We have an on-the-ground view of the critical influenza virus sharing summit, provided by Ed Hammond in Geneva. I am promoting his comment thread notes from earlier today and a fuller account from late in the evening on Wednesday (Geneva time) sent me by email. It is clear that the atmosphere is tense and not convivial.
First, if you haven’t been following the issue here or elsewhere, here’s a bit of background from an excellent piece at Intellectual Property Watch (h/t Agitant):
The politically explosive issue of ensuring everyone benefits from vaccines in the event of an influenza pandemic is the subject of a negotiation underway at the World Health Organization this week. The work of the member governments calls into question a longstanding WHO system for global sharing of disease strains, and involves questions of limitations on access from patents imposed on vaccines, in some cases developed from flu strains shared under the WHO system.
Under the Global Influenza Surveillance Network (GISN), countries are expected to send H5N1 virus strains from avian flu victims to WHO-operated regional collaboration centres. But this mechanism has been called into question by some developing countries, who suggest it may not be fair to them in case of a crisis.
The government of Indonesia took a strong position at the outset of the meeting in favour of ensuring equal access for developing countries, and charged unfairness in the WHO system. Indonesia has come under pressure for withholding samples of the avian flu strain occurring there out of concern that sharing it to the WHO process would lead it to be expensive and unavailable for its population.
Supari named three ways in which her country was treated unfairly. She charged that when Indonesia needed to procure Tamiflu, seen as potentially effective against avian flu, it had all been stockpiled by developed countries. Secondly, the DNA sequence for risk assessment and vaccine production was held exclusively by WHO-affiliated scientists, which Indonesia corrected by releasing the H5N1 sequence data to gene banks. Finally, Supari said, several developed country companies offered her vaccine and diagnostic kit developed from the Vietnamese flu strain.
The United States said the “sense of urgency” must be maintained, and pointed to a variety of preparations for a possible pandemic that reach beyond access to vaccines, such as rapid response or measures to mitigate the spread at the community level. It also criticised any withholding from the global system, but said countries sharing their samples should not expect something in return every time. Instead, they could get technical assistance. Finally, the US said, “We cannot accept any approach that undermines intellectual property rights.”
Edward Hammond of the Sunshine Project prepared a report on IP issues related to avian flu viruses that tracked the recent “dramatic rise” in patent applications related to influenza. As developed countries funnel public funds into a biomedical research and development system based on patents, “some key government players in the WHO GISN are fuelling the patent surge and, in fact, are politically and legally obligated to encourage such claims because they are an integral component of their health systems,” Hammond wrote. (IP Watch)
The IP article has an excellent account of Day 1. We are now through Day 2, and Ed Hammond sent along the following observations.
10:30 am, EST, 4:30 pm Geneva time:
We’re actually late into the second day of negotiations and we appear to headed into a late night.
Here is another article on the 1st day.
Some other countries are coming forward with constructive proposals, such as Brazil and Thailand and Nigeria, which, regrettably, are being lost in the Indonesia vs. US-focused coverage. Sadly, the EU and US remain quite unhelpful.
1:29 EST, 7:29 pm Geneva time:
Things take a turn for the worse in Geneva.
In addition to other uncertainties, a new problem has arisen. Two parallel working sessions have been formed, one working on “principles” and “scope”, with the other working on “operational”, or nuts and bolts issues.
Unfortunately, about a dozen representatives of the vaccine industry have been permitted to attend and speak at the “operational” working group, and all other non-governmental groups (i.e. the “real” NGOs) have been ejected.
The closed working group is working on critical issues and, unfortunately, the press and NGOs will not be able to see and hear what transpires.
1:51 pm EST, 7:51 pm Geneva time:
Still worse news from Geneva
In the all-important text for the operational provisions for sharing influenza viruses (the real nuts and bolts of how the system will work), the WHO Secretariat is accepting submissions of new text overnight.
I have just received an e-mail from the WHO Secretariat (in response to a question), stating that WHO plans to produce a text on the basis of those submissions that does not attribute text to the country that proposed it. In other words, unlike the usual transparent UN procedure in which it is clear who is proposing what text, WHO will hide the origin of language that may wind up in its resolutions.
Procedurally, this makes negotiation very difficult and frustrating. Because new text can – and is – introduced into negotiating documents by the WHO Secretariat, yet the source of that text is not revealed. This is not a modus operandi that is promising for working out the underlying problems that have led us here, and portends for continued problems.
Then this at 3:30 pm, EST, 9:30 pm Geneva time:
US Plays “Chicken”, Runs into Strong Oppostition
Late on Wedesday the first open fight between the US and Indonesia broke out. Indonesia, with support from other countries, had bracketed the word “mandatory” when it comes to sharing viruses. The idea was to see what the system looks like before deciding whether virus sharing will be mandatory or not, i.e. to see the whole package of requirements and benefits. Many developing counties do not want to see a system in which providing viruses is mandatory; but GISN providing benefits is optional. As proposed by Thailand, virus sharing and benefit sharing should be either be “mandatory-mandatory or optional-optional”, and not “mandtory-optional”.
In response, the US crafted a paragraph saying that countries would not receive benefits from the WHO system unless it was in “good standing”, a clear jab at Indonesia. What the US probably did not expect was that it’s attack on Jakarta prompted criticism of the US by every other country in the room that spoke. First, Indonesia immediately retorted by inserting the same US language into the paragraph on virus sharing. Indonesia proposed a rule saying that Collaborating Centers must be in “good standing”( a reference to patent applications by St. Jude, among others) in order to receive virus.
In short order, the rest of the room that spoke weighed in on Indonesia’s side. Switzerland said that even if a country misbehaved, that public health required that WHO provide network benefits to to all, and that this was a principle of the new International Health Regulations. Mexico called on the US to reconsider. Argentina agreed. Germany supported Switzerland and called for a retreat from polarizing proposals. The UK supported its fellow Europeans.
Asked by the Chair to withdraw its proposal, the US refused to budge, offering that it would submit a definition of “good standing” tomorrow (Thursday). Indonesia said it would define “good standing” as well.
Indonesia has not said that it will not participate in a mandatory virus sharing, mandatory benefit sharing system. It has said, and other countries such as Brazil have agreed, that whether or not virus sharing should be mandatory should remain in brackets until the result of other negotiations here are clear. Until the whole package is apparent. The US attack and subsequent inflexibility left it isolated on the issue and ended the day (at 9:30PM) on a relatively sour note.
Sounds like some fireworks. As long as the US and its allies stay wedded to the current IP system this will either be an insoluble problem or one where the solution is unsatisfactory (e.g., each country decides who licenses and gets its viral isolates).
There is a good case to be made that the current bird flu problem has been greatly exacerbated by industrial poultry farming practices. We can make another case that the current vaccine problem has been greatly exacerbated by US and Indonesian intransigence and allegiance to a system of intellectual property rights that is dysfunctional and doesn’t work for a global public health problem of this kind.
We’ll bring more of what’s going on in the important meeting as we get it.