Indonesia has still to provide the WHO flu surveillance program with any H5N1 viral isolates since the first of the year. The issue is access to what will certainly be a scarce vaccine supply if a pandemic would start in the next five or or even ten years. The leading candidate for a pandemic strain at the moment is one that starts in Indonesia, the world’s current hotspot for avian influenza both in poultry and people. So controlling access of vaccine makers to H5N1 isolate from within its borders recognizes they have something the rich countries that have the vaccine plants need. One reason Indonesia has this resource is it has done such an abysmal job of controlling the disease and in the process endangered everyone else. So they have a valid argument but it’s based on some damning history of their own.
Helen Branswell reports on WHO’s delicate mission to persuade the Indonesians they should start providing the virus again in exchange for some rather vague promises:
World Health Organization officials will take along offerings – and a sad dose of reality – when they travel to Jakarta next week to try to break a stalemate with Indonesia that threatens the globe’s capacity to track the pandemic risk posed by the H5N1 avian flu virus and make vaccines to protect against it.
The impasse was created when Indonesia announced last month it would not share H5N1 viruses with the WHO if the agency continues to allow the viruses to be made into vaccines Indonesia could not afford to buy for its citizens.
WHO officials will propose measures which over the short, medium and long terms should begin to address demands of developing countries that they too should have access to pandemic vaccine, the WHO’s influenza czar said Tuesday.
The reality will be a frank explanation of just how limited the world’s capacity to make that vaccine is at present.
“You can’t talk about access when there isn’t availability – and that’s clear in the vaccine issue,” Dr. David Heymann, WHO’s special representative for pandemic and avian influenza, said in an interview from Geneva.
“There isn’t enough vaccine. And one of the secrets is to get the capacity of production up in the long term – and that’s talking on a 10-year horizon – so that global pool of vaccine can be filled.”
Heymann insisted he and his team will be making proposals that will be attractive to developing countries angry that pandemic vaccine may be a tool available only to the richest nations.
Included among them is the notion that vaccine makers might hold back a portion of their already limited H5N1 vaccine production to be used as a virtual stockpile for developing countries. That stockpile that might be used, along with donated Tamiflu, to try to extinguish an emerging pandemic in the early days of person-to-person spread, he said. (Helen Branswell, Canadian Press)
Everyone is arguing about a vaccine that doesn’t exist and won’t exist in enough quantity to supply more than a tiny fraction of the world’s population — or even a tiny fraction of Indonesia’s population — for years to come. Indonesia is playing a very dangerous game. Either technical develops or a shift to a pandemic strain outside of Indonesia could make their bargaining chip worthless at any time. Then their current negotiating stance would be tremendous weakness, putting them far down the line for any vaccine supplies that might exist.
Indonesia and other poor countries have an important and valid point. It can only be addressed by a massive and prompt investment in global vaccine productive capacity. While they are arguing about nonsense like calling a life form “intellectual property,” the real solution to the problem is not going forward.