The current outbreak of influenza A (H1N1) “is testing pandemic preparedness strategies across the globe”, notes a new report, but while the world is better prepared than ever before, “important gaps regarding the logistics of drug and vaccine distribution remain”.

Datamonitor’s report notes that pandemic preparedness – stockpiling of antivirals, surveillance, measures to prevent the spread of infection and the development of vaccines – seems to be living up to the challenge caused by the outbreak of swine flu. The response has been “swift, visible and appears to be highly effective” but to date H1N1 has proved to be relatively mild with Mexico the only country to report significant mortality. Consequently, “the current outbreak has not yet tested the limits of global public health systems”.

The study claims that Roche’s Tamiflu (oseltamivir) and GlaxoSmithKline’s Relenza (zanamivir) are a good first liner of defence but “given the widespread confusion in the community regarding the mechanism of action and time of administration of influenza antivirals, it is crucial to improve public education in order to avoid panic and unnecessary supply shortages”. Also, considering the possibility that the virus could become resistant to Tamiflu and/or Relenza, “governments should not rely on antivirals alone”, Datamonitor says.

The analysis also claims that “an immediate switch from seasonal to pandemic influenza vaccine production is highly unlikely”, as this would jeopardize vaccine supply for the prevention of the former in the 2009/2010 season. It adds the development of “new, pandemic-relevant technologies and products” have the potential to overcome the current bottlenecks of long vaccine production times and manufacturing capacity shortages but most of these new technologies have not yet received regulatory approval.

As such, “unless the H1N1 pandemic takes a sudden turn for the worse”, Datamonitor expects regulators to continue relying on the “established and lengthy, but proven safe influenza vaccine manufacturing process in chicken eggs”.

The report adds that “speed, efficient mass distribution and delivery of vaccines could become a serious bottleneck in a pandemic response”. It requires “a seamless supply chain for the final product”, and consequently “the rapid transformation of existing public health infrastructure to deliver mass vaccinations”.

Datamonitor infectious diseases senior analyst Hedwig Kresse said that seeing as the current H1N1 outbreak is likely to remain relatively mild over the summer in the northern hemisphere, “governments and healthcare authorities will have an opportunity to reassess and improve their pandemic strategies over the coming months”. This interim period should be used to “re-evaluate and optimise the pandemic response”, to replenish stockpiles and develop and manufacture a vaccine before a more virulent version of the virus can return’, she said.

Ms Kress concluded by saying that”a timely re-assessment and implementation of anti-pandemic measures is our best hope to…avoid the millions of deaths observed in previous global influenza outbreaks”.