Sharing of influenza viruses and access to vaccines and other benefits
Dr Margaret Chan
Director-General of the World Health Organization
Distinguished delegates, ladies and gentlemen,
I appreciate the opportunity to speak to you at the start of this intergovernmental meeting.
The prospect of an influenza pandemic raises some very big issues for public health. For WHO, the biggest issue is the threat that an influenza pandemic poses for global health security.
Vulnerability is universal. A pandemic will, by its very nature, reach every corner of the earth, and it will do so within a matter of months. As I have said on several occasions: this shared vulnerability calls for shared responsibility, and collective action to fulfil that responsibility. In terms of the risk of disease, we really are all in the same boat.
The present situation is unique. In the past, pandemics have always announced themselves with a sudden explosion of cases, and taken the world by surprise. For the first time in history, we have been given an advance warning. As an international community, we have an obligation to use this opportunity wisely.
Preparedness has moved forward on multiple fronts, though more needs to be done. We understand influenza pandemics, and the viruses that cause them, much better than we did four years ago. We have developed some unique mechanisms for an early and effective response.
The capacity to manufacture influenza vaccines is increasing. Advances, such as the use of antigen-sparing technologies, have boosted capacity further. A stockpile of H5N1 vaccines is being established.
Most countries now have influenza pandemic preparedness plans. Efforts to strengthen basic surveillance and response capacities contribute to our collective public health security.
Let me give just one example. The August outbreak of Marburg haemorrhagic fever, in Uganda, was stopped dead in its tracks, before it had a chance to become a national or an international threat.
As the minister of health of Uganda informed me, the outbreak was promptly controlled by activating the preparedness plan for pandemic influenza. All the procedures were in place, and worked flawlessly.
Knowledge and experience in these areas are permanent steps forward that will hold us in good stead for whatever lies ahead.
Ladies and gentlemen,
We must never lose sight of what a pandemic can mean under the unique conditions of the 21st century. SARS taught us how much the world has changed in terms of its vulnerability to the economic and social disruption caused by a new disease.
And SARS was by no means a global event. It was not a pandemic. SARS was largely a disease confined to the hospitals of wealthy cities.
Think of what may be in store. The last influenza pandemic began in 1968. At that time, airlines were not carrying more than 2 billion passengers each year, as they do today. HIV/AIDS was unknown in 1968. Tuberculosis had not resurged as a global threat.
At that time, in 1968, the world did not have the internet, which has spawned global interdependence in so many areas. This interdependence has greatly amplified the economic and social disruption that new diseases can cause.
Pandemics are recurring events. Countries need to brace themselves for a situation where up to 25% of the workforce may be ill at a given time. They have to brace themselves for a possible meltdown of basic municipal services and a slowdown of economic activity.
And this situation will be occurring globally. There will be no fortunate unaffected parts of the world.
As I said, the stakes are high and the responsibility resting on our shoulders is great.
Ladies and gentlemen,
This meeting will be looking at access to benefits – that is, the transparent, fair, and equitable sharing of benefits. Access to vaccines has been given special emphasis. In terms of preparedness, access to vaccines is almost certainly the greatest concern in countries that lack their own manufacturing capacity.
I fully support any effort that leads to greater and more equitable access to pandemic vaccines. Vaccines are the best insurance policy for public health. They are our best protection against the risk that the next pandemic will negate or set back our hard-won achievements in health development. The meeting will also address the sharing of viruses. The sharing of viruses serves public health in ways that go beyond the development of pandemic vaccines.
Let us step back briefly into history. A network for the surveillance of influenza viruses was established in 1947, a year before WHO became fully operational. The devastating mortality of the 1918 pandemic was still a vivid memory, which explains the priority given to influenza surveillance by the founders of WHO.
At that time, influenza surveillance had three public health justifications. First, successful vaccination against influenza depends on knowledge of circulating viruses. Second, continuous vigilance is necessary to detect new and potentially dangerous strains at the earliest possible moment. Third, epidemiological reports can be correctly interpreted only in terms of laboratory studies of viruses.
This is as true today as it was in 1947.
Analysis and comparison of viruses allows WHO to update reagents and test kits. This contributes to diagnostic precision and sharpens surveillance. The sharing of currently circulating viruses is the only way to monitor the emergence of drug-resistant strains.
But above all, the sharing of viruses is the foundation of risk assessment. The analysis and comparison of viruses give us the first clues, the first early warning, that the virus may be evolving in a dangerous way.
This is our key difference from the past – this capacity to pick up the signal that tells us to gear up our defences and prepare our populations. This is one of the biggest advantages of the advance warning we have been given.
Ladies and gentlemen,
The present situation gives us an opportunity to take a hard look at the way a surveillance system, established in 1947, operates. Some weaknesses have been revealed.
The resolution on pandemic influenza preparedness, adopted at the May Health Assembly, asked WHO to improve the influenza surveillance system, notably by making its mechanisms and procedures more transparent. I am aware of problems in this area in the recent past, and I fully appreciate the need for the Global Influenza Surveillance Network to operate in a more transparent and equitable manner.
WHO has a responsibility, in its stewardship role, to make the necessary changes.
These weaknesses must not be allowed to undermine implementation of the International Health Regulations, or diminish the significance of the obligations they place on member states, in the interest of global health security.
We have been given a unique opportunity in the form of an advance warning. We must not – I can say, we dare not – squander this opportunity. The stakes are too high.
How will history judge us, collectively, as an international community, as an agency like WHO, responsible for safeguarding international health security, or as individual countries? As I said, we have a shared responsibility to pursue collective security.
With this question, I also want to give you a challenge. This is now the fifth large meeting, held this year, concerned with the sharing of viruses and access to vaccines and other benefits. Millions of people outside this hall depend on us to make progress.
I look to you for guidance and advice in devising mechanisms that can put us on the right course as quickly as possible.