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An avian-flu pandemic would overwhelm America's frail vaccine industry. A look at why it declined-and how it could recover.
In 2004, a 16-month-old boy died of pneumonia at the Children's Hospital of Philadelphia. He shouldn't have passed away-and therein lies a cautionary tale about the threat of avian flu. * The toddler was infected by a bacteria called pneumococcus. Before 2000, pneumococcus was often a death sentence. Worldwide, more than 1 million children died every year, according to the World Health Organization. The situation changed dramatically in 2000, when the pharmaceutical giant Wyeth brought to market a revolutionary vaccine that guarded against pneumococcus in young children. Suddenly, parents and doctors with access to the vaccine no longer had to fear pneumococcus as a killer.
But in 2004 the vaccine was in short supply, and the Philadelphia toddler received only two of the recommended four doses. "The pneumococcus isolated from the child's blood was a type that could have been prevented by the vaccine," Paul Offit, chief of the division of infectious diseases at Children's Hospital, wrote in a 2005 book called The Cutter Incident, named after a vaccine manufacturer that was sued in the 1950s over its polio vaccine. If the vaccine were made by several companies, he wrote, "children wouldn't have to rely on the production efficiency of one company to save their lives."
To the dismay of public health officials, vaccine shortages have become routine in the United States. Most vaccines now come from only one producer, and that leaves no margin of error when things go wrong in the production process-and they sometimes do. Between 1998 and 2004, nine of the 12 vaccines routinely given to children were in short supply at one time or another. The Centers for Disease Control and Prevention reported shortages of vaccines for chickenpox, diphtheria, flu, measles, mumps, pertussis, rubella (German measles), pneumococcus, and tetanus.
Over the past three decades, the vaccine infrastructure in the United States has steadily crumbled, and as Americans learn more about the deadly avian flu, concern about vaccine availability has escalated to fear, and even panic. The companies that would make vaccines for pandemic flu are the same ones that make seasonal flu vaccines, and only one of those suppliers-Sanofi-Pasteur, the...