HHS secretary blogs on impasse with Indonesia

Lisa Schnirring  Staff Writer

Apr 17, 2008 (CIDRAP News) – US Health and Human Services(HHS) Secretary Mike Leavitt, in Vietnam today on the second leg of a 10-daytour of Southeast Asia, revealed new details on his blog today about his talkswith Indonesian officials on two controversial issues: the country's refusal tofreely share H5N1 virus samples and the status of the US Navy's medicallaboratory unit, NAMRU-2.

Leavitt is visiting Indonesia, Vietnam, and Singapore todiscuss a host of issues, including import safety and collaborative efforts tohalt the spread of infectious diseases such as avian influenza and HIV,according to an Apr 14 press release from the HHS. The United States,recognizing the burdens Indonesia and Vietnam have faced in the fight againstavian influenza, has provided technical assistance and funding to furtherefforts to identify and prevent the disease, the HHS said.

"By working together, we can improve the safety of foodand other products and build a common defense against disease," Leavittsaid in the press release. Leavitt has maintained a blog on the HHS Web sitesince August 2007, and the HHS has said he is the first cabinet secretary touse the online forum.

In early 2007, Indonesia announced it had stopped sharingH5N1 virus samples with the World Health Organization (WHO) to protest, in itsview, that poorer developing countries that share samples will not have accessto or afford the pandemic vaccines that pharmaceutical companies in developednations will manufacture using the samples.

The US Navy's medical unit in Jakarta (NAMRU-2) is a WHOcollaborating laboratory, and its status in the county has been uncertain sinceIndonesia stopped sharing its H5N1 samples. However, on Apr 10 Kyodo NewsAgency, a Japanese news service, reported that Indonesia's health ministry hadbanned NAMRU-2 from operating in the country.

Uncertain times for NAMRU-2
In his blog post, which he wrote whilestill in Indonesia but posted today, Leavitt said that NAMRU-2 can help anySoutheast Asian country identify virus samples in the event of communicabledisease outbreaks. He added that the laboratory has operated in Indonesia fordecades; however, the memorandum of understanding (MOU) between Indonesia andthe United States expired 2 years ago, and efforts to renew the agreement havebeen unsuccessful.

The United States also has a Navy medical unit in Cairo,Egypt, NAMRU-3, that also serves as a WHO reference laboratory and has beeninstrumental in analyzing H5N1 samples.

Indonesia's health minister, Siti Fadilah Supari, recentlyordered Indonesian institutions to stop sending tissue samples to NAMRU-2,because she believes the sharing is illegal without an MOU and a materialtransfer agreement, Leavitt wrote. "Her action is obviously linked to herglobal initiative to seek specific benefits for sharing samples," headded.

Payment demand stalls virus-sharing talks
Leavitt wrote that he had useful talkswith many of Indonesia's top federal officials, including its president, SusiloBambang Yudhoyono, though much of his time was spent discussing virus-sharingissues and the status of NAMRU-2 with Supari.

A WHO working group on virus sharing has been trying tohammer out a virus-sharing agreement between global health officials anddeveloping countries, but has made little progress. The group last met inNovember 2007, and a smaller version of the group may meet again in May inadvance of the WHO's World Health Assembly, according to previous reports.

Little progress was made on the question of whethercountries that contribute virus samples should receive direct financialcompensation, Leavitt said.

"The minister's main point is that what she wantsshould not be considered 'royalties' or 'compensation,'" he wrote."What she says she wants is for the contributing countries to be eligiblefor some share of the value commercial companies create out of the influenzasamples they provide."

Leavitt said he acknowledged Supari's legitimate concernsabout her country's access to medicine and vaccines, but emphasized that healthofficials need to retain incentives that enable pharmaceutical companies todevelop new countermeasures.

"I pointed out that technology is improving and mightwell hold solutions that we don't currently have," he wrote. "Once weare using cell-based methods of making vaccines, the capacity and cost willdramatically drop, which will change the entire equation."

However, Leavitt said linking sample sharing to paymentwould erode the world's ability to make any vaccines, "because the slopeis slippery, and there will be no end to the demands."

Vaccine availability and sample sharing are both legitimateissues, he said. "And we must deal with them both, but we should not link[them]. World health should not be the subject of barter."

Countries set a 2-month time clock
Indonesia's coordinating minister AburizalBakrie suggested that the United States and Indonesia spend the next 2 monthsworking on a solution to the impasse, Leavitt reported. He said he instructedhis representative Bill Steiger and ambassador John Lange, the State Department'sspecial representative for avian and pandemic influenza, to continuediscussions with Indonesia.

Leavitt warned that, despite the new negotiations, thesituation might never be resolved.

"If we haven't been successful in resolving the matter,I think it will be time for the world to just accept Indonesia's unwillingnessto participate in the WHO influenza system and move on to other ways of makingthe world safer."

See also:

Apr 14 HHS press release

Nov 26, 2007, CIDRAP News story "Virus-sharingpact eludes WHO group, but work will continue"