November 03, 2005
A Mystery Solved
It took a few days, but I finally figured out the logic behind the Bush administration’s plan to spend $1.2 billion for 20 million doses of avian flu vaccine. This comes out to $60 a dose, far higher than previous flu vaccines which have been made available to public health authorities at $10 a dose or less.
Why the disparity? A spokesman for the Health and Human Services Department late Wednesday explained it this way:
Earlier this year, the National Institutes for Allergy and Infectious Diseases (NIAID) developed an experimental vaccine that prompted a weak immune response against H5N1 avian flu in about 400 test volunteers. In order to get that response, the government investigators had to inject two 90-microgram doses of vaccine – about 12 times the size of the seasonal flu vaccine, which weighs in at 15 micrograms.
On top of this weak response, there is a strong likelihood that the H5N1 avian flu vaccine won’t be very effective against the mutation that causes a pandemic. After all, it will be different from H5N1, which doesn’t easily move from human to human.
Despite these weaknesses, the government late last month ordered 20 million 15-microgram units of the H5N1 vaccine from Sanofi-Pasteur for $100 million ($5 per 15-microgram unit) and 12 million 15-microgram units from Chiron for $62 million (also about $5 per 15-microgram unit).
In outlining the advanced purchase program Tuesday, officials at HHS assumed it would take 12 of these 15-microgram units per vaccine if it was going to provide any help at all. That comes to about $60 per vaccine. This is nearly as high a price as gougers charged last year when the seasonal flu vaccine ran short, but it is reasonable in this case because the volume (and hence the amount of chicken eggs needed to produce it) is 12 times the size of the seasonal flu vaccine.
Meanwhile, Dr. Daniel Vasella, the chairman of Novartis, told the Wall Street Journal yesterday that the company wanted immunity from lawsuits before launching into manufacturing this “experimental” vaccine, which hasn’t been adequately tested in human. The company earlier this week offered to buy the 58 percent of Chiron it doesn’t already own for $5.1 billion and the last thing it wants on its hands is a Johnson & Johnson scenario (that company is backtracking from its offer for Guidant, the medical device manufacturer which has had numerous manufacturing problems with its cardiovascular stents).
The Journal also carried an interesting op-ed today by Johns Hopkins infectious disease specialist Donald S. Burke, who endorsed the Bush administration’s $7.1 billion program. But in doing so, he pointed out that beefing up the nation’s public health infrastructure and response capability was really the most important part of the plan.
“Can we stop it?,” Burke asked. “My public health and computational modeling colleagues have been furiously at work devising strategies to stop an epidemic or mitigate its impact. Our models show that it may be possible to identify a human outbreak at the earliest stage, while there are fewer than 100 cases, and deploy international resources -- such as a WHO stockpile of antiviral drugs -- to rapidly quench it. This 'tipping point' strategy is highly cost-effective. More reactive strategies, in which the U.S. protects its own borders in the face of a growing global pandemic, will have limited success. U.S. leadership in the International Partnership of Avian and Pandemic Influenza is a visionary step. Epidemics are global in nature, and demand a concerted international response if they are to be thwarted. The new mindset should be one that focuses upstream on the earliest events, emphasizing prediction and prevention before a pandemic begins.”
Burke still wants the government to pour money into stockpiling antivirals and vaccines. But like most public health experts, he knows that the best way to prevent a pandemic is to nip it in the bud with a strong public health response.