Thursday, December 17, 2009

Hand-me-down vaccines?

There have been months of fear and trembling (especially in the United States) about shortages of H1N1 vaccine. The idea of shortage -- in this one context at least -- in the land of plenty has motivated a rapid increase vaccine production and distribution, on the one hand, while the number of new cases of H1N1 has in fact decreased on the other. In little time, everyone in the United States who wants (and can afford) to have the vaccine, can get it. In fact, there will most probably be way too much of the stuff.

What should be done with the surplus? In a recent editorial in the San Francisco Chronicle, immunology and bioethics experts argue that the surplus should be donated to the world's poorer countries. These countries have health systems under tremendous stress, unhealthy populations at risk for H1N1, and have very limited access to the vaccine despite promises made by powerful governments and pharmaceutical companies. The argument for giving is especially pertinent at time of year. It is, as they point out, Christmas season.

It is hard to know what to make of this. First, the public health issue. The burden of disease that H1N1 constitutes is paltry in comparison to the diseases and conditions faced in developing countries. (It was already not very significant in terms of mortality and morbidity in developed countries themselves.) Sure, H1N1 will exacerbate pneumonia, one of the great killers in these nations. But we don't see significant donations of antibiotics which could save many more lives.
And then there is the symbolic issue. When the richer nations have had their fill of vaccines, and are getting out of danger, then we can think about the poor. The image is that of hand-me-downs, leftovers. Things we no longer need or want and can afford without sacrifice to give away as charity. Of course, it is not that it would be better if such donations were withheld. Some lives could be saved. But what do such acts of charity express about the relationship between richer and poorer countries? Should either party feel good about such a donation initiative? Perhaps some will find the spirit of Christmas in it somewhere, but the whole thing strikes me as deeply, deeply sad.

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Blogger Laura said...

Deeply sad and deeply shortsighted. Enough of the sadness -- there's not enough ghosts of Christmas to wake up all the people who need it. However, passing on the leftovers is still a step above keeping every medicine we have in a bunker until they're useless. The shortsightedness of this is what really alarms me. When the world needs vaccine for the next serious pandemic, no one knows where it will be developed first nor how countries will be able to acquire it. Even with new technologies emerging, development takes time. We need to ramp up our domestic exercises in determining who will be prioritized and begin talking about these processes globally. Maybe, just maybe, the new health surveillance initiatives underway will open the door to this kind of much-needed political conversation.

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