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TWN Info Service
on Intellectual Property Issues (Mar10/11) Please find below a paper by Chan Chee Khoon on the issue of Influenza Virus and Benefit Sharing presented at the Conference on Strengthening Health and Non-Health Response Systems in Asia: A Sustained Approach for Responding to Global Infectious Disease Crises (co-organized by Nanyang Technological University and the World Health Organization, 18-19 March 2010, Singapore Regards
Donor Leverage for Access to Avian Flu Vaccines In late 2006, the Indonesian
government made a controversial decision to withhold its H5N1 avian
flu virus samples from WHO’s collaborating centers as leverage for a
new global mechanism for virus sharing that had better terms for developing
countries. In breaking with the existing practice of freely
sending flu virus samples to these laboratories, Indonesia expressed
dissatisfaction with a system which obliged WHO member states to share
virus samples with WHO’s collaborating centers, but which lacked mechanisms
for equitable sharing of benefits, most importantly, affordable vaccines
developed from these viral source materials. The Indonesian decision,
invoking provisions in the Convention on Biological Diversity (1992)
for sovereign rights over biological resources, aroused indignation
and accusations of irresponsibility which endangered global health.
There were however also expressions of support and sympathy, including
an editorial from The Lancet: To protect the global population,
6.2 billion doses of pandemic vaccine will be needed, but current manufacturing
capacity can only produce 500 million doses. On March 29, 2007,
immediately following an interim agreement for Indonesia to resume sending
flu virus samples to WHO, health ministers of eighteen Asia-Pacific
countries issued a Jakarta Declaration which called upon WHO “to
convene the necessary meetings, initiate the critical processes and
obtain the essential commitment of all stakeholders to establish the
mechanisms for more open virus and information sharing and accessibility
to avian influenza and other potential pandemic influenza vaccines for
developing countries”. These concerns were tabled at
the 60th World Health Assembly in Geneva (May 14–23, 2007) as part of
a resolution calling for new mechanisms for virus sharing and for more
equitable access to vaccines developed from these viral source materials.
In the course of the deliberations, it emerged that WHO had not
abided by the terms of the 2005 WHO guidelines on sharing of viruses
which required the consent of donor countries before WHO’s collaborating
centers could pass on the viruses (other than the vaccine strains) to
third parties such as vaccine manufacturers. While discouraging
the use of material transfer agreements (MTAs) at the point when donor
countries transferred their virus samples to WHO, WHO’s collaborating
centers nonetheless resorted to MTAs when they transferred to third
parties vaccine strains containing parts of the viruses supplied by
developing countries such as
Global Health Security, or Global Public Health? In April 2003, as the
SARS pandemic was unfolding, Ilona Kickbusch, Professor of Global Health
at Yale University’s School of Public Health lamented the weak enforcement
mandate of international agencies such as the WHO for securing the cooperation
of member states in safeguarding global health. In parallel with
“an incentive system for countries who act as responsible global
citizens”, she issued an accompanying call “to explore sanctions
by the UN Security Council, the WTO and the IMF for countries that do
not adhere to global health transparency and their obligations under
the IHR”. Similar sentiments, couched in terms of
health security and health policing, had been expressed about Indonesia’s
refusal to dispatch H5N1 virus samples to the WHO’s collaborating centers.
In a strongly-worded op-ed in the Washington Post (August 10, 2008),
Richard Holbrooke and Laurie Garrett castigated Indonesia’s “dangerous
folly” as “morally reprehensible” actions of a recalcitrant state which
jeopardized global health security (perhaps calling for humanitarian
intervention?): Here's a concept you’ve probably never heard
of: “viral sovereignty.” This extremely dangerous idea comes to us courtesy
of A year later in July
2009, as the H1N1 pandemic was unfolding amidst efforts to boost vaccine
production, along with widespread concerns over supply limitations and
distribution, Garrett belatedly acknowledged the essential point about
“viral sovereignty”, that it was above all an exercise of sovereign
leverage for more equitable access to lifesaving vaccines in a pandemic
situation: The Minister of Health of Indonesia, Dr.
