Asian Bioethics Review

Introduction

Equitable access to vaccines in the event of an influenza pandemic has been debated for a number of years, particularly since the H1N1 pandemic. With the discovery of new avian H7H9 strain (along with other “odd” subtypes; see Capua 2013), and the prospect of another pandemic looming, it is critical that our planning creates the best conditions for responding to a public health emergency. It is our opinion that these debates and the proposed solutions have so far failed to achieve what would be expected of an ethical pandemic plan in respect to vaccine production. In the most recent analysis of influenza vaccine production, it was concluded that:

Currently ... global capacity will be far from able to meet even the essential needs for a monovalent vaccine in the event of a severe influenza pandemic.

(Partridge and Kieny 2013)

In this article, we propose a reorientation of the debate from one that looks to accommodate current vaccine production, to an analysis of what might be achieved by a paradigm shift. Political solutions addressing these concerns to date have not been far reaching, and have only scratched the surface of deeper problems in vaccine production (WHO 2010b). So, after a brief account of the H1N1 pandemic and concerns we have about shortfalls in vaccine development and production, we offer three scenarios in respect to future vaccine planning. The first scenario is one in which planning remains within existing procurement contracts. In light of 2009, we see this as a problematic option given the premise that economic interests of the vaccine manufacturing industry entailed slow and inadequate delivery of a vaccine due to protracted negotiations between governments and corporations.¹ [End Page 110]

The next two scenarios suggest a more radical approach to pandemic planning based on a particular typology of rights. During an emerging influenza pandemic, civil rights are likely to be curtailed by public health measures, which may include prohibitions on public gatherings, quarantine and forced treatment. The mandate for the state to act in such circumstances derives from the belief that coordinated action benefits the community as a whole and that uninformed or irresponsible actions could risk the entire population. The purpose is to create a favourable outcome defined in terms of reaching the recovery phase with as little damage as possible to persons, social networks, institutional frameworks and economic systems. In terms of ethics, this action is defined by the justification to mobilise an effective response to protect public health in spite of civil rights. Without this explanation, it would be inexcusable for democratic governments to withhold certain freedoms from its citizens. However, the seriousness of a global influenza pandemic prompts us to question how public health ought to relate to other kinds of entities, such as pharmaceutical corporations that are responsible for the expedient development and production of an effective vaccine. During the Influenza A (H1N1-2009) pandemic (hereafter, H1N1-2009), “preparedness plans” were activated that curtailed civil rights. Yet even though problems beset the production of an effective and safe vaccine, the pharmaceutical industry escaped the same state mandates that were used to organise the public into an effective response.

The second scenario then builds on this premise to assess the possibility of vaccine production takeover. However, such an option could be too shortsighted despite the moral rhetoric of providing essential drugs to those who need them. Our last proposal considers building a national vaccine infrastructure. This is our preferred solution; one that moves away from industry dependence and towards an (inter)national infrastructure by reasserting the ethical responsibility for state-led public health responses.

Fortuitously, the 2009 pandemic turned out to be far less destructive than was initially expected, and providence allows assessment of pandemic preparedness plans. Our intention is to thus raise the prospect of reform and demonstrate why, based on current systematic failures, alternatives models of global vaccine production should be considered.

The 2009 Pandemic, Vaccine Production and the Public Good

While much has been written about the escalation of events during 2009, the responsibilities of the vaccine industry have not been a significant focus of...