The need for global planned mobilization of essential medicine: lessons from a massive Thai botulism outbreak.

Introduction A massive outbreak of botulism in northern Thailand in March 2006 tested international capacity to respond to a public health emergency. Botulism poisoning due to contaminated home-canned bamboo shoots caused illness in 209 villagers, of whom 134 persons were hospitalized and 42 required mechanical ventilation. A global search for Botulinum antitoxin began, involving international agencies, embassies, national laboratories, airlines and commercial organizations in seven countries. Sufficient antitoxin was obtained from four sources for treatment of 90 patients, but with delays in treatment of 5 to 9 days from time of exposure. Rapid local outbreak detection and an effective international response likely prevented mortality and additional morbidity. However, the international response to this public health emergency was informal and conducted through professional relationships rather than through predefined protocol for antitoxin acquisition. Stronger commitment through formal international agreements, including creation of global and regional stockpiles of critical medicines and supplies, is urgently needed.