Day 1 of the flu virus sharing summit

The first day of the scheduled four day showdown in Geneva over sharing bird flu virus isolates is now over. What seems to have been accomplished is statements of opening positions. How moveable everyone is remains to be seen, as does whether there is an Alexander the Great around to cut the Gordian Knot (you can see the strands of the knot in some of our previous posts, for example (chronologically) here, here, here, here, here, here, here, here, here, here, here, here, here, here and here).

Here is Reuter's version of Day 1:

Indonesia, the nation worst hit by bird flu with 91 human deaths, has held back most of its virus samples and demanded guarantees that poor countries get access to affordable pandemic vaccines derived from them.

Speaking at the start of a four-day meeting hosted by the World Health Organization (WHO), Indonesian Health Minister Siti Fadillah Supari said developing countries were being denied their "sovereign rights" over bird flu virus samples sent to the WHO, a United Nations agency.

"We must have equitable sharing of benefits arising from the use of viruses through a fair, transparent and equitable mechanism. It is the moral thing to do," she said.

Jakarta has shared just two specimens this year, both from Indonesian women who died in the tourist resort of Bali in August, according to WHO's top bird flu official David Heymann.

Sharing samples is deemed vital to see if viruses have mutated, become drug resistant or grown more transmissible.

John Lange, U.S. special representative for avian and pandemic influenza, said "there should not be a one-to-one relationship between sharing of a particular sample and accruing a specific benefit".

"Countries that do their duty and share information and samples should not expect to receive something concrete each and every time they share," he said. (Reuters)

The Indonesian demand effectively wrecked the 50 year old influenza surveillance system used to predict what influenza A strains would be circulating in the next flu season and use isolates from them as vaccine seed strains for seasonal influenza. The isolates were given freely to WHO who made them available to researchers and drug companies for vaccine development. Usually no single country could be identified with a circulating strain, but with H5N1 the situation is changed. Indonesia has emerged as the world's hotspot for the virus although human cases exist in many other localities as well. None, except for China, has the resources of a developed nation however. So if a human pandemic strain develops from the current avian versions, it will likely come out of a particular country and Indonesia is at the top of the list of possibilities.

Because of the Indonesian position WHO has to revamp the old system and that is what the meeting is about. It was probably overdue, but prior to H5N1 the developing world was not much interested in seasonal influenza (although it probably killed many of their citizens). Now they are. And Indonesia's interest has taken the form of demanding something "concrete and specific" for providing the virus to the international community. In particular they want it recognized as their "property" and they want to retain intellectual property rights over it. Since 16 companies are now busy licensing pandemic flu vaccines, what Indonesia wants to do isn't so different. The US is one of the world's most vociferous defenders of a stupid and broken and dysfunctional intellectual property system, so they should support this insanity. But it all depends on whose ox is being gored. Here is how US representative Lange approached it:

Lange said countries must look beyond the issue of access to pandemic vaccine and have contingency plans for school closings.

"While important, such vaccines will not even be available until five or six months into a pandemic, and by that time the entire world is likely to have experienced the first wave of the pandemic," the U.S. envoy said in a speech.


Research and development of new drugs and vaccines was "very risky, time-consuming and extremely expensive" and it was critical to protect patents to ensure their continued development. "We cannot accept any approaches that would undermine intellectual property rights," Lange said.

The US apparently believes the proper way to fight bullshit is with bullshit. Lange is saying the vaccine won't do Indonesia or anyone else any good anyway. So what's the fuss about? Let's get something straight. Under the rules of the market place, Indonesia is doing what the US and every other predator in the global public health jungle has been doing all along. They've got control of the virus, and as a sovereign nation they are insisting on their right to act like a bad global citizen, a right exercised by the US and many other nations whenever they feel like it.

If vaccine development is so risky and expensive, let's turn it over to an international collaboration outside the market system. Why keep it in private hands? Why is it OK for the vaccine to be in private hands with the price set by private parties but Indonesia can't keep the virus in its hands and set the price the way the drug companies do, by the highest bidder? Here's why: Because the stakes are too high to let the hidden hand of the market decide everyone's fate. That hand isn't invisible. It's hidden, by design and intent.

Both the US and the Indonesian positions are reprehensible. We should be saying so.

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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:

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.

if it's only about vaccine, then give us the
other 7 non-HA-segments and the 3rd positions of HA.
These are useless for vaccine but suitable for

Things take a turn for the worse in GenevaIn addition to other uncertainties, a new problem has arisen. Two parallel working sessions have been formed, one working on "priniples" and "scope", with the other working on "operational", or nuts and bolts issues.Unforutnately, 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.

Still worse news from GenevaIn 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.

And I hear it will also be subsequentially voted down. Want to hear something really neat? Those medical/pharma types went in there and laid down the law. They will jack the prices up on everything if this gets passed. Its not legislation in a nation, its a multi-lateral attempt to break the system down.

This even though the US might sign the proposal is a treaty, all treaty's must be ratified by the Senate. Hold your breath, release when approved.

By M. Randolph Kruger (not verified) on 21 Nov 2007 #permalink

The World Health Organization is a 'dead horse' and isn't in a position to preach to anyone about ethics.

But that's not why I jumped in...

...I just wanted to sincerely wish everyone a Happy Thanksgiving...'s been an honour and a pleasure.

I wonder if Indonesia is using this as a way to distract people from the fact that they are continuing to do poor investigations, failing to isolate the virus in many human cases, failing to identify matching viruses and thus the source of infection, and failing to effectively control the disease in their own country. The best form of defence is attack.

I do not deny they are debating an important issue. A much more important issue is the need to control the disease. Many other nations have shown this disease can be controlled, Thailand, Vietnam, Turkey, etc. Indonesia is focusing not on controlling the public health threat but on who owns the public health threat. To me it is a poor use of the health departments resources and it should be redirected. Indonesians and the rest of the world may pay a heavy price for this misdirected energy.

The article on the limitation of international law below is interesting and gives little hope for a speedy resolution of this problem.

By Andrew Jeremijenko (not verified) on 21 Nov 2007 #permalink

Just to be clear, although the exact legal status of the "new system" (if there is not a catastrophic breakdown) has not been defined, I believe that few, if any, are thinking that this is a treaty negotiation. Thus, it is very unlikely that any ratification or, for that matter, any major changes in any country's domestic law, will be required as a result of these negotiations.

Also, it would very rare (if not unheard of) for the result to be submitted to a vote. Rather, the procedure is to try to operate on the basis of consensus (which is pretty elusive at this point in time).

Agitant I have it on good opinion in the Sr. Republican Party leadership that indeed if it creates any multinational operation then it does and will need the President to sign it, then the Senate to approve it. Its dead meat on arrival if that happens. They cant keep doing things the way they have with these informal relationships. Its like we go to a World Health kegger and get drunk, piss off some people and chase girls. Then the next morning we wake with a hangover and say oh shit what did we do.

Indon forced their way into the WHO leadership and now we are paying the price for letting that happen. I agree completely with Andrew J. that this is being done to divert attention from the money, and the fact that they are just stealing it. Its propping up the local economy because I cant find anyone from anywhere other than Jakarta or Padang that is aware of the simple procedures to reduce infection possibilities.

My friend Fardah who is with a news agency says that this is basically ignored. I asked him about the money that has gone in and he said its being used to provide general health care for the people, not bird flu awareness or protection. But he wouldnt say that in the papers you can bet.

Everyone have a good Thanksgiving Turkey and remember to fully cook that sucker!

By M. Randolph Kruger (not verified) on 21 Nov 2007 #permalink