The first day of the scheduled four day showdown in Geneva over sharing bird flu virus isolates is now over. What seems to have been accomplished is statements of opening positions. How moveable everyone is remains to be seen, as does whether there is an Alexander the Great around to cut the Gordian Knot (you can see the strands of the knot in some of our previous posts, for example (chronologically) here, here, here, here, here, here, here, here, here, here, here, here, here, here and here).
Here is Reuter’s version of Day 1:
Indonesia, the nation worst hit by bird flu with 91 human deaths, has held back most of its virus samples and demanded guarantees that poor countries get access to affordable pandemic vaccines derived from them.
Speaking at the start of a four-day meeting hosted by the World Health Organization (WHO), Indonesian Health Minister Siti Fadillah Supari said developing countries were being denied their “sovereign rights” over bird flu virus samples sent to the WHO, a United Nations agency.
“We must have equitable sharing of benefits arising from the use of viruses through a fair, transparent and equitable mechanism. It is the moral thing to do,” she said.
Jakarta has shared just two specimens this year, both from Indonesian women who died in the tourist resort of Bali in August, according to WHO’s top bird flu official David Heymann.
Sharing samples is deemed vital to see if viruses have mutated, become drug resistant or grown more transmissible.
John Lange, U.S. special representative for avian and pandemic influenza, said “there should not be a one-to-one relationship between sharing of a particular sample and accruing a specific benefit”.
“Countries that do their duty and share information and samples should not expect to receive something concrete each and every time they share,” he said. (Reuters)
The Indonesian demand effectively wrecked the 50 year old influenza surveillance system used to predict what influenza A strains would be circulating in the next flu season and use isolates from them as vaccine seed strains for seasonal influenza. The isolates were given freely to WHO who made them available to researchers and drug companies for vaccine development. Usually no single country could be identified with a circulating strain, but with H5N1 the situation is changed. Indonesia has emerged as the world’s hotspot for the virus although human cases exist in many other localities as well. None, except for China, has the resources of a developed nation however. So if a human pandemic strain develops from the current avian versions, it will likely come out of a particular country and Indonesia is at the top of the list of possibilities.
Because of the Indonesian position WHO has to revamp the old system and that is what the meeting is about. It was probably overdue, but prior to H5N1 the developing world was not much interested in seasonal influenza (although it probably killed many of their citizens). Now they are. And Indonesia’s interest has taken the form of demanding something “concrete and specific” for providing the virus to the international community. In particular they want it recognized as their “property” and they want to retain intellectual property rights over it. Since 16 companies are now busy licensing pandemic flu vaccines, what Indonesia wants to do isn’t so different. The US is one of the world’s most vociferous defenders of a stupid and broken and dysfunctional intellectual property system, so they should support this insanity. But it all depends on whose ox is being gored. Here is how US representative Lange approached it:
Lange said countries must look beyond the issue of access to pandemic vaccine and have contingency plans for school closings.
“While important, such vaccines will not even be available until five or six months into a pandemic, and by that time the entire world is likely to have experienced the first wave of the pandemic,” the U.S. envoy said in a speech.
Research and development of new drugs and vaccines was “very risky, time-consuming and extremely expensive” and it was critical to protect patents to ensure their continued development. “We cannot accept any approaches that would undermine intellectual property rights,” Lange said.
The US apparently believes the proper way to fight bullshit is with bullshit. Lange is saying the vaccine won’t do Indonesia or anyone else any good anyway. So what’s the fuss about? Let’s get something straight. Under the rules of the market place, Indonesia is doing what the US and every other predator in the global public health jungle has been doing all along. They’ve got control of the virus, and as a sovereign nation they are insisting on their right to act like a bad global citizen, a right exercised by the US and many other nations whenever they feel like it.
If vaccine development is so risky and expensive, let’s turn it over to an international collaboration outside the market system. Why keep it in private hands? Why is it OK for the vaccine to be in private hands with the price set by private parties but Indonesia can’t keep the virus in its hands and set the price the way the drug companies do, by the highest bidder? Here’s why: Because the stakes are too high to let the hidden hand of the market decide everyone’s fate. That hand isn’t invisible. It’s hidden, by design and intent.
Both the US and the Indonesian positions are reprehensible. We should be saying so.