Bird Flu: Science and Policy

[DewDiligence]

Poor Countries Seek Pact on Avian-Flu Vaccines

http://online.wsj.com/article/SB117486117267548356.html

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By NICHOLAS ZAMISKA
March 26, 2007

JAKARTA -- Earlier this year, Indonesia's health minister asked a stark question: What does her poor country get out of sharing bird flu samples with scientists and vaccine makers? This week, global and regional health authorities and scientists meeting here will try to hash out an answer.

Among the thorniest issues in the battle to protect the world against a bird-flu pandemic is how to ensure that vaccines are available to the people at greatest risk of catching the disease. In recent years, poorer countries such as Indonesia and Thailand have given samples of the H5N1 strain of bird flu they collect from sick and dying patients to laboratories and companies in richer countries, such as France and the U.S., to study and to develop life-saving vaccines.

But what they can get in return for sharing the virus has remained unclear. Even given best-case scenarios, the world's current manufacturers could produce only a fraction of the amount of vaccine that would be needed if a pandemic were to break out. And because the world's largest vaccine makers are in rich countries, far from Asia, where nearly all of the deaths have been, many have wondered privately whether the supplies would be hoarded at the expense of people closest to the source of the outbreak.

That is what prompted Indonesian Minister of Health Siti Fadilah Supari to ask her question, explicitly and publicly for the first time. She stopped sending the samples her government was collecting to the World Health Organization, leaving vaccine makers and laboratories without access to the most recent, and potentially useful, strains of the virus. The move was intended to protest what Indonesia felt was a one-way exchange, with little sign Indonesians would benefit from a vaccine made from a virus collected on its soil.

At the meeting, which opens today, officials from the WHO and health ministries in Asia, along with top influenza scientists, will focus on these issues. While many similar gatherings often have relatively predetermined outcomes, and officials convene merely to ratify an agreement that's already been endorsed, both sides agree the Jakarta meeting could result in a pact or a continuing conflict.

Nancy Cox, director of the influenza division at the U.S. Centers for Disease Control and Prevention in Atlanta, is one of the many attendees.

The Jakarta meeting is "very important," Dr. Cox said. "We really need to have more viruses from all the affected countries so we can compare and contrast what's happening so we can be as prepared as possible."

In an interview, Dr. Supari said: "We want a mechanism to ensure access to vaccines. "To make vaccines more accessible, more affordable to all of the countries, especially developing ones."

Dr. David Heymann, the WHO's representative for avian influenza, said one solution to the issue could involve the WHO soliciting funding to buy stockpiles of vaccine from manufacturers on behalf of developing countries. He said wealthier nations might have a direct incentive to contribute to such purchases as those vaccines could help contain an nascent pandemic if deployed quickly before it could spread.

"She has raised an issue that had to be addressed," said Dr. Heymann of Dr. Supari. But he added that if the meeting doesn't produce a solution, "we will have to use our moral authority...we will have to begin to talk about this as a threat to public health security." He added, "Nobody else is withholding viruses. She's the only one that's doing this."

When asked what prompted her to stop sharing her country's samples with the WHO, Dr. Supari said she worries ordinary Indonesians, as well as people in other developing countries, wouldn't have access to affordable vaccines if a pandemic breaks out.

She mentioned what she called a disheartening experience in 2005 when she approached Swiss drug giant Roche Holding AG to buy two million doses of the antiviral drug Tamiflu, Roche's blockbuster treatment for influenza that has been used on patients with bird flu. The company said it didn't have any available, she said.

"They said, 'Sorry, ma'am... the stocks have run out because several other countries bought everything,'" she recalled. The health minister said "I am worried about the next experience with the vaccine."

Roche said that it did take around 10 to 12 months for Indonesia's order to be filled. But Martina Rupp, a company spokeswoman, said that was only because Roche was in the process of meeting surging Tamiflu demand and had to fill orders "on a first come, first serve basis." Other countries placed orders earlier, she added.

Indonesia has had the highest number of human deaths from bird flu. World-wide, there have been at least 281 human cases since the virus re-emerged in 2003, according to the WHO. Indonesia has had 81 cases, of which 63 have been fatal.

"I didn't agree with the rules of the game, so I asked the WHO to please think about the developing countries like us," Dr. Supari said. "My country suffers from avian flu. We have lots of patients dying. When the other companies take advantage of the virus, I think this is just an ethical matter."

But the minister said WHO "is our global organization. Indonesia is also in this organization. WHO is not my enemy."
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