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.
Labels: bioethics, developing world, H1N1 virus