# 2826
I'll admit going into this entry, that I'm a bit skeptical at some of the numbers presented in the article below. About once a year, we get one of these updated estimates of our global vaccine production capability.
First the article, then a bit of discussion.
Bird flu vaccine production still lags - study
Tue Feb 24, 2009 5:59am EST
GENEVA, Feb 24 (Reuters) - Drug companies have increased their capacity to make bird flu vaccines by 300 percent in the past two years but will still need four years to meet global demand in the event of a pandemic, a study said on Tuesday.
It also said doses of vaccine tailored to the actual strain of pandemic influenza that emerges will not be available until four months after that strain is identified.
"We found that considerable progress has been made to enhance the production capacity of pandemic influenza vaccine," Adam Sabow, partner at consultanting firm Oliver Wyman which conducted the study, said in a statement.
"While capacity still falls short of global need during a pandemic, the surplus capacity during the inter-pandemic period creates opportunities for preparedness efforts," he said.
Oliver Wyman carried out the study with the World Health Organisation (WHO) and International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).
<snip>
In the most likely case, manufacturers could produce 2.5 billion doses of pandemic vaccine in the 12 months following receipt of the production strain, requiring four years to satisfy global demand, the study said.
In the current best-case scenario, 7.7 billion doses could be produced in the first 12 months, requiring 1.5 years to satisfy global demand, it said. Production was expected to increase significantly over the next five years.
First, let me stipulate that I've not read this study yet. I made a quick visit to the Oliver Wyman website, but could not find it posted. Nor could I find it on the WHO website. Perhaps it will show up later.
We'll use their `most likely scenario' of a global output of 2.5 billion doses in the first year of a pandemic. I won't quibble about supply chain issues, employee absenteeism, or other impediments to manufacturing.
They may, or may not happen. We'll assume that manufacturers are able to overcome these adversities.
Vaccination would require two shots per person, 30 days apart, to confer partial immunity. So there would be enough vaccine for roughly 1.25 billion people in the first year of a pandemic.
The question becomes . . . can we deliver 2.5 billion doses of vaccine, in the midst of a raging pandemic, to 1.25 billion people during the first year?
The logistics of doing that during ongoing supply chain, transportation, and human resource crises will be horrendous.
Perhaps not impossible, but very difficult.
Some groups, like the military, health care workers and first responders should be relatively easy to target. They are easily scheduled, tracked, and prioritized.
Delivering vaccines to the general public will be more problematic.
Below you will find the prioritization for pandemic vaccines proposed for the United States. Other countries will, no doubt, apply their own standards.
(click to enlarge)
Four to six months into a pandemic, vaccines should begin to come off the manufacturing line. They must then be packaged, equitably divided up, and then (through a series of steps) shipped to tens of thousands of PODS (Points of Distribution) in dozens of countries each week. Probably in small lots.
These dispersal points (health departments, hospitals, local governments) must then arrange to have syringes (which may be in short supply), trained personnel (also likely to be in short supply), and security on hand.
In the United States alone, according to the USGS there more more than 35,000 cities, towns, or villages. Expand that just to the 11 or so vaccine producing nations, and you are talking hundreds of thousands of locations.
While there may not be vaccine PODs in every one of these locations, we are still probably talking about tens of thousands of distribution points around the world.
With just a few million doses a week coming off the assembly line for each country, how does a central government decide where to send the vaccine each week?
In the US, the vaccines will probably be sent to each state (on a per capita basis), but then each state must decide how to disperse it.
In week 26 of a pandemic, will some committee here in Florida decide that Tampa gets an allocation, but Winter Haven won't? Jacksonville gets lucky, but St. Augustine will have to wait?
Those are the kind of decisions that someone will have to make. Public health departments, already seeing cuts in their budgets, will be put in an almost impossible situation.
And each POD will have to selectively administer the vaccine - not once, but twice, a month apart - to prioritized individuals.
Just a few of the problems these PODS will face include:
- How willing will people be to stand in line, perhaps for hours, with hundreds of other people during a pandemic? I know some localities are talking about drive-thru vaccination clinics, but that assumes everyone has access to a car and gasoline, six or twelve months into a pandemic. In place likes New York City, or New Orleans, where car ownership is low, that idea won't go very far.
- How do these PODs keep track of who has already received their first, or even second dose? Many in the public may decide that if two doses are good, three would be better. Will they issue cards? What if someone loses their card? Keeping track of who is, or isn't vaccinated, may become a big issue.
- Since pregnancy is considered a high risk factor, here in the United States pregnant women are included in the first tier of vaccinations. Exactly how will these PODs determine if a woman is pregnant? On site pregnancy tests? Requiring a letter (which may be difficult to get in a pandemic) from a doctor ?
- The same problem will arise when vaccinating tier 2 `essential personnel' (pharmacists, mortuary workers, utilities workers, community services etc.). How do you verify these people are essential? Vaccinate at their workplaces? If so, you've increased the number of PODs you need to staff. Who gets inoculated first? Pharmacists, utility workers, or `critical government' employees? A community probably won't get enough vaccine to do everyone in the same tier at the same time.
Well, you get the idea.
Manufacturing a vaccine is just the beginning of the vaccination process. Our ability to actually deliver a prioritized vaccine to billions of people over a short period of time has never been tested.
So, while I'm happy to see that progress is being made on the manufacturing end, an awful lot of things would have to go exceedingly well - under the worst possible conditions - to get billions of people vaccinated in the first couple of years of a pandemic.
Something to shoot for, of course. But it may not be possible.
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