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may provide protection for only 450,000 people. As one researcher told Science magazine, "it's a vaccine for the happy few."
At the least, gearing up for larger-scale production will take many months and production itself is limited by the antiquated technology of vaccine manufacture which depends upon a vulnerable and limited supply of fertile chicken eggs. It would also likely mean the curtailment of the production of the annual winter flu vaccine that is so often a lifesaver for many senior citizens.
Likewise, Washington's new orders for antivirals, as Senator Frist predicted, will have to wait in line behind the other customers of Roche's single Tamiflu plant in Switzerland.
In short, it is good news that the vaccine tests were successful, but that does little to change the judgment of the New York Times that "there is not enough vaccine or antiviral medicine available to protect more than a handful of people, and no industrial capacity to produce a lot more of these medicines quickly."
Moreover, the majority of the world, including all the poor countries of South Asia and Africa where, history tells us, pandemics are likely to hit especially hard, will have no access to expensive antivirals or scarce vaccines. It is even doubtful whether the WHO will have the minimal pharmaceuticals to respond to an initial outbreak.
Recent theoretical studies by mathematical epidemiologists in Atlanta and London have raised hopes that a pandemic might be stopped in its tracks if 1 to 3 million doses of oseltamivir (Tamiflu) were available to douse an outbreak in a failsafe radius around the early cases.
After years of effort, however, the WHO has only managed to inventory about 123,000 courses of Tamiflu. Although Roche has promised to donate more, the desperate rush of rich countries to accumulate Tamiflu will be certain to undercut the World Health Organization's stockpile.
As for a universally available "world vaccine," it remains a pipe-dream without new, billion-dollar commitments from the rich countries, above all the United States, and even then, we are probably too late.
"People just don't get it," Dr. Michael Osterholm, the outspoken director of the Center for Infectious Disease Research and Policy at the University of Minnesota recently complained. "If we were to begin a Manhattan Project-type response tonight to expand vaccine and drug production, we wouldn't have a measurable impact on the availability of these critical products to sufficiently address a worldwide pandemic for at least several years."
"Several years" is a luxury that Washington has already squandered. The best guess, as the geese head west and south, is that we have almost run out of time. As Shigeru Omi, the Western Pacific director of WHO, told a UN meeting in Kuala Lumpur in early July: "We're at the tipping point."
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