Effect Measure

The Indonesian vaccine problem again

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.


  1. #1 Andrew Jeremijenko
    March 21, 2007

    “Govt backs Jakarta in bird flu row”
    Virus samples may be withheld from WHO
    By: Apiradee Treerutkuarkul
    “Thailand has backed Indonesia in refusing to share samples of the H5N1 avian influenza virus with the World Health Organisation (WHO), unless it can be sure of getting a share of any vaccines made. ”We don’t want to take advantage of anyone. Fair distribution is all we want,” said Public Health Minister Mongkol na Songkhla.
    Thailand will make its case at a WHO-organised meeting on vaccine agreements in Jakarta next week. Deputy Health Minister Morakot Kornkasem and special adviser to the health minister Suwit Wibulpolprasert will represent Thailand in talks about sharing virus samples. Dr Mongkol said he believed the 10 Association of Southeast Asian Nations country members would take the same stance as they were facing similar problems in dealing with bird flu outbreaks.
    The WHO has called a meeting to seek ways of making sure drug companies can make more vaccines, and that these vaccines will be available to all countries that need them. Indonesia insisted that it would only share samples of the H5N1 virus strain if it could be certain that the samples would not be used to make vaccines that would profit any company or another country. It feared that it might be the last to get vaccines against H5N1 should the disease evolve into a pandemic.
    Dr Mongkol claimed the country had not received any benefits by sharing virus samples with vaccine companies via the WHO. It seemed that companies received most benefits from developing vaccines, before offering small benefits to cash-strapped countries for ”charitable purposes”. Dr Suwit said the virus sharing policy should be based on ”fair benefit distribution” and that the WHO as the organisation overseeing the issue on behalf of its member nations should develop a system to ensure that developing countries most at risk of an influenza pandemic would get the vaccines.
    At present, the country would continue sending samples of the virus to WHO if any new human case was found, he said. P. T. Jayawickramarajah, the WHO representative in Thailand, said the WHO’s stance was neutral.”
    end of article

    In my view this is a nice distraction and interesting hypothetical debate, but the efforts Indonesia and now Thailand are focusing on trying to get their hands on to limited vaccine, should be focused on helping the world try to understand this virus and hopefully stop the pandemic. The money and time should be put towards research, effective controls and the sharing of knowledge.

    Bottom line if the pandemic breaks, all the models predict third world countries like Indonesia will be decimated before enough vaccine to control the virus is available. They are making a choice to put their 240 million people and the rest of the world at risk to argue a point that will be unlikely to assist them.

    The virus is continuing to mutate and Indonesia is continuing to block the study of the virus, not only by not sharing but in many other ways as well. In effect Indonesia is trying to take our focus off criticising them by criticising the “unfair” system.

    Whose fault is it that Indonesia has not adequately funded its own universities and research such as vaccine manufacturing. The scientific inadequacies in Indonesia are largely of its own making. To blackmail the world with a deadly virus to share a limited vaccine because they haven’t invested in their own facilities, somehow seems inappropriate.

    If a pandemic comes I hope that those who refused to share viruses, refused to effectively control the virus and refused to let others help are remembered. If any of them survive they should be held partially accountable for their role in killing millions of people.

  2. #2 Tom DVM
    March 21, 2007

    The World Health Organization is upset with Indonesia…but are falling all over themselves to congratulate China on its openness?

    That is the problem when the ‘Pied Piper’, the World Health Organization, has double standards and questionable ethics…no one want’s to join the parade.

    Next to China’s many and varied transgressions of the past ten years, Indonesia is taking a highly principled stand on behalf of their citizens…isn’t that the role of Government?

  3. #3 M.Randolph Kruger
    March 21, 2007

    I dunno Tom, regardless of whether the principles are right and the reasons wrong it equates to dead people all the way across. Indonesia’s time and ability to do this is shrinking every hour and day and will last right up until Myanmar or Australia or the PI turns up with it. Then its likely to the highest bidder anyway. The Indons ARE taking a stance like its their virus and its really a money thing with them anyway. Their people will still be just as sick from Dengue, Typhus, Typhoid, Malaria even if they do or dont. Revere saw both sides of the coin and thats what its about. Nobel Prizes and money… is there really any difference.

    The last guy I saw that had no money aspirations beyond where he was as a doc was Fred G. Banting. I believe he died on an airplane ride to England to plead for the right to work on the front lines. He discovered insulin, made an annual grant of 7500 bucks from the Canuck government. His discovery of insulin made him literally run down the halls of the hospitals shoving this stuff into people as both guinea pigs and savior. Last ditch for most and he didnt even from what I read know what to charge them for the stuff beyond what it cost to pull cow pancreas out.

    Are the Indons right or wrong? They are right up until this shit breaks out, then they are dead wrong and their own people are going to suffer in a huge way. It just cant be done the way they want after it breaks because everyone will remember their little transgressions against the mighty UN. I make no aspersions because I dont plan to ever see any vaccine, so I doom and gloom everyone I see so they will prepare like I have. Why? Because six months after it breaks out in a four month wave scenario means that everyone is deluding themselves anyway. Vaccine? Posh! Vaccine means politicians and disaster workers. It doesnt mean me for the first reason, the second is that I wont take it even if it is available… I can protect myself to a military score of 98% in biowarfare. If it gets me then, well its destined. Besides, if it were available I would want someone else to have it. Maybe my over prepared kids and wife.

