Indonesia sample sharing moves to World Health Assembly

Indonesia has just registered its 76th death and 95th case of bird flu, making it the country with more of each than any other nation. Not that you would know it by looking at the current WHO count of confirmed cases. That's because Indonesia hasn't sent WHO any viral isolates for confirmation since January. We've covered this too often to repeat the details (see here, here, here, here, here, here, here, here and here for some background), but the issue is now front and center in this week's World Health Assembly, the official governing body of WHO convened in Geneva:

The issue of sharing research data on avian influenza is shaping up to be the most controversial and potentially damaging item on this year's agenda of the World Health Assembly. The annual assembly of 193 governments, which opens in Geneva on Monday, will debate ways to tackle a possible bird flu pandemic. Other global health problems will also be under review. Lisa Schlein has more for VOA.

The World Health Organization has been working feverishly to get nations to prepare for a potential avian flu pandemic that could kill millions of people. Cooperation among nations to try to ward off this global danger is increasing.

But, a dispute over the sharing of bird flu virus samples threatens to prevent many of these advances. Indonesia is one of the worst affected countries. WHO spokesman Ian Simpson says there is great concern about that country's reluctance to share its data.

"It is extremely important that all governments share virus samples in order that it is possible for the world to really track the development of avian influenza and track the emergence of a pandemic influenza strain," said Ian Simpson. "So, this is a really important global public good and we hope that there will be agreement at this World Health Assembly to really stick to the global agreement that there is on sharing samples and that we can move on." (Lisa Schlein, Voice of America)

WHO's Simpson also declared the relationship between public health and intellectual property another "hot button issue":

He says a strong division exists between those who believe promoting public health is paramount and those who consider the protection of intellectual property rights to be more important.

"As WHO, we see the value of both of those things," he said. "We know that it is important for people to get access to drugs at prices they can afford. But, we also know that unless intellectual property is protected, then we will not see the investment in the development of future tools, which we will need. So, we have to find a way to satisfy both the concerns of intellectual property and the concerns of public health. (VOA)

Hmmm. If I may be so bold as to ask, "Why"? Patenting and licensing are not "natural rights" that have to be accorded in all instances, especially in those instances of global public goods where the market doesn't seem to work well, like vaccines. There are alternatives. We could start making vaccines at cost, on a regional basis and with international support and financing. But we've covered this before (see links to previous posts, above). We mention it again to emphasize that it isn't correct, especially in the WHA arena, to assume that things have to continue just as they have in the past.

Indonesia's claim of "ownership" of viruses isolated within its borders also has some interesting consequences. As one of our commenters has pointed out, and we have often thought, what about the liability that comes when your "property" hurts everyone else? If your reactor melts down and contaminates the globe with radioactive materials, shouldn't you also get the blame? If Indonesia's inability to control the virus within your borders creates a regional epidemic or a pandemic, shouldn't it also get the blame?

The US is on record as opposing the Indonesian position, too:

The United States on Monday urged countries to share bird flu virus samples "without pre-conditions" as Indonesia's decision to withhold samples dominated the start of a World Health Organisation's assembly.

"We continue to call on countries everywhere to share influenza samples openly and rapidly, without pre-conditions," US Health Secretary Mike Leavitt told journalists at the annual meeting of health ministers and officials from 193 countries.

[snip]

"No nation can go it alone, all nations have responsibility," Leavitt said.

A senior Indonesian health official said last week that Indonesia will urge WHO members to scrap the existing international policy on bird flu samples during the assembly.

[snip]

Leavitt said: "In the past few months, the media buzz about bird flu has died down, but the H5N1 strain of avian influenza has not."

"It remains a serious danger that we must all face together, he added, underlining support for the existing Global Influenza Surveillance Network. (Agence France Presse via Yahoo)

Of course maybe Indonesia won't be "going it alone." They could djinn up a "coalition of the willing" to go along with them. Would it be all right then?

Update: Newswires are reporting that Indonesia has agreed -- again -- to share their samples:

"I am pleased to announce to all of you that Indonesia has resumed sending its H5N1 specimens to the WHO collaborating centre in Tokyo," Siti Fadillah Supari told the WHO's annual assembly in Geneva. (Reuters)

That's good news -- except -- we've heard that twice, already. Keep checking the WHO case count for Indonesia to see if they make a sudden jump.

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Why are they sending samples to Tokyo? I thought they were previously sending samples to Hong Kong. Is this part of the deal they struck? Does Indonesia have 'trust' issues with China, and you know WHO?

By Chuck Mundy (not verified) on 15 May 2007 #permalink

Chuck: Tokyo is one of the WHO reference labs. I don't know why it was chosen, but I wouldn't read a lot into the choice. Indon scientists have used the Tokyo lab before.

Again the issue of national security comes up. It is based in the liability part of Revere's above posting. At what point in time would witholding of samples, sequences, and information become not a legal issue but a national security one? You are table-topping here, what would YOU do?

Indonesia is at the top of the roller coaster getting ready to take a ride. It could be a mild event or a catastrophic one. If its the latter then they could bear the full brunt of a miltary action... Not by the US even though they might think about it, it would be the Asian nations. What in the mind of the Chinese would it take for them to act unilaterally or in accord with all of their SE Asian friends? I think that a clear and fully blown three island wide epidemic might do it.

