Nature’s senior correspondent, Declan Butler, was one of the first to raise the profile of a pandemic threat in the scientific community and has had done some superb reporting since, including several stories on sharing gene sequences. The problematic actors in his earlier stories were respected scientists and the business-as-usual way they were approaching release of genetic sequences even as the world worried that the virus they were studying, influenza A, was inexorably searching for the right recipe to enhance its own raison d’etre, to make still more copies of itself, potentially with the help of the 6 billion bioreactors called human beings. That was then. Now the problematic character is Indonesia’s health minister, Siti Fadilah Supari, an erratic, obstreperous, often ignorant sounding one person obstacle to access to viral isolates of great interest to the global public health community, the ones isolated from humans and birds in Indonesia, the world’s hot spot for bird flu.
Declan is an excellent reporter and understands the issues. I knew he was going to interview Supari and was curious about what he would learn. The answer: not very much. She repeated the same arguments she has been using for over a year, with little variation:
Indonesia is open to international collaboration but this must be fair, transparent and equitable. The WHO’s Global Influenza Surveillance Network system is obviously unfair and opaque. Samples shared become the property of the WHO collaborating centres in rich countries, where they are used to generate research papers, patents and to commercialize vaccines. But the developing countries that supply the samples do not share in these benefits. In the event of a pandemic, we also risk having no access to vaccines, or having to buy them at prices we cannot afford, despite the fact that the vaccines were developed using our samples.
The above mechanisms can lead to a vicious cycle, in which poor countries become poorer because they have diseases, and industrialized countries become richer at the expense of poor countries. As a consequence, there will be some people who will create diseases and take advantage of the situation. This is a form of neo-colonialism and neo-capitalism. (Declan Butler, Nature)
This is vintage Supari. Some of it makes sense and some of it is orbiting slightly past Pluto. WHO reference labs don’t “own” Indonesia’s or anyone else’s viral isolates. The idea that someone should have property rights to a naturally occurring pathogen is outlandish and Supari is accusing WHO of what in fact she is advocating. On the other hand, she is signaling an important, unsolved problem, the problem of access for poor countries, a problem that won’t be solved by “selling” their pathogenic property to the highest bidder. But of course that’s what Big Pharma intends to do with the vaccine they make from the pathogen and they have a full arsenal of intellectual property laws and the best lawyers money can buy to obliterate anyone who doesn’t like it.
But the idea that neo-colonialists (who do exist) and neo-capitalist (who do, too) are creating diseases so they can sell vaccines to countries that can’t afford them is bizarre and stupid. Supari also responded to the question of why Indonesia does a much worse job at controlling bird flu than other countries with this defense:
Vietnam, as a centralized socialist country, can get high compliance on national policies and so has succeeded, for example, in implementing rapid culling of birds. Thailand’s monarchy is well respected, resulting again in good compliance. In contrast, Indonesia is in transition towards a decentralized democracy after three decades of authoritarian national rule. We are still on a learning curve, and compliance of the relatively independent regional authorities with national policies is often poor. Indonesia is made up of more than 17,000 islands, which again complicates compliance.
The cultures are also different. Birds play an important role in Indonesian culture — pet singing birds are considered signs of respectable households, for example. In rural communities, backyard farming is a major income source, and has been a key element in improving nutrition.
But bear in mind that Indonesia has a population of more than 200 million, so one needs to keep in perspective the total of 113 cases of H5N1 — I’d argue that we’ve been fairly successful in controlling the disease.
Again, a mixture of truth and implausible deniability. Indonesia’s government is extremely decentralized and the central government has little ability to issue decrees and hope to see them implemented. But it is also corrupt, incompetent, ineffective and elitist from top to bottom, according to many with intimate knowledge of the country. We have written before (more than once) that the special place birds play in Indonesian culture is critically important and unlike what we are used to in Europe and North America. Birds are companion animals more like cats and dogs here. And the country is huge, with many parts geographically distant or difficult to access. But the problems of decentralization, corruption and an even huger population describes China. China has reported only 27 cases to Indonesia’s 115. Does anyone believe either number? And does anyone believe either has been “fairly successful in controlling the disease”?
When it was pointed out that many scientists still don’t think Indonesia is doing enough, here was her response:
It is the international scientific community that delays the acquisition of critical knowledge. If they wish to have rapid results, why don’t they come to Indonesia and work with our scientists here? We have the necessary facilities, such as biosafety level-3 secure labs and good Indonesian scientists. That would also put an end to disputes over virus sharing.
This doesn’t make sense from many points of view, but there is an important point here she doesn’t make. There are still too many scientists — good ones, decent people — who have isolates, sequences and databases they have yet to be shared in a timely way because they are profiting off it, not monetarily, but professionally. Supari can’t make this point because she wants Indonesia to be as bad as they are. Neither can see that this attitude is ethically unacceptable if we are on the threshold of a pandemic.
Supari is neither rational nor responsible. Some very reputable scientists are rational but also irresponsible. There is more than a grain of truth to the fact that Indonesia and other developing countries have a problem which the developed countries aren’t solving. The scientists can’t see it because they are merely conducting themselves in the same ways as always. No one has ever said it was wrong or unethical. But this is a special situation.
I’m saying it, now. We can’t keep pointing fingers at Indonesia when we refuse to put our own house in order.