However, the criterion eliminated emerging manufacturers that were keen to establish local influenza vaccine production but had not (yet) registered a vaccine for human use. In order to address the urgent need for regions such as sub-Saharan Africa to be able to produce pandemic influenza vaccine, future calls may see modified criteria to take this into account. Pfizer Licensed Compound Library To complement its review of production technologies, WHO undertook an analysis of intellectual property (IP) issues related to each manufacturing

process to identify potential IP barriers and areas where new manufacturers would have to seek licences [5]. The report noted that it was not patents, but access to technical know-how and regulatory dossiers that potentially constituted significant barriers, even for conventional egg-derived influenza vaccines. Thus, partnerships with technology holders were sought to ensure the successful and rapid establishment of production capacity. Similarly, there are no significant patent barriers to produce live attenuated influenza vaccines, which have been widely used in Russia and

the former Union of Soviet Socialist Republics for the last thirty years. Nonetheless, access to strains with a well documented safety and efficacy profile, and to corresponding regulatory documentation, would avoid the lengthy and expensive process of deriving a new LAIV through de novo attenuation of pathogenic virus strains. To facilitate access to such attenuated strains, WHO acquired from Nobilon (now Merck) Trichostatin A a licence on the technology developed by the Institute of Experimental Medicine in St Petersburg, Russia. This royalty-free licence to develop, manufacture and sell Linifanib (ABT-869) to the public sector both seasonal and pandemic egg-derived LAIV allowed WHO to provide sub-licences to manufacturers in developing countries (see article by Rudenko et al. [8]). The report also noted that no IP barriers existed in developing countries for an oil-in-water emulsion that permits considerable dose-reduction with IIV, since patents had not been filed in these areas of the world. This opened the

possibility for developing country vaccine manufacturers to produce and use adjuvants to expand IIV capacity in the event of a pandemic. Again, know-how was identified as a major hurdle. Effective technology transfer is arguably the most effective route for developing countries to secure sustainable access to quality influenza vaccine production technology. As pointed out above, technology transfer from an entity that has a registered product is the most effective, as this reduces risk to the recipient and facilitates rapid approval of the locally produced product. However, while most major vaccine manufacturers have undertaken technology transfer for early childhood vaccines, few have been willing to transfer their influenza vaccine technology.