We have been here before. If they used either chemical or a tactical nuke it wouldnt stop it. Some animal or person would survive and carry it, but it might bring it down to a manageable level for the WHO. Remember we are all being told it will/would be a <=5%. All of this is in the face of it really being right now about <= 83% CFR. Someone is going to call a big bullshit here pretty soon and when they do the gloves are going to come off. It wont be polite, it wont be pretty. It likely will get very, very, threatening and it will also come from the normally moderate nations down that way. Even the normally placid Aussies might get into that act.

Indonesia's inability to manage the money sent in there, their inability to cull properly and above all contain the flu in the face of what we see continuing to happen is going to be their downfall. It also probably would mean ours. They will try nice first. If that doesnt work, they will get downright shitty about it.

I cant say that they would but you have to know that they (China in particular) are considering their options. You have a group that has gone off the reservation while the rest of the world requires their assistance in what could be the big game of the future of humanity. A new Dark Ages could come from BF if it breaks out. The WHO talks about a Tamiflu blanket being thrown over this along with isolation/quarantine. It isnt possible to do that with a population that is a tad higher than the US and is highly integrated in their living situations. Why in Hell do you think the USGOVT keeps harping on the supplies thing with us and extending the number of days we will need to be self sufficient.? It would be terrible if this broke into Indon, but if it got into China I couldnt begin to estimate what it would do. I dont think anyone could.

As Revere says, they have agreed to resume sending information, samples and sequences. Lets see what happens. If we hear anymore of Supari's BS about vaccine that doesnt exist for anyone and that its our virus, we got it first then we should shut their money off and let nature take its course.

By M. Randolph Kruger (not verified) on 15 May 2007 #permalink

If it got into China?

Odd; I was under the impression it had come out of China, we just don't know how the villagers there have been faring under the "containment measures", the past decade.

By crfullmoon (not verified) on 15 May 2007 #permalink

It came out of China as did H1N1. It also has been apparently rattling around over there since the 70's if you read Niman's opinion on it. Certainly some sort of sequence data that I pulled up by date at GenBank showed 1976, 78. etc.

But high path hasnt broken yet but you could watch the progression down from China, thru Vietnam, Thailand then Java, Sumatera in the cases that have happened. Fear not, I wouldnt exclude the Chinese from this if I thought it would do any good but when their vaccine aspirations turned to mush they still turned to the west.

China still has to account for the outbreak of some sort of hemmoraghic (BF?) fever that has symptoms amazingly like those of their pigs over there in the last couple of months. New clade or variance of old? Dunno. Fact is that Indon just wants the money and it wont be used for bird flu. They also want nearly all of the pre-virus vaccination vaccines on their doorstep. So the question is do we give into what is essentially extortion or do we wait them out. If the vaccine cant be made fast enough that is antigen specific, its a moot point what Supari and Indon think. We will by then all be huddled in the homes and waiting it out. My biggest fear is that it goes transgenic across multiple species, pigs, dogs, cats, birds, horses and we end up having to do battle with it for generations rather than the one to three wave hit. Thats been actively discussed too in a few circles and its very sobering.

No CRF you are right it originated out of there but IMO Indon is treating it like its a petting zoo bug. We will give you this if you basically give us by my accounting yet another 300 million dollars. As I posted before, this is a liability issue. In this case though liability might mean you dont post monetary damages you post up chemical/nuke warfare tally's on a board. I can assure you that there are chemicals out there that are as bad if not worse than nukes because they could be persistent agents. Poison the earth in Indon for years to come. It would only happen if the situation became desparate. 70 to 83% CFR's would make just about any nation adjacent to Indon desparate in feelings, if not action.

I dont know. I keep on seeing more and more people/countries getting onto the wagon so do they know whats happening more than us or is it just being prudent. My criteria for that is they begin to spend money and large buckets of it. You see them dumping millions into something in a furious way and you can expect that they know somehting furious is about to happen.

There have been about 12 cases since January or so. Lets see what the sequence data produces and see if its getting more nasty. Militarily speaking it would isolate the Spratleys, and most of the sea lanes to the west out of Australia. The Phillipines would also be isolated. It might present some unique opportunities for the Chinese and a coalition of the willing as Revere puts it. It wouldnt be for a pandemic though, it would be for the oil that Indon has. Once taken we would be hard pressed to knock them off or out of one of those islands. Never miss an opportunity those ChiComs.

By M.Randolph Kruger (not verified) on 15 May 2007 #permalink

Howdy Randy, you wrote: "My biggest fear is that it goes transgenic across multiple species, pigs, dogs, cats, birds, horses..."! H5N1 (((IS))) transgenic precisely cos a variety of strains (clades) have been found in these and other animal/avian species... Hey, I aint a professional scientist but, like you, terribly well informed -- the ques which utterly (((SCREAMS))) to be answered is, "Why is this particular RNA virus capable of recombining quickly across and between different species!?!"

By Jon Singleton (not verified) on 15 May 2007 #permalink

Why ?
Because humanity and human nature's proverbial chickens have come home to roost?
Because it isn't nice to fool Mother Nature?
Because the Gods of the Copybook Headings are due?

(No HIV vaccine yet, either.)
H5N1 in so many mammals and food species; I had no idea everyone's govt would be so stupid as to hide the public's eyes rather than
mobilize societies to meet this level of threat.

By crfullmoon (not verified) on 16 May 2007 #permalink