The critical summit on sharing influenza viruses entered its third day (previous coverage here and links therein). The big media outlets covered the opening but not since. Fortunately, you can read about developments here (Day 2, here). Ed Hammond is there and is keeping us abreast of developments.

A participant’s view at the start of Day 3 (5:30 am, Thursday, Geneva time):

Halfway Through and No New Ideas from the US and EU

To be sure, Indonesia has not been the most effective leader for its cause. Its multiple failures at this meeting (if not previous ones) to put forward clear language describing what it wants has held potential allies at a distance, sometimes out of concern that Jakarta has hidden agendas. In fact, in terms of new proposals for how a reformed virus sharing system would work, it is Thailand and Nigeria that have been most concrete, with frequent contributions from clear-minded Brazil and Chile. These countries have laid out important principles and practical proposals for virus and benefit sharing.

But if those four countries are making a strong constructive effort from the perspective of the developing world, where are the new ideas from wealthy countries? Sadly, there are none to date. Halfway through this important meeting and neither the US nor the EU have put forward a single new idea about how to make the system more just. Sure, Indonesia has not been the most articulate; but at this point nobody can say that they don’t understand that the inequities of the old GISN [Global Influenza Surveillance Network] have led us here. It’s a mantra of the WHO Director General (who has thus far sat in, full time) that the system needs reform to be more transparent and responsive to poorer countries’ influenza needs. So where are the US and EU’s ideas? Apparently, they don’t have any. The wrongs of the current system are widely acknowledged but the US and EU are refusing to show any leadership by saying how they are prepared to address them. What changes they are willing to make? Instead, they have so far proposed to leave an unacceptable status quo intact.

Indonesia and other countries with similar concerns are taking notice. Instead of negotiating, the US and and EU are stonewalling, pretending the current system can continue fundamentally unaltered. The US might say that if from its point of view GISN “ain’t broke”, so Uncle Sam is “not gonna fix it”- after all, it’s a pretty effective virus vacuum – but that’s a recipe for disaster, because that self-centered position will cause alienation in the developing world. There are many countries watching closely, like China and India, to name two large ones. The longer time passes without the US and EU putting new ideas on the table and signaling a real willingness to work to address Indonesia’s concerns, the more likely that GISN will suffer severe consequences.

End of Day 3, 7:42 pm Geneva time:

With the exception of the final few minutes before breaking for supper, the entirety of the morning and afternoon plenary sessions on Day 3 (Thursday) was dedicated to discussion of principles for virus sharing. Meanwhile the “operational” working group has also been working in parallel. What it has done nobody but governments and WHO know, or said more accurately, governments and the 19 industry lobbyists who have been permitted to to enter the closed working group under the banner of the International Federation of Pharmaceutical Manufacturers and Associations (IPFMA).

Much more transpired than can be adequately captured here, so I will focus on a couple of important points and hope that more can be covered later.

First, there is a possible conflagration brewing with respect to influenza (and, by inference, other diseases) and the new International Health Regulations (IHR). It goes like this:

The WHO Counsel has conceded “preliminarily” that the IHR does not require sharing of viruses with WHO. Fidler’s recent EID article concurs (even if Fidler is badly wrong about the Biodiversity Convention [Revere note: see quote from Fidler here along with our take on it]). Despite these legal opinions, it is abundantly clear that the US is trying to manufacture language in the products of this meeting to suggest that the IHR requires virus sharing. The US hasn’t stated its intent in so many words; but it is coming. The US is repeatedly seeking to introduce language referring to the IHR inappropriately in the principles related to virus sharing. They might think they are getting somewhere; but this is a strategy likely to backfire.

It’s not that your correspondent is hostile to virus sharing or the IHR. Rather, it is a fact that the IHR simply does not require WHO Member States to hand over disease agents. The US should stop trying to misconstrue the IHR in this discucssion about flu. Because once Member States completely grasp what the US is up to, there could be a serious backlash. This will not only further polarize the flu discussion; but it could be dangerous to the IHR itself.

Second, this meeting is not getting very far. The results appear unlikely to move us very far forward. Not only is there too much hotly contested text resulting in too little time to properly work through the issues, but the main players that need to pony up their ideas for fixing the GISN (namely, the US, EU, and Indonesia) are not articulating solutions. For much of the meeting, it has seemed more like a struggle for tactical advantage than a real attempt to resolve conflict. There are dangers in that some countries are tiring, and in that there is no clear way forward. It’s perhaps a bit premature, but it is quite possible WHO Member States may be forced to schedule another 4 day grope in the dark before the next World Health Assembly. Remember the closed Working Group is a wild card for all of us not allowed inside — but the whispers are not encouraging. In the halls there are ideas being circulated about possible interim measures for GISN … but it is unclear if they will see the light of day or if there will be time enough to adopt them in the little more than one day that remains.

Finally, there is the big question of Benefit Sharing’s relationship to vaccine stockpiles. It can be read or inferred that the rich countries are pretty much in agreement that a big benefit of the system, probably “the” benefit, for developing Member States is access to a (pre)pandemic vaccine stockpile, unless one counts the opportunity to buy vaccine or medicine on the market as a “benefit” (some would cynically suggest that being able to shop is a benefit.)

There’s another probable problem here. It’s clear vaccine stockpile will happen — is happening, in any event. Inclusion of a stockpile as a “benefit” in a new GISN might make a vaccine stockpile bigger and possibly better managed, but without regard for the GISN, it would be much preferable to the US, EU, Australia, Japan, et al. to fight an incipient pandemic on a Southeast Asian isle rather than in Chicago … or Rotterdam. So what vaccine is not completely reserved for rich countries will be rushed to the developing world in the event of the appearance of a pandemic-type strain …. in a desperate attempt to stamp it out before it spreads too far.

But beyond the fact that a stockpile may not properly be a GISN benefit, some developing countries (and NGOs) see other benefits, among them, knocking down the obstacles to vaccine production in developing countries — not only by stopping the injustice and ominous surge of proprietary claims on flu virus pieces and vaccines, but through access to vaccine technologies like adjuvants and cell culture systems and the know-how to use them. Put the tools to make vaccines in more hands than a few companies focused on rich markets.

Put simply, the idea, at least as this NGO [the Sunshine Project] endorses it: If companies want access to the viruses of the system, then they need to let poorer countries have access to their production technologies. (The companies can make their money from the rich.) [NB: In essence, this is also our position here at Effect Measure]. That benefit does not make the vaccine, but it’s just about access to the ability to do so.

But there’s not enough vaccine to go around. Fixing GISN is not the same thing as fixing the pandemic preparedness problem. Pandemic preparedness is still bigger.

This is not to say that vaccine stockpiles are not important; but it is to say that more benefits can and should be expected from the WHO system. And it seems unlikely that there will be broad satisfaction with a reformed GISN in which vaccine stockpiles are the sole major benefit. The lack of practical new ideas from governments is a major problem.

This summit wraps up later today (Day 4). We hope to have some additional comment on results or lack of results.