Pandemics: working together for an effective and equitable response

Dr Margaret Chan
Director-General of the World Health Organization

Address to the Pacific Health Summit
Seattle, Washington, United States of America

13 June 2007

Distinguished delegates, ladies and gentlemen,

For the first time in history, the world has been watching the conditions that might start an influenza pandemic unfold in real-time.

Nature has given us an unprecedented warning. And we have been given more time to prepare that anyone dared hope.

Scientists have tracked the changing situation with unprecedented precision. A flurry of research has chased after every clue – from the molecular genetics of viruses, to the pathways of human infection, to the flight patterns of migratory birds.

In a stunning technical feat, the 1918 virus was reconstructed as part of the detective work. This virus caused the most lethal pandemic ever recorded.

Many headlines have competed with each other for the biggest number of predicted deaths.

The most respected scientific journals have published scenarios of the havoc a pandemic could wreak under the unique conditions of the 21st century.

The World Bank has estimated that a pandemic could cost the world economy between 800 billion dollars and 2 trillion dollars, depending on the virulence of the virus.

But both estimates agree: the greatest cause of economic loss will arise from the uncoordinated efforts of the public to avoid infection.

WHO has coordinated laboratory and epidemiological investigations, provided direct support to countries, and constantly assessed the level of threat.

We have also strongly advised and supported all countries to develop pandemic preparedness plans.

All of these events, stretched over almost four years, have raised unprecedented concerns, and unprecedented ethical dilemmas.

An influenza pandemic is a unique event. I know of no other health emergency that can spread to every corner of the globe within a few months.

Once a fully transmissible pandemic virus emerges, its international spread is considered unstoppable.

The three pandemics of the previous century encircled the globe in six to nine months, even at a time when most travel was by ship.

Pandemics are very different from natural disasters and other international emergencies, which usually affect only limited areas or regions of the world.

In such situations, fortunate unaffected parts of the world can provide generous assistance to those in need, as we saw in the Asian tsunami.

This sharing of resources is not expected to take place during a pandemic, especially when protective measures are in short supply. There will be no fortunate unaffected parts of the world.

Faced with a universal threat, each country will look after itself, at least in the immediate pandemic period.

This is a natural behaviour of governments: to give first priority to protecting the lives and well-being of directly threatened citizens.

WHO has advised and supported all countries to prepare. Pandemic preparedness has many components, and not all are prohibitively expensive.

But experts agree on one point. Vaccines are the single most important medical intervention for reducing morbidity and mortality during an influenza pandemic.

This creates our most difficult ethical dilemma. The dilemma has two dimensions.

One is a technical problem, related to vaccine manufacturing. The second is a resource problem, related to money.

One touches science. The other touches policy.

We know that manufacturing capacity for influenza vaccines is overwhelmingly concentrated in Europe and North America. We also know that manufacturing capacity is finite.

Current capacity is 1.5 billion doses for a monovalent vaccine. This falls far short of what will be needed for a world of well over 6 billion people, all susceptible to infection.

I know that your deliberations have explored the science side of this issue.

The second dimension is a policy issue. I believe that developing countries are right to ask us to address the issue of equitable access to vaccines now.

Now is the best time to develop an insurance policy for an unpredictable, yet potentially catastrophic event.

Preparedness for an influenza pandemic was the most hotly debated issue during last month’s World Health Assembly.

After more than 40 hours of negotiations, WHO Member States adopted, by consensus, a resolution on the sharing of influenza viruses, and on the sharing of access to vaccines and other benefits.

Developing countries have a strong and valid point to make. The benefits of scientific research on H5N1 viruses need to be shared in a fair and equitable way.

I commend the ambitions of the Pacific Health Summits: to make the future healthier than the past.

Pandemic influenza and other emerging diseases are a particular challenge.

The conditions of our highly mobile, interconnected, and economically interdependent world have made these diseases a much larger menace than in the past.

This menace is likely to grow in the future. And it is a menace that can directly threaten every country in the world, not just developing nations.

Such threats to our collective health security call for broad collaboration. We need all the sectors represented in this room.

