Aug 7, 2007 (CIDRAP News) – A World Health Organization official said yesterday that Indonesia is endangering the world's health by continuing to withhold H5N1 influenza virus samples collected from human patients.
"Indonesia is putting the public health security of the whole world at risk because they're not sharing viruses," David Heymann, the WHO's assistant director-general for communicable diseases, said in a news teleconference yesterday. He briefed reporters on the results of a WHO-sponsored meeting last week in Singapore on virus-sharing issues.
Indonesia, the country with the most H5N1 cases and deaths, stopped sending H5N1 isolates to the WHO last December to protest the cost of commercial vaccines derived from the viruses. The virus samples are needed to track the virus's evolution and drug resistance and to make vaccines, since the virus is viewed as the potential precursor to a pandemic strain of flu.
In May Indonesia said it was sending three H5N1 samples to the WHO, ending its embargo. But Heymann reported yesterday that those samples contained no live viruses.
"Although they were PCR [polymerase chain reaction] positive, they did not have living virus in them," he said.
Indonesia is the only country that is not sharing samples from its human H5N1 cases, Heymann said. China sent some samples in June, and Vietnam "is trying to ship specimens to WHO, but those specimens are not cleared through all the mechanisms and rules required in Vietnam and receiving countries," he added. Vietnam has had several human cases this year, after going about a year without any.
Heymann said Indonesia is endangering its own people by withholding the viruses. "If those viruses are not freely shared with industry, vaccines will not contain the elements of the Indonesia infections," he said.
Indonesian officials are aware of the risks they are taking, he added. "Indonesia understands these issues and is working with WHO . . . to see how they can best begin sharing again, and we're hoping that can occur fairly soon," he said. "We have hope but no guarantee."
Last week's meeting in Singapore stemmed from a resolution passed by the World Health Assembly (the annual meeting of WHO member countries) in May that outlined steps intended to ensure the equitable distribution of vaccines in the event of a flu pandemic. The meeting involved officials from 23 countries, Heymann said.
The resolution requests the WHO director-general to develop a mechanism for sharing of viruses and prepare a report on intellectual property issues related to vaccine development, Heymann said. The resolution also calls for establishing a global vaccine stockpile and drawing up guidelines for the handling of flu viruses by WHO collaborating centers, meaning the laboratories in the United States, Japan, Australia, and the United Kingdom that study flu viruses for the agency. Further, the resolution calls for setting up an "oversight mechanism" for the WHO's Global Influenza Surveillance Network.
Heymann said the Singapore conference produced three documents, two of them dealing with the handling and sharing of flu virus samples by the WHO and one dealing with the requested oversight mechanism.
He gave no details on the documents' content, but said they will be discussed at an "intergovernmental meeting" in November to which all 193 WHO member countries will be invited.
"The meeting in November will attempt to finalize the documents and review and debate other issues and pass on a report to the [WHO] executive board, which will then review the report and see what's necessary to put into a resolution to pass on to the World Health Assembly," he said.
In response to questions, Heymann said one of the possibilities discussed at the meeting was the WHO's taking "ownership" of viruses supplied by countries. "There would be no change in procedures if WHO took ownership of these," he said. "It would be very difficult if not impossible to patent a virus."
"If WHO did have ownership, if this were feasible, WHO would make sure they [viruses] were freely shared and would work at the same time to make sure the benefits were shared," he said.
"What we will ensure is that there is transparency in the flow of viruses so that countries can determine where their viruses have gone," Heymann added. "This was asked for by all countries."
He said the WHO would be providing a report on the meeting and copies of the documents produced, possibly as soon as the end of next week.
In reference to Vietnam's problems in sending virus samples to the WHO, Heymann said the complex rules and procedures governing the shipment of infectious materials were not part of the agenda at the Singapore meeting. He reported that the Universal Postal Union and other groups are working with the WHO on those.
"It's a very complicated international system which is standardized only in guidelines, but each country seems to take those guidelines and adapt them quite severely to their needs, setting up additional layers of potential obstacles," he commented.
Aug 1 CIDRAP News story "WHO working group grappling with virus-sharing issues"
May 23 WHO resolution on virus sharing
May 23 CIDRAP News story "WHO adopts resolution on flu virus sharing"