3 Asian countries top list to get donated H1N1 vaccine

Afghanistan, Azerbaijan, and Mongolia will be the first three countries to receive donated supplies of pandemic H1N1 vaccine funneled through the World Health Organization, the WHO announced Dec. 17 as it cautioned that it's too early to declare the pandemic over.

The WHO aims to vaccinate health care workers initially and other priority groups later in 95 developing countries, with the hope of covering about 10 percent of the population, or roughly 200 million people, officials said Dec. 17, according to CIDRAP News.

At a news briefing, Dr. Keiji Fukuda, special assistant to the WHO director-general for pandemic flu, said six manufacturers and 12 countries have pledged about 180 million doses of vaccine, and the agency is negotiating with other countries about potential donations.

According to an online update, the vaccine pledges so far total 178.4 million doses. In addition, the WHO has collected pledges of 74.5 million syringes and 500,000 "safety boxes," out of 2 million needed. Also, donors have pledged $67 million for the effort, but the estimated need is about $233 million.

"The first doses have not gone out yet, but we are I think very close to that," Fukuda said at the news briefing.

The first shipments will go out considerably later than once projected. At a Sept. 24 briefing, WHO officials predicted that developing countries would start getting their first doses in late October or in November.

Fukuda did not specify how many doses particular countries or companies have pledged. The United States has promised to give 10 percent of its supply to developing countries. On Dec. 17, U.S. officials said 99.5 million doses have been produced and made available for use nationally, out of about 250 million doses ordered by the government.

At a separate news briefing Dec. 17, U.S. Health and Human Services Secretary Kathleen Sebelius said the United States is working with the WHO on a timetable for sending its pledged vaccine doses. "The U.S. intends to stand by its commitment," she said.

Fukuda said logistical and regulatory hurdles make the task of providing the vaccine very complex. Countries that want doses must make a formal request, sign an agreement with the WHO, and develop a national vaccine deployment plan, he explained.

The WHO is focusing on a first group of 35 countries, 34 of which have requested vaccine supplies, according to the written statement. Another 20 of the 35 countries have signed agreements, and just four have completed deployment plans.

"The vaccination effort will be to get vaccine out for approximately 2 percent of the population of the recipient countries in order to allow health care workers to be vaccinated," with the aim of ensuring that hospitals can keep functioning, Fukuda said. "That would be followed later on by providing enough vaccine for 8 percent of the population," for a total of 10 percent.

The countries chosen to receive vaccine reflect the fact that H1N1 is currently more active in the Northern Hemisphere than the Southern Hemisphere, he noted. He did not specify countries in line to receive supplies, other than Afghanistan, Azerbaijan and Mongolia.

In response to a question, Fukuda said it's not too late to vaccinate people in developing countries. "The pandemic virus is now a virus which has really spread around the world, and it is quite likely this is an infection that we'll continue to see circulating for a number of years," he said.

"We believe that it is too early to say that the pandemic is over," Fukuda said. High flu activity persists in parts of Europe, including France, Switzerland, and the Czech Republic; parts of central Asia, such as Kazakhstan and Kyrgyzstan; and Russia, he explained.

In addition, though H1N1 activity is declining in North America and some parts of Europe, a third wave is possible, given that months of winter lie ahead, he said, commenting, "We simply are not able to answer this question right now."

Fukuda declined to list any specific criteria the WHO might use to determine when the pandemic is ended. Identifying those criteria will be a matter of deciding when it's safe for governments to discontinue the protective measures now being used, and that will require consultations with virologists, epidemiologists, and other experts, he said.