Siti Supari, has insisted for several years that it is not the duty
of her country to share samples of H5N1 bird flu viruses. Supari’s
position all along has been that the drug companies will turn these
viruses into vaccines, and then charge so much for their products that
the poor countries will never be able to afford the life-saving products.
What we now see unfolding with the H1N1 vaccine scenario would seem
to validate her argument… when a pandemic comes, the rich world takes
everything and saves itself (ScienceInsider, July 28,
2009). Despite appeals to humanitarian solidarity and
to enlightened self interest, almost all of the first billion doses
of H1N1 vaccine produced in 2009 were allotted to 12 wealthy nations
which had made advance orders. Sanofi Pasteur and GlaxoSmithKline
pledged 120 million doses to the WHO for distribution to poor countries,
but even those pledges could only be fulfilled months after the pandemic
had waned. In Access to Pandemic H1N1 Vaccines: A Worrisome Preview As it turned out, the
H1N1 pandemic peaked in October-November 2009 in the northern hemisphere,
and it furthermore remained mild, more comparable in severity to the
1957 and 1968 pandemics than to the feared 1918 pandemic.
Many nations cut back on their vaccine orders, others attempted to sell
off excess stock or pending deliveries as the threat perception receded
and skepticism about the vaccines’ safety resurfaced among the general
public. As of early February
2010 however, only two of the 95 countries listed by WHO http://www.who.int/en/ as having
no independent means of obtaining flu vaccines - In the wake of the mild pandemic, WHO’s alert system for influenza pandemics also came under scrutiny. Under WHO’s six-stage approach, the highest (pandemic) stage is declared when a new flu strain that spreads easily among humans and causes serious illness, shows evidence of sustained community level spread in at least two regions of the world. The system however focuses more on transmissibility, while lacking an index of virulence or lethality. This causes confusion among people who equate “pandemic” with a high death rate, usually measured by the “case-fatality ratio” (CFR, the ratio of deaths to infections). In truth, the CFR is an unstable parameter in the early stages of a novel outbreak, since it is usually the fatalities and severe cases that come to early attention, thus inflating the CFR as an artifact of underreported mild or asymptomatic infections. There were also allegations of scaremongering by parties with vested interests in vaccine manufacture and sales, squandering of scarce health resources and diversion of attention from more urgent priorities in global health. Prior to the H1N1 pandemic, some researchers had already begun to question the efficacy of seasonal flu vaccines (Jackson 2005, Jefferson 2006). In any case, whether one felt cheated by or relieved at the mild course of the pandemic, it provided a valuable preview of likely scenarios for vaccine supply and timely access, in the event of a more virulent pandemic. For developing countries, this dress rehearsal was uncomfortably close to the scenarios anticipated by Dr Siti Fadhilah Supari, the Third World Network, and others. Resolution WHA60.28 in 2007 (“Pandemic Influenza Preparedness: Sharing of Influenza Viruses and Access to Vaccines and Other Benefits”) was notable in declaring for the first time, at the highest levels of representative global health diplomacy, that affordable access to the benefits of virus sharing in such forms as vaccines, medicines, and diagnostics was the equitable quid pro quo of global virus sharing arrangements for pandemic alert and response. Indeed the WHO Intergovernmental Meeting (IGM) on Pandemic Influenza Preparedness, a process mandated by WHA60.28, included by consensus the following paragraph in its draft framework for reforming the GISN : Recognise that member states have a commitment to share on an equal footing H5N1 and other influenza viruses of human pandemic potential and the benefits considering these as equally important parts of the collective action for global public health. In the absence of reciprocal benefits, the International Health Regulations (2005) in particular, which impose mandatory disease reporting obligations on signatory member states, could reduce poorer front-line states to the role of pandemic “canaries” in an early warning system for emergent flu pandemics.
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