“Days of Tranquility” during a New Pandemic

Cristina Zesatti
Posted June 23, 2009 from Mexico
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Can a public health crisis stop war? If the past is any indication of the future, then the answer is yes. In 1985, in the midst of a civil war in El Salvador, hostilities ceased for three days to permit the implementation of a vaccination campaign for children, an event that was repeated each year during the war.

This practice became known as "Days of Tranquility" and it has been implemented in countries facing armed conflict such as Uganda, Lebanon, Sudan, the former Yugoslavia and later in Sierra Leon. The statistics spoke for themselves: each year disease killed more people than armed conflicts. Today, just like before, a simple vaccine might just be the secret weapon.

Cristina Avila-Zesatti -- Corresponsal de Paz Translated by Erin DeBell

Towards the end of April, the news that came from Mexico shocked the world: a possible Pandemic (defined by the WHO as the rapid spread of a new virus in different world regions) threatened the globe.

In the midst of this shattered calm, few remembered that April 25 commemorated World Malaria Day, focusing on a disease that kills one child every thirty seconds despite being curable. These deaths occur in several countries, the majority of which are found in Africa.

Up until now, and perhaps since the last pandemic threat of Bird Flu in 2003, the world seemed to be at peace with the prevailing health conditions of its inhabitants, even when the statistics and our memories offered few reasons for such optimism.

Non-existent vaccines, inevitable disease.

According to the international NGO Doctors Without Borders, in the first four months of 2009 in Sub-Saharan Africa there have been over 56,000 registered cases of Meningitis, another curable disease that has caused 2,000 deaths in countries such as Niger, Nigeria and Chad so far this year.

With regards to Malaria, sometime towards the end of May this year the first—just the first!—phase of the immunization of a mere 14,000 children could occur since the RTS-S vaccine is currently the first—just the first!—to pass the final phase of clinical trials, although other vaccines are still being developed.

Meningitis, on the other hand, is a bacterial infection that is easily passed from person to person and can be transmitted when an infected person coughs or sneezes. It usually kills half of those infected if medical attention is not quickly obtained. This epidemic, which is present in several countries, has afflicted Nigeria since 1996. Around 50,000 cases have been registered in the zone known as "the Meningitis belt" during this time.

And this is just a brief synopsis of the deaths caused by poor health conditions worldwide since there are multiple diseases such as AIDS, Cholera, Dengue and dehydration that decimate the world's population on a daily basis, predominately affecting the world's poorest areas. According to the World Health Organization, hunger, which may very well be the worst disease on earth, currently takes the lives of approximately five million children under five years old each year.

Amazingly, none of this seems to affect the world or the media as they go about their daily routines.

So, what else do we need to know about influenza?

Influenza, also known as the "seasonal flu," does not rank as one of the WHO’s Top Ten Causes of Death but it generally affects ten percent of the world's population each year, causing between 250 and 500 thousand deaths on average, which falls within the "normal" yearly range.

Again, it is worthwhile to focus on these statistics and keep past events in our memories in order to understand the current threat.

Even though it is not "under control," the seasonal flu (normal influenza) is not a priority for the World Health Organization as are influenza variants such as Bird Flu from 2003 to 2005 and the current Swine Flu epidemic. It is disconcerting because humans have not yet developed sufficient immunity, which makes the risk of passing the virus to others even higher.

What is especially interesting in light of the current alert is that the WHO expected a new flu such as this to arrive, and the world—and public health organizations—failed to initiate the necessary precautions soon enough.

Near the end of 2006, David Heymann, former Executive Director of the WHO’s Communicable Disease Cluster, indicated that the initiation and increase of vaccine production was an urgent matter: "We must start increasing production with the risk of a pandemic occurring in the next five, ten or thirty years." The problem is that current market restrictions only allow the production of 350 million doses per year and general immunization for the seasonal flu is still far from becoming a feasible goal since the fact of the matter is that public health organizations in 2006 were (and are) more concerned with more dangerous strains, such as Bird Flu (H5N1) and the current Swine Flu (A/H1N1). In a press release from October 2006, Marie-Paul Kieny, director of the WHO’s Initiative for Vaccine Research, said, "We have to take sustainable actions; otherwise within three or four years we will find that nothing has changed with regards to the vaccine supply."

Three years ago, immediately following the Avian Flu threat, the WHO stated that if the creation and supply of vaccines is based on market whims, "in 2009 vaccine production will not exceed 2,340 million doses per year.” Since each person would need two doses of the vaccine, the demand would increase to 12,000 million.

A pre-pandemic vaccine that never materialized

This is a reason for international concern since the task of creating a more potent vaccine (capable of defending the human body against the seasonal flu and resisting the attack of the bird flu mutation) was never finished; nor was the goal of comprehensive immunization completely reached, most notably in developing countries.

Another trip down memory lane serves as an example: In May of 2007, the World Health Assembly assured the equitable distribution of the development of vaccines against Bird Flu with the supposed objective of avoiding a possible "pandemic."

Sengeeta Sashikant, an expert from a NGO called “Third World Network,” assured at that time that, "Realistically, developing countries don't get anything." Between 2003 and 2007, countries affected by Bird Flu delivered their samples of the H5N1 virus to WHO Collaborating Centers, although it was later commercial companies who took over the research and creation of medications and vaccines.

