Poorer countries in Africa, Asia and Latin America are far from ready to deal with an H1N1 pandemic, and will need help to develop stockpiles of drugs and vaccines, health officials announced on Monday.

Senior health officials from 193 member countries are currently attending the 62nd World Health Assembly which opened yesterday in Geneva. While the purpose of the meeting is to review the activities of the World Health Organization and set new priorities for the future, the subject of the new H1N1 outbreaks and preparing for a possible pandemic is likely to dominate the agenda.

The meeting will finish early, on Friday, so that ministers can get back and deal with the crisis in their own countries.

Tonga's health minister said it was fortunate in a way that the new H1N1 strain is affecting affluent countries like the United States, Canada, Spain, Britain and Japan first, according to a report from Reuters news agency.

"Somehow, somebody decided to start this epidemic in very rich countries ..." said Health Minister Viliami Tangi, who is also deputy prime minister of Tonga.

"This helped all of us," he said, explaining that poorer nations don't have the medical equipment, people, drugs and vaccine capacity to tackle the outbreak as well as the richer nations.

African health officials are concerned that if H1N1 starts to spread there it will hit their populations much harder because many people have HIV/AIDS and other chronic diseases.

At present fewer than 100 of the thousands of confirmed cases of new H1N1 have resulted in deaths, showing that the current strain is a mild one (unlike the much deadlier H5N1 avian flu), but this ratio could change dramatically if and when H1N1 spreads in poorer nations with a high burden of chronic diseases.

In her opening address, Dr Margaret Chan, Director-General of the World Health Organization, also talked about this.

She said that today, about 85 per cent of people with chronic diseases are in low and middle income countries, and the "implications are obvious".

"The developing world has, by far, the largest pool of people at risk for severe and fatal H1N1 infections," said Chan, explaining that so far, as many as 25 per cent of H1N1 cases have been accompanied by diarrhoea or vomiting, which is unusual. If the virus is shed via fecal matter, this will be especially significant in areas with poor sanitation, such as crowded shanty towns.

The world has not seen a pandemic since the emergence of HIV/AIDS, and the resurgence of tuberculosis, including its drug-resistant forms. At present, there are millions of people affected by these diseases, living in countries with overburdened, underfunded and understaffed health systems, said Chan, who then posed two questions:

"What will happen if sudden surges in the number of people requiring care for influenza push already fragile health services over the brink?"

"What will happen if the world sees the end of an influenza pandemic, only to find itself confronted, say, with an epidemic of extensively drug-resistant tuberculosis?"

Chan urged all delegates to look at "anything and everything" that we can all do "to prevent developing countries from, once again, bearing the brunt of a global contagion".

She said that while not all people become infected, nearly all people are at risk when a pandemic occurs, and that manufacturing capacity for drugs and vaccines will not be enough to treat a global population of 6.8 billion people.

"It is absolutely essential that countries do not squander these precious resources through poorly targeted measures," said Chan.

Thailand's delegate said the global financial crisis should not stop the more affluent nations and pharmaceutical companies making sure that antiviral medicines like Tamiflu and Relenza reach the poorer nations.

Reuters reported that Nimal Siripala de Silva, health minister for Sri Lanka and president of this year's WHO assembly said he hoped officials in Geneva would reach an agreement about how vaccine makers should deal with samples of viruses they use to make H1N1 injections.

In the case of H5N1 avian flu, developing nations such as Indonesia have been reluctant to provide samples to companies that then patent the injections and sell them at rates poorer countries can't afford.

Siripala de Silva said it was important to reach a "just and fair resolution" on this problem.

Chinese Health Minister Chen Zhu also said that international cooperation was essential.

"Economic globalization has led to a global transmission of diseases. To address this global challenge, a better way is to take global actions," Chen told the assembly.

He called for better cooperation and a demonstration of solidarity. Nations should support each other by sharing information, technology and knowledge and work together to stop the disease from threatening the economic and social development of mankind, reported Xinhua, the Chinese state news agency.

"The Chinese government would like to cooperate with other countries and relevant international organizations in sharing information, technology and best practices in outbreak response, to better cope with this challenge to global public health," said Chen.

Chen also said China would host an international seminar in Beijing in July to discuss the prevention and control of A/H1N1 influenza, and to share experience and enhance capacity of response in the event of a pandemic, he added.

Later this week, WHO Director General Chan and UN Secretary-General Ban Ki-moon will be meeting with chiefs of the top pharmaceutical companies to talk about vaccine making capacity for H1N1.

The current world capacity for flu vaccines lies with about 20 companies around the world, incuding Sanofi-Aventis, Novartis and Baxter International, said a report in the Guardian earlier today.

Many health officials are concerned that switching capacity to focus exclusively on H1N1 will cut production of vaccine for seasonal flu, which kills up to half a million people worldwide every year.

Sources: Reuters, Xinhua, WHO, Guardian.

: Catharine Paddock, PhD

View drug information on Relenza; Tamiflu capsule.