As the rich countries of the West burn billions of dollars in "preparing" for a looming swine flu pandemic, as vaccines, Tamiflu and face masks fly off shelves to combat a still-dormant disease, a bitter debate about equity is starting to swirl.
Some critics say the spending is so imbalanced that it amounts to health apartheid, protecting rich countries against H1N1 but leaving poor nations to fend for themselves.
AdvertisementOthers argue gargantuan sums are being spent on a disease that is no more lethal than seasonal flu, which is grotesquely disproportionate when thousands die each day of less media-friendly diseases.
"It's another example of the gap between the north and south," said Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
"In the (wealthy countries of the) north, vaccines are being stockpiled, antiviral drugs are being stockpiled, all with the risk that these things will not be effective," he said in an interview with AFP.
"In the (poor countries of the) south, there are neither diagnostics nor treatment."
Vaccines and antiviral drugs are being allocated for poor countries under strategies espoused by the United Nations, through gifts by countries at the bilateral level and as donations by pharmaceutical giants.
But UN Secretary General Ban Ki-moon and World Health Organisation (WHO) chief Margaret Chan say there is a worrying shortfall.
They are pounding the drum for a billion dollars to help poor countries to shore up their defences.
"Manufacturing capacity for influenza vaccines is finite and woefully inadequate for a world of 6.8 billion people, nearly all of whom are susceptible to infection by this entirely new and highly contagious virus," Chan said on July 14.
"The lion's share of these limited supplies will go to wealthy countries. Again we see the advantage of affluence. Again we see access denied by an inability to pay."
Another question is whether huge spending on a pandemic of swine flu is morally right.
Each day, around 11,500 people are killed from the long-running, entrenched pandemics of AIDS, malaria and TB. Swine flu has killed 816 people since the disease was notified in April, according to a WHO toll issued on July 27.
Marc Gentilini, a professor of infectious disease and former head of the French Red Cross, scathingly calls swine flu a "a pandemic of indecency," in which rich-world politicians opened the financial spigots to forestall accusations of not doing enough.
He gave the example of France which is spending a billion euros (1.4 billion dollars) to buy enough vaccines to inoculate its population of 60 million.
The vaccine is currently being tested for safety and effectiveness, and should be ready in the next two to four months, although the precise date is unclear.
Just as uncertain is whether the vaccine, formulated against the current strain of H1N1, will provide a shield if the virus mutates into a more lethal form, which is the big fear.
"A billion euros for a vaccine with so many unknowns, it's pure haste," said Gentilini. "This is money that can be better used elsewhere. It's ethically unacceptable."
Defenders of the big-spending strategies say three influenza pandemics in the 20th century, especially the "Spanish flu" of 1918-19 that slew tens of millions of people, point to the need for preparedness.
A day after the WHO had declared the new flu to be a pandemic, New York microbiologists Taia Wang and Peter Palese wrote to the US journal Cell to urge a sense of proportion.
There was little sign that the circulating virus will cause a pandemic on the scale of the past, and vaccines, antivirals and antibiotics are all weapons today that doctors did not have in 1918, they said.
"Around 80,000 children die from malaria and more than twice that number of diarrhoeal diseases worldwide in any four-week period," they said.
"On a scale of global health crises, the current H1N1 swine influenza outbreak would seem to rank low on the list. Why, then, has this outbreak caused such alarm?"