国際関係練習問題

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Tamiflu expiring in some Asian countries: Can they afford to toss and buy more?
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By MARGIE MASON
AP Medical Writer

HANOI, Vietnam (AP) -- After three years of fighting bird flu, some poor Asian nations must face a painful health dilemma: whether to spend millions of dollars to replace expiring drug stockpiles for a pandemic that may never come.

Vietnam, Cambodia and the Philippines will be the first on the front lines to see their stocks of Tamiflu medicine expire by year's end. Countries worldwide have been racing to stockpile the antiviral, which experts hope might help fight a pandemic flu, but no one knows for sure whether it will actually work.

Leaders must decide whether to play it safe and restock at great expense or gamble that the H5N1 bird flu virus will never become a mass killer and spend the money on diseases like AIDS or tuberculosis instead. This choice will eventually confront every nation that stockpiled antivirals amid fears that a pandemic was looming.

"If the threat lingers for many years, what happens then?" asked Megge Miller, an epidemiologist at the World Health Organization in Cambodia. "It's just (like) throwing money into a black hole."

Since bird flu began ravaging Asian poultry in late 2003, 80 governments worldwide have ordered enough Tamiflu to treat around 200 million people, at a cost per person of US$9 (?6.90) for the poorest countries to more than US$19 (?14.60) for the richest, said Martina Rupp, spokeswoman for the drug's manufacturer, Swiss-based Roche Holding AG.

Each person must take 10 pills to complete a treatment course. The cheapest form of Tamiflu is sold in bulk powdered form, but it poses logistical challenges because it must be measured and mixed with water for drinking.

If stored properly, Tamiflu capsules have a shelf life of five years before the outer coating starts to break down. Roche is researching whether the drug can last longer, and Rupp said the company will help countries test expired stocks for effectiveness. But some Asian health officials say they plan to simply toss their pills when the expiration date arrives.

"If they expire, we have no choice but to destroy them," said Richard Panjaitan, director general of Pharmacy and Health Equipment at Indonesia's Health Department. He said the law requires that all expired drugs be thrown out. The country's stockpile for 1.6 million people will remain good through 2009.

Since Indonesia - the nation hardest hit by bird flu with 63 deaths - also is one of the few countries where Tamiflu is not patent protected, it can produce its own cheaper version of the drug for domestic use.

Others do not want to see their supplies go to waste. Vietnam plans to start using its Tamiflu to treat patients with seasonal flu, hoping to use at least some of the medicine that's stored for 60,000 people before it expires in December, said Cao Minh Quang, who oversees the reserve. All of Hanoi's current Tamiflu was donated by Taiwan in 2005, and it's unclear whether Vietnam will restock, Cao said.

Additionally, the WHO in Hanoi has enough Tamiflu for 4,500 people that could be deployed in an emergency, said country representative Hans Troedsson.