Commentary: From scarcity to abundance: pandemic vaccines and other agents for "have not" countries

The recent impasse between the Indonesian Ministry of Health and the World Health Organization (WHO) over sharing H5N1 viruses in return for access to affordable pandemic vaccines highlights slow progress in defining an antigen sparing vaccine formulation, developing licensing requirements that meet the needs of populations and obtaining government funding for vaccine trials. Currently, vaccine-producing countries would have difficulty producing enough doses for their own people and few doses would be left over for non-producing ("have not") countries. Yet within a few months of the onset of a new pandemic, several billion doses of live-attenuated and recombinant hemagglutinin H5 vaccines could be produced for "have not" countries, provided a new and disruptive system of "top down" management could be organized. In its absence, a "bottom-up" alternative that uses widely available and inexpensive generic agents like statins must be considered. The "have not" countries must continue to put pressure on WHO and leading countries to ensure that they will have access to the interventions they will need.