Inside, a world of biotech is gathering momentum--whirring steel tanks, moving glass vials, humming fermentors and fast-flowing filters. India is developing a modern flu vaccine for the first time in history.

With 208 countries reporting at least 14,142 deaths, the pandemic virus has spun a complex tale of its own. It has united the world in ties of fear, split it up over the race for a vaccine, tied it up in knotty blame-games and offered a real-world drill to find gaps in the way nations handle epidemics. If initially all eyes were turned to the infection, now the spotlight is on vaccination.

"ALREADY THE VIRUS HAS SPREAD OUT. BY THE TIME ONE YEAR IS THROUGH, MOST PEOPLE WOULD HAVE ANTIBODIES. THEY WON'T NEED THE VACCINE." Dr V.M. Katoch, Director General, ICMR

Not much, beyond airport screenings, a few test centres and antivirals. "We will be among the first few countries to come out with an indigenous vaccine by the end of this year," Union Health Minister Ghulam Nabi Azad had declared at the peak of the pandemic panic.

But by October, as vaccines appeared in the western world, it became quite clear that India had been pipped to the post in the vaccine race. The titillating possibility of a homespun vaccine does the rounds every month, as deadlines are systematically pushed back--from January, February, March, April to June 2010.

Global flu tracker

• 208 countries report 14,142 deaths.
• 52% infected are between age 16 and 44.
• 462 people per million infected in Australia.
• It's the highest infection rate per capita.
• 47 million people infected in the US, considered the largest infection hub in the world.
• 600 million vaccine doses stockpiled by the US, 130 million by the UK, 94 million in France--more than one for every citizen.

Meantime, as reports of a public backlash against the pandemic vaccine in the West circulate, a new debate emerges in India: do we need a vaccine, after all? And will it really protect us?

"The flu is past its prime and you want to give the vaccine now?" asks an angry Dr Madhav G. Deo. When the man who brewed the first anti-leprosy vaccine in India gets agitated, it's time to sit up and take note. Throughout the flu odyssey, Deo has been trying to make sense of the unconventional virus. But never in his life has he felt so frustrated--not while teaching pathology at the All India Institute of Medical Sciences (AIIMS), not as the chief of the Cancer Research Institute, not in his efforts to disseminate cutting-edge knowledge to rural students.

He gets irritated when the vaccine is projected as a panacea for taming the novel H1N1, feels let down when the Government listens to a cacophony of messages and announces ad hoc policies, and gets scared at the thought that India may have missed a "unique opportunity" to understand a pandemic threat, let alone to develop an effective treatment.

With 28,251 cases and a death toll of 1,136 so far, India has not seen a raging pandemic spread compared to the global majors. The US has the highest infection rate (47 million), while Australia saw the highest number per capita (462 per million). It's quite clear now that there are likely to be far fewer deaths from H1N1 than was initially believed. So why does one need to get vaccinated?

Don't worry, the Government probably doesn't have you on the radar. "We will give it to high-risk groups," says Dr V.M. Katoch, director-general of the Indian Council of Medical Research. Apart from healthcare professionals, pregnant women, emergency workers, etc, the virus is expected to lose out through collective natural immunity.

"A community develops immunity when more and more people get infected and start developing resistance to the pathogen," he says. He mentions a study done on Panchgani schoolchildren in Pune: "About 60 per cent of children developed antibodies within a week. Less than 5 per cent got the clinical disease. And all responded to the drug."

"WOULD YOU CALL THIS A PANDEMIC? THE FLU IS PAST ITS PRIME. IN FACT, IT IS PLATEAUING. IS THIS THE RIGHT TIME TO INTRODUCE A VACCINE? Dr M.G. Deo, Pathologist and Former Chief, Cancer Research Institute

"OTHER COUNTRIES HAVE A BACKGROUND OF REGULARLY USING SEASONAL FLU VACCINE. SO IT'S MUCH EASIER FOR THEM TO SWITCH TO A NEW STRAIN." Dr T. Jacob John, Professor Emeritus, Clininal Virology, CMC, Vellore

Listen to what experts say on the effectiveness of vaccines. "Vaccination may be the crucial line of defence in most countries, but every flu vaccine is not effective," says Katoch. Western countries have a background of regularly using seasonal flu vaccines. It's easier for them to come up with a new flu vaccine using a new strain. But influenza has never been on India's radar. "We had to start from scratch, needed more start-up time, had to fast-track the new vaccine." he adds.

