A major problem with the vaccine strategy for coping, assuming a vaccine could be developed, is that the world's production capacity for influenza vaccine is limited to perhaps 500 million doses. European countries have already placed orders for much of the potential vaccine, should one be developed. The United States has some production capacity and stands a chance of getting at least some vaccine. But most of the world, including virtually all developing countries, would obtain little or no vaccine and be left out in the cold. It is not clear if world production capacity could be ramped up in time, but this option should be explored. Considerations of profit and patents should not be allowed to stand in the way.
Who Profits
Marshall is again correct that pharmaceutical companies stand to make a lot of money from selling Tamiflu and avian flu vaccines. The system of private development and ownership of drugs in the world today is irrational and immoral. But she presents no evidence that the major motive behind the administration's plan is to enrich these companies. Further, her theory in inconsistent with the fact that the Bush administration has essentially ignored the avian flu threat for two years during which public health professionals were becoming increasingly concerned. If the goal was to enrich the pharmaceutical companies, why waste two years of potential enrichment?
None of this is to say that the administration plan to respond to avian flu is the best or is even adequate. [See my: Avian Flu Excuses Begin] This plan places far too great an emphasis on Tamiflu and vaccines and not enough on either prevention or strengthening our public health infrastructure to cope with a potential pandemic. The plan does not place primary responsibility for coping with a pandemic where it belongs, with the federal government's pubic health professionals. Rather, it places primary responsibility with state and local governments that are ill-equipped to cope with a risk of this magnitude. Even in the case of its centerpiece Tamiflu stockpile, the plan states that the resource-starved states and localities are supposed to develop the bulk of these stockpiles, not the federal government. The plan devotes only limited resources to prevention efforts, such as reimbursing poultry farmers in poor countries for culling their sick. These prevention efforts may not, at this late date, prevent a pandemic, but, as the World Health Organization points out, the efforts may buy time for countries to prepare if a pandemic breaks out.
Most tellingly, as already mentioned, the administration's avian flu plan was developed two years after many in the public health community became aware of a dangerous mutation in the H5N1 virus which made it a greater threat than had previously been the case. That is, it is too little, too late, which is quite the opposite of what Marshall argues.
Of course, in the broader scheme of things, Marshall's comments are not likely to significantly impact public health policy. But the attitudes she exemplifies are no doubt held by other progressives suspicious of anything said or done by this administration. We must be careful, however, to not let that justified suspicion interfere with what little is being done in this country to prepare for this potential, though not inevitable, catastrophe. At the same time, we must, however, exercise vigilance to identify counterproductive policies quickly and to call public attention to them. We also must resist attempts to protect Americans while letting the poorer parts of the world suffer the full effects of any potential pandemic unaided. In addition to being immoral, such a policy would be counterproductive. In a pandemic, an injury to one will, indeed, be an injury to all.
1 | 2
