Developing Countries, Vaccine Access and Influenza Outbreaks: Ethics and Global Health Governance When Facing a Pandemic

The threat posed by influenza pandemics raises serious ethical issues, as well as questions of global health governance. In order to create pre-pandemic vaccines, global health authorities need access to virus from regional outbreaks. But because the countries where these outbreaks occur are unlikely to benefit from the vaccine, they are sometimes reluctant to share this seed stock, and may try to make proprietary arrangements with pharmaceutical companies, as briefly occurred in Indonesia. Although these arrangements may increase developing countries\u27 access to vaccine, they hamper the global cooperation necessary to prepare for influenza outbreaks. Developing countries, in contrast, point to the United States\u27 decision not to use adjuvants in influenza vaccines with the 2009 H1N1 outbreak, even though this is common in Europe, and it might make tens of millions of individual doses available for donation to developing countries. Similar issues bedevil preparation efforts, particularly concerning advance contracts for vaccines. This paper will examine a number of these challenges, and the global health policies needed to address them, based on Indonesia’s 2007 decision not to share viral samples with the WHO, as well as events during the 2009 H1N1 pandemic