Doctors in Asia fear western countries will grab the lion's share of vaccines and other drugs needed to fight an avian flu pandemic.
They also question the governments' apparent dependence on one antiviral treatment pending development of a vaccine, saying other treatments should be considered in head-to-head trials as part of global contingency planning.
The doctors, from Hong Kong, South Korea, Singapore and Malaysia, warn that a failure to adequately protect health workers in countries expected to be near the start of any pandemic could put such a strain on healthcare workers that they become demoralised and desert their posts.
Writing in the Lancet medical journal, they say: "Protection of core personnel should also be planned to underpin recovery in the aftermath when many key players in healthcare and governmental institutions would have perished."
Britain is among many governments that have ordered stockpiles of the antiviral Tamiflu made by Roche, ordering tablets for 14.6 million people, as well as 2m doses of vaccine against the flu currently found in birds across south-east Asia. These would have to hold the line as vaccines were developed against any flu that might mutate and threaten millions of humans worldwide.
But the Asian doctors say governments should also consider Relenza, an antiviral from GlaxoSmithKline, dispensed through an inhaler, which governments are largely ignoring because they believe it could prove difficult to administer quickly to elderly people and children, those most at risk in a pandemic. The doctors say it might show less resistance to any new virus and have fewer side-effects.
"The geographic location of vaccine manufacturers in developed countries would delay poorer Asian nations from obtaining the updated influenza vaccine," they say. Manufacturing facilities for vaccines and antivirals should be established in Asia, adding that "the ethics of maintaining drug patents in a potential worldwide catastrophe is questionable".
The Philippine health secretary, Francisco Duque, has also expressed concern at Roche's hold on the world's key defence against the pandemic. "It is almost bordering on the immoral," he said.
Roche is holding talks with the WHO about producing emergency stockpiles of Tamiflu that could be sent to affected countries as well as the orders it has signed with various governments.
A spokeswoman said yesterday the company had to triple its manufacturing orders. It had increased production sites from one to four in the US and Switzerland and had quadrupled its capacity over the past two years.
GSK has announced a deal with the German government for 1.7m doses of Relenza but has received far fewer orders. A spokesman said: "As far as flu pandemic planning is concerned, there is no reason why Relenza should not be part of any government armoury.
"We are committed to working with any government to help prepare for such an event."