    Talk about slippery slopes, this is one that goes into alligator pits on either side.

  4. #4 Patch
    March 21, 2007


    I fail to see the logic in condemning the WHO or the UN, in the same breath as Indonesia. Just like “something is better than nothing” in the vaccine world, so it goes with the UN and WHO. At least SOMEBODY is trying to pull things together. I applaud any organization doing ANYTHING. I beleive any work deserves our respect. Certainly we can’t fault the WHO (or it’s leader) for the China gov’t.

    Is Indonesia truly concerned enough about H5N1 and it’s citizens alone, to make such a threat? It’s right in their backyard..they’ve seen what it can do. But why then aren’t they doing everything in their power to stop this monster? Maybe money IS the issue?? I’m just asking.

  5. #5 Tom DVM
    March 21, 2007

    Randolph. China is the mix master…the incubator of this thing. They are the ones refusing to release the index case sequence from the soldier or soldiers. They are the ones emailing American Journals to block publications. They are the ones retracting pig sequences so no one can look at them…and they are the ones at the head of the recieving line for the World Health Organization and the United Nations while the WHO prevents any involvment by Taiwan.

    Indonesia is a dead-end by the World Health Organizations own admission. These are imported strains from China that are dead ended there for the moment.

    I am not saying there is no risk but why should the other Asian countries release their sequences when there is a double standard for China.

    Whether Indonesia every releases another sequence doesn’t change the fact that China is where the pandemic will be cooked up and I would imagine that a large numbers of humans have already been vaccinated created from sequences that we are never going to see.

    Soon…very soon…any credibility the WHO has left will be gone…it will be no great loss because they are doing more harm then good anyway.

  6. #6 caia
    March 21, 2007

    Andrew: I don’t actually blame the Indonesian government for not having created their own vaccine infrastructure. Indonesia is not a wealthy country, and until recently, doing so was not clearly an urgent public health need. The U.S. also needs to increase and update its vaccine production capacity, and we haven’t done that either.

    What I do blame the Indonesian government for is how they denied they had H5N1 in poultry for a year or more, because they didn’t want to hurt tourism or the poultry industry. In doing so, they lost any chance they had of preventing it from becoming endemic in birds, and thus made themselves one likely candidate for the dubious honor of becoming ground zero of a pandemic.

    But there’s plenty of blame to go around, and there will be more if and when a pandemic hits. I hope the Indonesian government isn’t pinning their hopes on vaccines, rather than trying to control the disease now… because even if they got all the world could make as fast as the world can currently make it, it wouldn’t do them much good.

  7. #7 v
    March 22, 2007

    Every time Australia tries to ask the Indonesians to be accountable for the millions of Australian dollars that are given in aid, Indonesians become extremely agitated, with violent mass demonstrations in the streets, and extremely abusive rhetoric about Australia and her peoples. Diplomatic relations breaks down and we come in for months of tit for tat.

    It is a cultural thing. Negotiation Indonesian style. So while Indonesia tries to get more foreign aid and drugs for her peoples, we are forced to sit back, play the fiddle and watch while Rome burns (so to speak).

  8. #8 Jason
    March 22, 2007

    I don’t blame Indonesia for not trusting the WHO here. Look at the secret deal the WHO Secretariat cut with China in 2005 giving China the right of first refusal for any assistance the WHO may give Taiwan. It’s always sad to see purportedly responsible countries play politics with health, yet here we are.

  9. #9 M. Randolph Kruger
    March 22, 2007

    I guess my point is that it has to be money because of the time delay between start of pandemic to the arrival of vaccine for anyone. Four month wave followed by vaccine at six months. I wonder what the Indons think is going to protect them in the interim? Its insane and witholding the sequences and tissue etc are a fools errand. The Jakarta Post opinion section today was bombing the adminsitration(s) into small pieces about just this particular problem.

  10. #10 anon
    March 22, 2007

    how much worth is the Indonesian deal with Baxter ?
    Can they keep it secret ? It must somehow appear
    in the Baxter-bilance or in the Indonesian budget.
    Mustn’t Indonesian parliament approve it ?
    As I understand it, Indonesia gets vaccine from Baxter for
    special low prizes in exchange for not giving
    samples to WHO. (?)

  11. #11 v
    March 22, 2007

    The question should really be – Who benefits from a deal with Baxter? Who are the interested parties? Who will gain from the deal?

  12. #12 anon
    March 22, 2007

    and how much ?!? Are we maybe overreacting ?

  13. #13 Melanie
    March 23, 2007

    v and anon ask the interesting questions: cui bono?

  14. #14 Greg
    March 24, 2007

    Yes. Cui bono?

    And anyone who writes the words, “Indonesian government”, without the words, “lobbied by …” is babbling nonsense.

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