The result? The price of these preventative measures and cures for an outbreak that threatened to spread became completely inaccessible for developing countries, which were the most affected by the outbreak. What is worse, these were precisely the people who had facilitated research by donating blood samples.

"If vaccines are patented and expensive, it will be impossible for poor countries to obtain them, at least in the required amounts." If a pandemic is declared, these countries fear that their residents will remain vulnerable since the majority of stored vaccines will be held in industrialized nations," said Sangeeta Shashikant, from TWN, to the press.

If immunization is a large part of the solution, then what are we waiting for?

A vaccine certainly needs the strain in order to be developed, although the fact of the matter is that the OMS had proposed developing a more potent immunizing agent for the seasonal flu as well as the bird flu that could potentially help combat the strain that is causing worldwide panic: A/H1N1, which is composed of a mix of human, bird, and swine flu.

According to researchers from St. Jude Children's Hospital in Memphis and the University of Tennessee, "Pre-pandemic vaccines can stimulate a better immune system response than was previously believed." Does this mean that if a pre-pandemic vaccine for the human-bird flu would have been developed, that we would be less vulnerable to the current swine flu mutation? Perhaps. But that alone wouldn't have been enough, since vaccination of a large percentage of the world's population would have been necessary in order to reap the benefits.

Even in the United States, vaccination against the seasonal flu is relatively uncommon due to the low capacity of the manufacturer. The situation is even more desperate in developing countries, where the vaccine costs up to thirty dollars when it should be just 1 to 3 dollars.

According to the WHO’s Global Pandemic Influenza Action Plan to Increase Vaccine Supply, created in 2006 with the assistance of 120 experts from national immunization programs, one of the three proposed strategies was the vaccination of large portions of the population to prevent infections that could lead to a global emergency.

Investing in "Days of Tranquility" in the Face of Emergency

In 2006, the United States contributed 10 million dollars to the research of a pre-pandemic vaccine; Canada and other developed countries made their own contributions. Nonetheless, these amounts set forth for the development of a vaccine, just like the world’s subsequent vaccination campaign, weren't much more than a drop in the bucket. In 2007, the Stockholm International Peace Research Institute (SIPRI) noted that the annual expenditure in arms purchases reached approximately 1.4 trillion dollars.

This is exactly six percent more than what was spent in 2006, the year that WHO member countries had supposedly proposed the creation and global supply of a vaccine that would prevent an influenza pandemic.

If the new strain of Swine Flu that still doesn't have a suitable vaccine "has put the world on edge," we should remember that as recently as February of 2009 the WHO made it known that 2.5 million children die each year from diseases for which vaccines already exist.

Today few remember James P. Grant (1922 - 1995), UNICEF director for 15 years and the primary promoter of the largest worldwide vaccine campaign in history: a man whose strategy saved approximately 25 million children by providing them access to a generalized immunization as well as low-cost medical care.

Grant was also the pillar of what would later become known as "Days of Tranquility." Three full days during which nations at war literally ceased fire in order to permit the immunization of their residents.

Countries such as El Salvador, Uganda, Lebanon, Sudan, the former Yugoslavia and later Sierra Leon created "Corridors of Peace" which were conflict-free zones dedicated to public health.

Is this not an applicable solution for the world today? It's wouldn’t be impossible, although a series of financial, logistical and medical incentives would certainly be necessary. This would require the cooperation of the entire international community in pursuit of a common goal.

But if fear of a global pandemic is real and if the mortality rate is truly as threatening as WHO experts suggest, then a global contribution should be possible.

Between 1980 and 1995 the UNICEF immunization campaign led by James Grant reached 80% of the population in 72 countries; upon immunizing 80% of the population, infection in the other 20% was greatly reduced.

James Grant himself affirmed that this represented "the most important health measure in times of peace."

If the current outbreak is declared a pandemic and the entire world is threatened by one virus that has been "unknown until now," it should be possible to take concrete financial, logistic and sanitary measures—first to find a vaccine and then to ensure the immunization of a large percentage of the population.

We should be able to witness our own version of "Days of Tranquility" in a world that has undeniably experienced globalization yet continues spending more money on weapons acquisition than on public health.

Comments 1

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Jun 23, 2009
Jun 23, 2009

It has been shown timely mass vaccinations remain the most effective means of limiting the spread of disease and epidemics.

According to Doctors without Borders, two companies have divided the world meningitis vaccine market as follows: "Aventis Pasteur covers need in the US (2 million doses per year), while GSK supplies for consumers in Europe and the Middle East (10 million doses). Africa has been left out of the equation: it isn't considered a lucrative market, so the companies do not have plans to produce enough vaccine to cover Africans, although they are the hardest hit. Aventis Pasteur donated 25,000 doses to Burkina Faso at the time of the spring epidemic, and GSK has said small quantities could be made available for the next epidemic. But both companies have argued that there simply isn't enough production capacity to cover all of Africa. The estimated need for the next five years is 20-50 million doses."

It is not a matter of availability but desired profit margins that prevent these vaccines from being within reach of the African people and their governments. Production costs have clearly shown that the vaccines can be offered at lower prices yet the pharmaceutical companies refuse to do so. The tragedy is that thousands will continue to die while the means to protect them remains readily available.