We need science. We need policy-makers. We need industry. And we need leaders from the business community.

The world faces its first chance ever to have a vaccine available near the start of an influenza pandemic. This summit has been exploring all the right issues.

In this session, you want to move from science to policy. What priorities are needed to meet the challenges facing the global community?

Priorities and expectations for WHO were clearly set out in the resolution on pandemic influenza adopted in May.

Developing countries want WHO to help them develop their own capacity to manufacture vaccines, to conduct research on influenza viruses, and to perform diagnostic tests.

They have asked WHO to establish an international stockpile of vaccines for H5N1 influenza.

They want WHO to establish mechanisms, including innovative financing, to help ensure fair and equitable distribution of pandemic vaccines at affordable prices.

These are some tough assignments, but I am personally committed to doing everything I can to ensure equitable access to H5N1 and pandemic vaccines.

WHO work on this problem began long before the May resolution. A global pandemic influenza action plan to increase vaccine supply was issued last year.

The first agreements to transfer technology to vaccine manufacturers in developing countries have been signed, and I am grateful to the governments of the USA and Japan for their financial support.

Advance procurement mechanisms for a pandemic vaccine are under development. In April, a strategic advisory group of experts confirmed the scientific feasibility of establishing an H5N1 vaccine stockpile.

The experts saw two immediate needs for such a stockpile: to intervene near the start of a pandemic in an attempt to contain it, and to allow protection of essential personnel, such as health care staff, in the initially affected countries.

WHO has initiated work to establish such a stockpile.

I am in dialogue with development partners and with executives from all the leading influenza vaccine companies. I am greatly encouraged by the firm commitments we have received from several companies.

GlaxoSmithKline is announcing their substantial commitment today to provide 50 million doses of H5N1 vaccine to a global stockpile managed by WHO, for which we are most grateful. I am also pleased to announce that Sanofi Pasteur, Omnivest and Baxter will also contribute to the stockpile. These commitments strengthen our collective security. I hope other companies will join.

These are all important steps. But the bigger challenge remains. Will we have enough pandemic vaccine to protect enough people in time?

This brings us back to the issue of fairness.

It is also an issue of self-interest: can the world afford to leave vast populations vulnerable to the high morbidity and mortality that inevitably accompany pandemics? Is it not in our collective best interest to strive for more equitable protection?

This, I believe, must be a priority concern. But there are other priorities.

The current pace of scientific research is commendable, and this needs to continue.

It is deepening our knowledge about pandemics and pandemic viruses. This knowledge will hold us in good stead, whether the next pandemic is caused by H5N1 or another virus. Virus sharing must continue without exception, without interruption. This is our key to understanding the threat, and planning for protection

Our collaborative leadership should be another priority.

I ask you all to maintain vigilance, maintain preparedness activities. Influenza pandemics are recurring events, and the threat has not diminished.

If you put a burglar in front of a locked door with a sack full of keys and give him enough time, he will get in.

Influenza viruses have a sack full of keys and a bag full of tricks.

They are constantly mutating, constantly delivering surprises. We must not let down our guard.

In conclusion let me remind you that the revised International Health Regulations will come into force in just two days.

These regulations greatly strengthen our collective defences against emerging diseases and other international threats to health.

They also place greater responsibility on WHO and on its leadership.

The responsibility of declaring an influenza pandemic falls on the Director-General of WHO.

Should this responsibility come within my term of office – and I hope it doesn’t – I need to be sure that I have all the information needed to perform my duty well.

This will almost certainly be the greatest health crisis experienced for almost a century.

This will almost certainly be a major economic crisis as well.

Even the most conservative estimates predict that around 20% of the world population will fall ill within a short period of time.

I have mentioned the World Bank estimates of economic losses, most of which will arise from the uncoordinated efforts of the public to avoid infection.

Apart from ensuring equitable access to vaccines, all of us here will need to provide leadership. It is this leadership that will make efforts to avoid infection more rational and coordinated.

This leadership will need to be based on evidence, and on a firm understanding of the connection between science and policy.

The deliberations of this summit will be a major contribution to this objective. I am pleased to be here.

Thank you.