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Analysis: Indonesian-U.S. bird flu sharing

disclaimer: image is for illustration purposes only
by Shaun Waterman
Washington, April 22, 2008
A row involving Indonesia, the United States and the World Health Organization over the sharing of bird flu virus samples is jeopardizing the global early warning system for a potential influenza pandemic and putting lives at risk, say experts and officials.

The row centers on the issue of profits made by multinational pharmaceutical companies from vaccines developed using the samples. Indonesian officials say their country -- and other poorer nations that send samples to the WHO -- is being cheated out of the benefits and cannot afford the vaccines manufactured using the virus samples they provide.

Last year, to the dismay of public health specialists, Indonesia stopped sending WHO laboratories samples of the H5N1 bird flu virus from new outbreaks. The labs analyze and gene-sequence the samples, looking for new variations that might herald the much-feared mutation of the virus into a human-to-human transmissible form.

But data from the samples is also used by pharmaceutical companies to develop new vaccines.

By withdrawing from the global surveillance system that keeps track of the mutating varieties of avian influenza, Indonesia -- the country with the most reported human deaths from bird flu -- is damaging the ability of the international community to spot and respond to viruses that might be the source of a new, global influenza pandemic.

"You might say we're (statistically) overdue another flu pandemic," WHO spokesman Gregory Hartl told United Press International.

"The less information we have (about new forms of the virus) the less able we are to protect global public health," he said of the Global Influenza Surveillance Network, the WHO-run system that assesses new outbreaks of the deadly disease among humans.

The current strain of bird flu, H5N1, has killed 240 people since 2003, the WHO said in figures released last week. But almost all of those are believed to have caught the disease from birds. So far H5N1 has not proved to be transmissible from human to human under normal circumstances. But the virus is constantly mutating, and scientists need to track new outbreaks to watch for the emergence of new varieties.

GISN is made up of 122 public health institutions from 94 countries that collect tissue samples and virus cultures for analysis at one of the network's four "Super Labs" around the world, according to the WHO Web site. "A recent comprehensive analysis," says the site, revealed that about 87 of them "participate actively in the (GISN)."

Apparently the Indonesians no longer do.

There have been more than 50 outbreaks of bird flu in Indonesia since the boycott was instituted last year, but Indonesian labs have sent only three sets of tissue samples to the Super Lab in Tokyo in that period and have imposed conditions on their usage, saying they are not to be used in vaccine development, according to U.S. and international officials.

Hartl would not comment on the precise details of the transfers, saying only, "We are still not receiving virus samples on a regular enough basis to ensure proper functioning of the żż (GSIN)."

The WHO is holding a series of intergovernmental meetings about the issues of virus sharing and benefits, said Hartl, and a working paper was being prepared for two meetings in November.

"The two main planks of the process are developing working procedures for virus sample transfer" and "a system for allocating the benefits" derived from analysis of the samples, he said.

The Indonesians want the two issues linked, but the United States is insisting they be kept separate.

"Linking sample-sharing to payment in any form will immediately begin to erode our ability to make vaccines at all, because once the practice of free and open sharing of viruses stops, the slope is slippery, and there will be no end to the demands," U.S. Health and Human Services Secretary Michael Leavitt wrote in his blog last week.

"World health should not be the subject of barter."

The Indonesians say they do not want royalties or any other direct form of payment, but rather "a method that leads to the allocation of values derived by commercial interests into one commonly defined system, which will provide benefits to those that have made contributions," according to a letter to Leavitt from Indonesian Health Minister Siti Fadilah Supari.

During his visit to Jakarta last week Indonesian officials told Leavitt they wanted the issue resolved within two months. He responded by saying that, after that time, the WHO should move ahead with new virus-sharing arrangements without Indonesian participation -- effectively setting a deadline for negotiations to end well in advance of the WHO's next intergovernmental meetings on the issue.

"We will work on this for the next 60 days. If we haven't been successful in resolving the matter, I think it will be time for the world to just accept Indonesia's unwillingness to participate in the WHO influenza system, and move on," he wrote.

Leavitt accused Supari of playing the issue for domestic political benefit. "The Indonesian health minister has used the sample-sharing debate żż to set herself up as an antagonist of the United States, a position I suspect helps her politically among the constituency of her party."

He noted the next presidential election in Indonesia will take place next year. "Just like in the United States, the upcoming election has begun to affect the formulation of policy," he wrote.

Supari alleged in a book published earlier this month, "It's Time for the World to Change -- Divine Hands Behind Bird Flu," that the United States and the World Health Organization were trying to profit from bird flu by using data from samples of new virus strains cultured in laboratories in Indonesia and other less-developed countries.

She claimed bird flu virus samples sent to the United States were under U.S. military control at Los Alamos National laboratory. In reality, bird flu samples are analyzed for the U.S. government by the Centers for Disease Control and Prevention in Atlanta -- one of the four GSIN Super Labs.

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Flu Tracked To Viral Reservoir In Tropics
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