take a year, but it is based on an optimal scenario and is unrealistic.

The eggs are needed to make the flu vaccine and the figure of six billion is based on the assumption that the egg supply remains intact. This is unlikely during an outbreak of bird flu (the 2009 outbreak and the 1918 Spanish flu outbreak were both strains of bird flu). The figure is also based on the smooth transition from seasonal flu vaccines to pandemic influenza vaccine – a notoriously delicate change that could lead to a loss of production. It is also based on all the plants capable of producing influenza vaccines making them, without interruption, for a whole year.

In fact, the number of pandemic vaccines we can do in a year can be closer to half of the most recent estimate. This means a global supply deficit of nearly two billion doses a year.

Poor countries are the most affected

Although vaccines are essential for fighting the epidemic, the poorest countries have long complained about their inability to access influenza vaccines in the event of a pandemic. My research has shown that almost all of the supply is purchased by the richest countries, leaving the world's poorest dependent on vaccine donations from the World Health Organization (WHO).

In an effort to address this problem, WHO adopted the pandemic influenza preparedness framework in 2011. This has created a "virtual stock", a stock of vaccines promised to WHO of at least 150 million doses that developing countries can access in the event of a pandemic.

Today, the virtual stock contains about 230 million doses. This sounds positive, but my research shows that this number is too low to meet the needs of the poorest countries.

Vaccine manufacturers are committed to providing the influenza vaccine to the WHO through a Standard Material Transfer Agreement (SMTA). This is a legal agreement whereby the manufacturer agrees to provide WHO with a percentage of the vaccines they manufacture in exchange for access to samples of pandemic influenza virus with which to develop vaccines.

More worrying is the fact that the WHO stock is not able to meet the demand because it is unlikely that vaccines under these agreements will be sent to WHO for the first time. If we are faced with a particularly serious pandemic, it is unlikely that the governments of the countries where the vaccine manufacturers are located will let 10% of vaccines leave the country, regardless of the agreement between the manufacturer and WHO. The SMTAs signed between the WHO and the manufacturers even anticipate this result.

If the next pandemic is serious, millions of people will die, mostly in the poorest countries, and largely because they do not have access to a vaccine – the only thing that the PIP cadre was supposed to solve.

This year marks the 100th anniversary of the most deadly flu epidemic in history, the 1918 Spanish flu pandemic, which killed 50 to 100 million people. A major pandemic influenza on this scale will recur and the world is not prepared for it.

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