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 talks with Indonesian officials on two controversial issues: the country's refusal to freely share H5N1 virus samples and the status of the US Navy's medical laboratory unit, NAMRU-2.
Leavitt is visiting Indonesia, Vietnam, and Singapore to discuss a host of issues, including import safety and collaborative efforts to halt 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 against avian influenza, has provided technical assistance and funding to further efforts to identify and prevent the disease, the HHS said.
"By working together, we can improve the safety of food and other products and build a common defense against disease," Leavitt said in the press release. Leavitt has maintained a blog on the HHS Web site since August 2007, and the HHS has said he is the first cabinet secretary to use the online forum.
In early 2007, Indonesia announced it had stopped sharingH5N1 virus samples with the World Health Organization (WHO) to protest, in its view, that poorer developing countries that share samples will not have access to or afford the pandemic vaccines that pharmaceutical companies in developed nations will manufacture using the samples.
The US Navy's medical unit in Jakarta (NAMRU-2) is a WHO collaborating laboratory, and its status in the county has been uncertain since Indonesia stopped sharing its H5N1 samples. However, on Apr 10 Kyodo News Agency, a Japanese news service, reported that Indonesia's health ministry had banned NAMRU-2 from operating in the country.
Uncertain times for NAMRU-2
In his blog post, which he wrote while still in Indonesia but posted today, Leavitt said that NAMRU-2 can help any Southeast Asian country identify virus samples in the event of communicable disease outbreaks. He added that the laboratory has operated in Indonesia for decades; however, the memorandum of understanding (MOU) between Indonesia and the United States expired 2 years ago, and efforts to renew the agreement have been 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 been instrumental in analyzing H5N1 samples.
Indonesia's health minister, Siti Fadilah Supari, recently ordered Indonesian institutions to stop sending tissue samples to NAMRU-2,because she believes the sharing is illegal without an MOU and a material transfer agreement, Leavitt wrote. "Her action is obviously linked to her global initiative to seek specific benefits for sharing samples," he added.
Payment demand stalls virus-sharing talks
Leavitt wrote that he had useful talks with many of Indonesia's top federal officials, including its president, SusiloBambang Yudhoyono, though much of his time was spent discussing virus-sharing issues and the status of NAMRU-2 with Supari.
A WHO working group on virus sharing has been trying to hammer out a virus-sharing agreement between global health officials and developing countries, but has made little progress. The group last met in November 2007, and a smaller version of the group may meet again in May in advance of the WHO's World Health Assembly, according to previous reports.
Little progress was made on the question of whether countries that contribute virus samples should receive direct financial compensation, Leavitt said.
"The minister's main point is that what she wants should not be considered 'royalties' or 'compensation,'" he wrote. "What she says she wants is for the contributing countries to be eligible for some share of the value commercial companies create out of the influenza samples they provide."
Leavitt said he acknowledged Supari's legitimate concerns about her country's access to medicine and vaccines, but emphasized that health officials need to retain incentives that enable pharmaceutical companies to develop new countermeasures.
"I pointed out that technology is improving and might well hold solutions that we don't currently have," he wrote. "Once we are using cell-based methods of making vaccines, the capacity and cost will dramatically drop, which will change the entire equation."
However, Leavitt said linking sample sharing to payment would erode the world's ability to make any vaccines, "because the slope is slippery, and there will be no end to the demands."
Vaccine availability and sample sharing are both legitimate issues, 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 Aburizal Bakrie suggested that the United States and Indonesia spend the next 2 months working on a solution to the impasse, Leavitt reported. He said he instructed his representative Bill Steiger and ambassador John Lange, the State Department's special representative for avian and pandemic influenza, to continue discussions with Indonesia.
Leavitt warned that, despite the new negotiations, the situation 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 unwillingness to participate in the WHO influenza system and move on to other ways of making the world safer."
Apr 14 HHS press release
Nov 26, 2007, CIDRAP News story "Virus-sharing pact eludes WHO group, but work will continue"