PARTICIPANT: I think it is a little unrealistic to ask industry to increase capacity to the surge that would be needed for a pandemic, especially when we have to recognize that we are not controlling inter-influenza now. I think the burden on us is to increase demand. Right now the ACIP recommendations include 185 million people. And you know how much vaccine we regularly distribute here. So, if we were distributing anywhere near the amount that we recommend, a lot of that supply problem would be taken care of. The same goes for antivirals. I do not think we are using antivirals nearly as effectively as we could to supply vaccine. And if we were doing that, recognizing flu in the community has occurred, and treating it appropriately, we would increase the demand, and therefore increase the supply. So, I think that is something we need to work on, and help industry work toward the goals that we have for pandemic preparedness.

DR. FINEBERG: Do you think it is imaginable that there could be an experimental demonstration, or does it just have to happen gradually across the country? Could there be a state or a region which said we are going to take this seriously. We are going to get our professional groups, we are going to get industry, we are going to get the public health authorities, we are going to have a community education program, we are going to make sure every family knows how important this is, et cetera, could that be imaginable?

PARTICIPANT: I think it is not only imaginable, I think that is what we are trying to do now. And I would just like to have more support and other groups to join us.

PARTICIPANT: I have actually seen a number of pharmaceutical people here, more than I thought might be here. I've seen leaders from GSK, Chiron, and Merck. I am really glad for the opportunity to be here and be part of this dialogue.

I just wanted to say even though we do not currently have a flu vaccine on the market, we certainly did have one in the past. Our interest in influenza has never waned, whether it is a vaccine or the antiviral efforts. And there are different roles for different aspects of the industry.

I do not know that it is the best thing at this time to be a contract manufacturer for egg-based vaccines. Certainly in an emergency we will do whatever needs to be done. What we focused on, particularly in the last decade in the 15 years among other things, is trying to come up with new ways of making better flu vaccines and getting broader immunity is really the goal of our work. That may or may not be something that is going to be feasible in our lifetimes, but certainly there is unmet need there, and that is something the world needs. And we are looking for ways to not only continue our efforts; we are looking for support and communication with groups like this one to do a better with this.

DR. FINEBERG: Thank you for your comment. I think you also in these remarks, highlight the transitions in capacities and interests that are represented I would say in universities, as in industry and in government increasingly as well. And thinking afresh about the relative contributions that can be made I think is a very important reminder, and a very welcome one.

PARTICIPANT: I would just like to highlight a theme that has been mentioned several times in the course of these meetings, but perhaps one that needs emphasis. And that is, this is an international event with which we would be dealing for this. And certainly one of the issues that needs a top priority, if not in terms of resource commitment, at least in terms of policy evaluation is if there is indeed a limited supply of antivirals, and that is possessed by the more developed countries, what is that commitment to the developing world? Because this is where at least most



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