"But what if they don't work or have undesirable effects," asks Deo. He recalls the Swine Flu Fiasco of 1976--a projected pandemic in the US that actually never happened. The new vaccine was administered to 40 million people and resulted in severe pulmonary complications and Guillian Barre Syndrome (an autoimmune disorder). "Because of the unacceptable side effects, the vaccine was withdrawn and the US government paid millions as compensation."

Epidemiology, economics and ethics form the three pillars of public health. To Dr T. Jacob John, a distinguished force in infectious diseases in India and the former head of clinical virology at Christian Medical College, Vellore, the pandemic management appears limited in all three.

"There's an unfortunate lack of clarity in the national policy," he says. "The Government has done as much as they could, with the best of intentions. But that's not enough to pay the right dividends." To the man who first reported oral polio vaccine efficacy problems in India and was the first to identify individuals with HIV infection in the country, a serious lack of attention to influenza has resulted in this.

"We never developed a policy on the study of epidemiology and interventions of endemic influenza, including the need for vaccination," he points out. The Pasteur Institute of India in Coonoor, for instance, had first isolated the H2N2 and H3N2 strains during the pandemics of 1957 and 1968. But that knowledge, which could have proved precious now, was left to gather dust, he explains.

The economics of swine flu vaccine also doesn't work in India's favour. The Government committed Rs 333 crore to check the pandemic. A worthy amount, but certainly not in the same league as the global majors that are driving free, mass vaccination campaigns.

The UK Government, for instance, spent more than £100 crore in preparation for a flu pandemic and is ready with 130 million dozes--more than one for every citizen.

The US started with $100 crore and kept $750 crore more available in emergency preparedness funds. No wonder, the country has stockpiled 600 million doses of vaccine. With imported vaccines at Rs 300-500 and indigenous varieties at Rs 50-100 per vial, mass vaccination is hardly practicable for India.

"Our philosophy of high volume and low cost would definitely be the real answer to providing affordable vaccine," adds Cyrus Poonawalla, CMD, Serum Institute. "But that depends to a large extent on both the World Health Organization (WHO) and the Government to lift, support, procure and stockpile the vaccine."

There are some troubling issues with the pandemic in India that refuse to go away: India may not have seen a raging spread compared to the global figures, but the death toll has been twice the world rate (1.9: 0.82 per cent). Also, 75 per cent of the infection has been heavily concentrated in the more affluent urban centres. Surprisingly, that's not because of the presence of unhygienic slums in cities.

Deo's study, for instance, shows that slum dwellers of Pune (42 per cent of the 4 million population) account for just 4.5 per cent of the deaths. The country is witnessing a spurt in new pockets-- Maharashtra, Rajasthan, Karnataka and Gujarat--from mid-December.

Will it spin out of control during the next flu season of July-August? The answer, like the capricious virus, is blowing in the wind. The novel virus created panic in public mind from the very beginning.

With the WHO now admitting that its seriousness may have been overestimated (and with reports on "conflict of interest" between its committee members and pharma majors doing the rounds) the confusion is fast turning into a "pandemic double think": some rubbishing it as a "hoax", others waiting to get immunised, and still others determinedly refusing to get a vaccine whose efficacy is still untested.

The road ahead is uncertain, but definitely not short. The health sector can start by thanking its stars that the pandemic proved to be mild. The need of the hour is to learn from the experience and shore up a shaky public health infrastructure to prevent a future disaster. The next time, we might not be so lucky.

Do you need the vaccine? 6 points to consider before you go in for a jab... SPREAD BET: It's official: there's likely to be far fewer deaths from the H1N1 virus than was initially believed. So should you bother? TIME FACTOR: To be effective, the vaccine has to be given before a flu 'season'. India is too late, even if it starts in February. SAFETY FIRST: India has little experience in flu vaccines. Plus it is being fast-tracked.Will the speed of manufacturing sacrifice quality? MATCH MAKING: Flu virus mutates. So vaccines are made by guessing at strains likely to appear next season. Effective only if the match is good. WAVE THEORY: Constant mutations often do not allow vaccines to provide immunity and protection during later waves. SIDE EFFECTS: In the past, there've been instances of death and debilitating diseases as the side effect of a new vaccine. VERDICT: Go slow.