The Indonesian vaccine solution (again)

So the vaccine sharing summit in Jakarta is over and Indonesia says they will begin sharing virus again. The proviso is that they can't be shared with pharmaceutical companies until a vaccine-sharing agreement is hammered out with WHO and that will take an estimated 3 months. I'll be surprised if it is done that quickly, but Hope springs Eternal. Meanwhile the scientific community will be able to see the sequences (at least that's how I read it) and WHO can prepare seed strains but not distribute them. The agreement should also allow determination if any markers of antiviral resistance have appeared and permit developmnet of diagnostic tests.

We don't know the details of vaccine sharing because they don't exist yet. The meeting seemed to accomplish the main thing, get Indonesian provision of the isolates unstuck so surveillance functions can resume. But what we know about the proposed strategy for vaccine sharing doesn't sound very promising to us:

The meeting endorsed WHO's efforts to link vaccine manufacturers in developed and developing countries to speed the transfer of influenza vaccine manufacturing technology.

"We have struck a balance between the need to continue the sharing of influenza viruses for risk assessment and vaccine development," Heymann said, "and the need to help ensure that developing countries benefit from sharing without compromising global public health security."

Individual countries will negotiate how vaccine is made available to them.

"WHO is not involved in financial negotiations, either in selling viruses or buying vaccine," he added. "Countries will negotiate bilaterally with vaccine manufacturers. We will certainly facilitate if countries are asking for support, but it won't be standard."

WHO best practices for sharing flu virus were developed for seasonal influenza vaccine, which has a market in developed countries but in only a few developing countries.

"H5N1 vaccines are a different issue," Heymann said. "We will now modify our best practices to ensure that they are transparent to the developing countries which are providing samples and which have requested to share in the benefits resulting from those viruses."

The director-general of WHO is committed to working with pharmaceutical companies and donors to develop a possible stockpile of vaccine for developing countries if they need vaccine, he added, but this is at an early stage of feasibility study. (Cheryl Pellerin, US State Dept. Washington File)

The fundamental problem, as we noted before, is that there isn't enough productive capacity to make enough vaccine, even for the rich countries. Saying to developing countries, "You negotiate with Big Pharma and have them show you how to make vaccine in your country" doesn't sound like it will work. We need an international effort to establish regional vaccine institutes on a global basis, financed by governments and international donors and outside the market system.

The Indonesians got what they asked for. Like everything else related to bird flu in that country, it probably won't work.