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Implementing a Hong Kong Stockpile

Posted by plosmedicine on 31 Mar 2009 at 00:18 GMT

Author: Robert Kahn
Position: Co-ordinator
Institution: Avian Flu Action,
Submitted Date: December 15, 2007
Published Date: December 17, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

This essay is timely in view of the continuing failure to reach agreement with Indonesia about how samples of the H5N1 virus should be shared [1]. Garrett and Fidler’s imaginative proposal to establish a large stockpile in Hong Kong of highly specific influenza vaccine and antiviral medicines makes sense especially if linked to three other major policy initiatives.

First, sustained lobbying needs to take place within the G-8 nations and a significant number of Asian nations to encourage national governments to finance the proposed international Advanced Market Commitment (AMC) mechanism. As the Atlantic Storm international bioterrorism exercise demonstrated in 2005, leaders of all major countries reserve their limited vaccine supplies for their own countries. Furthermore, “International leaders cannot create the necessary response systems in the midst of a crisis. Medical, public health and diplomatic response systems and critical medical resources (e.g. medicines and vaccines) must be in place before a bioattack or a pandemic emerges” [2].

Second, funding and production of effective H5N1 vaccines is difficult, even with advance purchase agreements. A recent draft working paper from the World Health Organization explained it will take from 28 to 52 weeks to begin production of an H5N1 human vaccine after the virus is diagnosed, isolated and analysed [3]. Moreover, this will need to be linked to both a clear pharmaceutical strategy and a viable public health strategy. New innovative approaches to pandemic vaccine research and development will be required, such as cell-culture-based vaccines, DNA vaccination, and perhaps most promising, reverse-genetics-based inactivated vaccines with adjuvants [4].

Third, in addition to financing issues, the role of pharmaceutical companies requires close scrutiny. The way ahead lies in some form of hybrid public-private model for financing, developing and distributing vaccines.

In conclusion, the underlying problem is the present structure of financing, developing and producing vaccines, rather than the Indonesian demands. Indeed, by signing an agreement to sell their virus samples to Baxter, rather than donate them to WHO-approved laboratories, the Indonesians may be supporting the tendency of vaccine markets “to evolve toward a single dominant supplier” [5]. Whatever the outcome, and many lives will depend on that outcome, Laurie Garrett and David Fidler are to be congratulated on setting out the dangers and opportunities that confront us.


1. Reuters (2007 November 26) Indonesia says no to bird flu virus sharing. Available: Accessed 5 December 2007.

2. Smith, B. T. et al. (2005) After-Action report: Navigating the storm: Report and recommendations from the Atlantic Storm Exercise. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science 3 (3): 256-267. Available: http://www.atlantic-storm.... Accessed 5 December 2007.

3. World Health Organization (2007 November 19) DRAFT: A description of the process of seasonal and H5N1 influenza vaccine virus selection and development. Available: . Accessed 5 December 2007.

4. Horimoto T, Kawaoka Y (2006) Strategies for developing vaccines against H5N1 influenza A viruses. Trends in Molecular Medicine 12 (11): 506-514.

5. Danzon P, Pereira NS (2005) Why sole-supplier vaccine markets may be here to stay. Health Affairs 24 (3): 694-696.

No competing interests declared.