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.

Others 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?"

earlier related report
Swine flu's uneven spread raises pandemic questions
Take two neighbouring countries, of equal population and prosperity, each with advanced health systems.

Swine flu is bound to affect them equally, wouldn't you say?

After all, we live in a globalised world. Borders are open or porous. People -- and therefore microbes -- are highly mobile.

Which means the H1N1 virus is bound to hit both countries at roughly the same time and spread at the same rate, surely.

Yet a remarkable disparity between Britain and France shows how false such thinking can be.

And understanding why this has happened could help save lives if H1N1 genetically reshuffles into something more lethal.

"Influenza in its distribution is always heterogeneous. It doesn't go evenly everywhere," says Angus Nicoll, head of the flu programme at the European Centre for Disease Prevention and Control (ECDC) in Stockholm.

In the past two weeks, there have been nearly a quarter of a million cases of A(H1N1) in England alone. Twenty-seven have died in England since the outbreak began, and another four in Scotland.

In France, there have been 1,022 cases and a single death, announced on Thursday. And that is the official tally over three months, since the disease first emerged.

Experts say the data are reliable and even though different counting methods are used, the gulf in cases is clear. They conclude that Britain got whacked first -- and badly.

Why?

Marc Gentilini, a professor of infectious disease and former head of the French Red Cross, suggests British health surveillance may not have been as rigorous as its French counterpart in spotting and tackling early cases, especially in inner-city areas with mixed, mobile communities and big households.

"But this is just an idea. Frankly, it's impossible to know at this stage," says Gentilini.

But Alyson Warhurst, a professor at Warwick Business School in central England, says she is unsurprised by what has happened.

On June 12, a day after the World Health Organisation (WHO) declared the pandemic, her risk-assessment company, Maplecroft, ranked 213 countries according to their vulnerability to viral spread.

It placed Britain squarely at the top -- unexpected given that the country has one of the best health services in the world. France, whose health system persistently ranks at or near the top, ranked 33rd in risk.

But Warhurst explains Britain was susceptible because it has a very dense population, a very high proportion of urban dwellers and a large number of people arriving from abroad.

"While the risk factors for France are high in terms of tourist arrivals, population density (there) is not so high as in the UK," she explained to AFP.

Canadian researchers have found strong evidence for the role of jet travel in propagating the virus.

Kamran Khan of St. Michael's Hospital, Toronto, analysed the flight itineraries of more than 2.3 million passengers who left Mexico, where the new flu erupted, in March and April.

Their destinations mirrored places where swine flu swiftly started up, notably cities in the United States, Canada, Spain, Argentina and Brazil.

France was the third biggest destination while Britain ranked 11th, figures that confirm Warhurst's belief that foreign arrivals are a factor in spreading flu but not the only one.

There are several other hypotheses to explain swine flu's faster spread in Britain, says Thomas House, an epidemiologist at the University of Warwick.

They include damper weather compared with France -- the virus is more vulnerable to dry conditions -- and even different school systems.

France's schoolchildren began their summer vacation at the end of June, while Britain's began theirs two weeks later, and during this period, its flu cases took off.

Yet within the puzzle is another puzzle: swine flu prevalence in Britain is not homogenous. It varies greatly among regions and even within cities.

That raises intriguing questions about "micro-networks" of transmission at work, in transport or socially.

All this offers priceless knowledge if pandemic flu -- right now, relatively mild - becomes more virulent, said House.

For instance, closing an airport may be impossible, but screening incoming travellers may be useful. School closures, or extending school holidays, could in some cases also be helpful. Targeting districts or communities that seem more at risk would also be beneficial. Antiviral drugs, if stockpiled and used in time, can also brake the spread.

"There are some things we can do in public hygiene, in keeping people away from certain locuses where there is strong mixing, giving antivirals, all these things make a difference and are very sensible things to do," said House.

"It's certain that by doing those we will reduce human suffering compared to previous pandemics."

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