Bird Flu: Science and Policy

[DewDiligence]

How Dr Chan Intends to Defend the Planet from Pandemics

http://www.economist.com/world/international/displaystory.cfm?story_id=9340488

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The new powers vested in a UN agency's boss should, in theory, cut the risk of killer diseases raging round the world

Jun 14th 2007

With its big electronic screens and global satellite links, the command centre feels like the heart of a vast military campaign. Every morning, there are strategy sessions to mull the latest intelligence, and rapid-response teams are sent to remote places at the commander's bidding.

In this case, the control room answers not to any general, but to the World Health Organisation (WHO)—the Geneva-based United Nations agency whose job is to monitor and respond to infectious diseases. In recent years, it has nipped in the bud over six dozen outbreaks that could have led to global crises. Unless outbreaks are spotted early, and virus strains shared with researchers worldwide, there is a recurring risk of a pandemic similar to the strains of influenza which caused havoc over the past century (see table).

That may sound obvious, but in practice, countries don't always help the WHO. In 2002, when the respiratory disease dubbed SARS emerged in China, the authorities hid the early signs for fear of hurting trade and tourism. More recently, Indonesia has been mired in a more intractable dispute—raising hard questions about the balance of economic power in the world.

Last year, the Indonesians stopped giving the WHO samples of the H5 virus which is responsible for avian flu, a disease that has forced a mass slaughter of poultry in many countries and could, if it mutates, cause a deadly epidemic among humans. Indonesia won some sympathy for its complaint that it was giving away precious intellectual property, while it might well be unable to afford the vaccines which are then developed. There was little the WHO could do in response.

However the agency's hand will be strengthened by a treaty that enters force on June 15th. The new “international health regulations” (IHRs) oblige governments to co-operate with Margaret Chan, the WHO's director-general, and report potential pandemics at once. If it succeeds, this could lead to a “good-governance revolution” in disease prevention, says David Fidler of Indiana University.

But will it work? Sceptics are not short of arguments. The new system requires countries to do a lot of things to improve public health, but provides no money. Implementing the treaty could prove hard in federal states like Canada and the United States, adds Kumanan Wilson of the University of Toronto; some of the actions required by the IHRs are handled at state or provincial level. Even so, the IHRs have one advantage over treaties like the Kyoto protocol on climate change. At least in the short term, Kyoto imposes heavy costs on some countries that are hard to explain to voters. But every country has an immediate, obvious interest in avoiding pandemics. That, in principle, could put a great deal of power in Dr Chan's hands.

The new treaty commits countries to tell her within 24 hours of any emerging global health threat, something they have often failed to do. In a break with normal UN practice, the WHO will no longer be required only to rely on data from member governments: it can now use non-government sources, including the press and the internet, in its surveillance. If a country tries to hide vital data about a potential pandemic, Dr Chan can override national sensitivities and ring the alarm bells.

That sounds promising, but it does not quite deal with the problem raised by Indonesia. Poor countries, where most potential pandemics start, rarely have the health facilities or vaccine-making capacity to combat a serious outbreak on their own; they rely on external help and vaccine imports. They complain that big firms in rich countries are exploiting their vulnerability. Indonesian officials put it bluntly: why should they hand over precious virus strains when the resultant vaccine may never benefit their people?

The Indonesians have a point. It is true that most of the factories that make pandemic vaccines are located in rich countries, and those plants cannot make enough to cover even the rich world's needs. And in previous global health panics, it has been obvious that rich states think of their own voters first. So at a WHO assembly in May, rich countries agreed that the poor must have access to life-saving vaccines in the event of a pandemic; Indonesia duly agreed to share its virus samples again. On June 13th Dr Chan announced plans to create a global stockpile of avian flu vaccine with the help of donations from GlaxoSmithKline, a British drugs firm, and others.

Fine, but how exactly any strategic stockpile will be split up during a global pandemic remains a mystery. The new rules do not offer much help on that front.

What Indonesia and other poor states really want is to have vaccine-making units within their borders. The WHO has helped a few poor countries to start such plants, but the technology involved is tricky. Not every country in the world can expect to have such factories; and those that do may well resist the idea of helping rival states. As Laurie Garrett of America's Council on Foreign Relations notes, Indonesian politicians would balk at sharing vaccines with Papua New Guinea. That explains why stockpiling and building new factories are partial answers at best to the global challenge.

Perhaps the best reason to take the IHRs seriously is that by making it harder for governments to hide pandemic data, they make innovation more likely. And innovation is desperately needed: today's vaccines cannot be made in the volume needed for the whole world, and they cannot keep up with the evolution of some virus strains. But as Joseph Hogan of GE, an industrial firm with a health division, points out, smarter vaccines and more efficient manufacturing may solve that problem. Vijay Samant of Vical—one of several firms now investing heavily in a new generation of pandemic technology—also welcomes the increased powers for Dr Chan and her agency. “Without access to the latest strains, researchers can't come up with new vaccines,” he argues. Dr Chan faces a big job, and big expectations.
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