April 24, 2008

Virus Sharing: a Puzzle of Consequences

A scare of pandemic bird flu has been circulating through the news for a few years now, but recently a new flu crisis has sprung up that threatens the readiness of all countries for next year's flu season. Indonesia, the world's hot spot for flu viruses, has refused to provide the World Health Organization (WHO) with this years collected virus samples. The Indonesian government is demanding compensation for providing such crucial information in the fight against seasonal flu, a prospect that the United States has condemned.

US Secretary of Health and Human Services, Michael Leavitt, is currently in Indonesia to discuss the matters of mutual interest with the Indonesian government. The main topic was the Indonesian government's opt out of the international influenza surveillance system which has been in place for almost 60 years and provides vital information on what flu strains to include in the next year's seasonal flu shots. But non-seasonal flu viruses are also part of global surveillance, including the all-famous H5N1 avian influenza virus (bird flu) and Indonesia's decision to opt out means that the biological and genetic character of viruses from the world's hot spot for bird flu disappeared from the view of the world scientific community.

In my view, Siti Supari, the Indonesian Health Minister, has acted irrationally and shown bad judgment but the uncomfortable truth is that there is merit to her concerns.

Last year a virus isolate from the bird flu virus was used by Australia to create a vaccine for emergency workers should a pandemic occur. They then followed up with an announcement that only Australians would have access to the vaccine. This pushed Supari over the limit and as of January 2007 she suspended sharing of viruses isolates. It has always been a dirty secret that the countries who provide the most valuable genetic information for vaccines rarely gain access to the high-cost, low-supply vaccines, but this time was too much.

Supari has long been an outspoken critic of the current surveillance system as the truth is an incredibly small amount of vaccine is made available in Indonesia, and even that small amount is too expensive to be useful to the populace. Hence, a small country sharing the bulk of the important health information we need is also shouldering a large burden from the disease while industrialized nations produce and quickly price out any weaker competition. Supari suggests being able to auction off the virus for money that would be used toward the purchase of the vaccine. This sounds like a logical answer as countries recognize the intellectual property of the vaccine developed from the virus, but do not recognize the value of possessing the genetic information to produce the vaccine.

Selling viruses though is a rather slippery slope because you open the option that one country could purchase a virus to hoard or produce biological weapons (in fact, this was one of Supari's concerns, that the samples she was sending the WHO were being shared with Los Alamos Laboratories, and they were).

When considering Indonesia's situation it is easy to see how dire economic stability and public funding is. The country was devastated by the 2004 Indian Ocean Tsunami and now are suffering through a vicious food crisis (as is the rest of the world), and their virus information is a valuable commodity which could hold substantial value.

Its been said that the governments have failed to reach an agreement during a United States visit to Indonesia this month and that outside help will have to be employed. It just so happens that Bill Gates will be representing the Bill Gates foundation in Indonesia in two weeks and I feel that his organization may try to bring the stalemate to an end.

The real danger in this situation is a rise in a highly contagious and deadly strain of flu which escapes surveillance and hits the world unprepared. Honestly the world isn't ready to deal with a pandemic outbreak of the bird flu, which is scary since we have a vaccine for it. The US doesn't have enough vaccines to ensure the safety of the nation and I can guarantee you that many Asian, African, and South American countries won't be ready either, and that could create an incubating population that can't escape the grasp of the illness. And why do I think this is really getting serious now?

The countries surrounding Indonesia have been gearing up on the defensive lately which makes me believe the situation inside of Indonesia is worse than they are letting on. They have confirmed more cases (113) and more deaths (91) than any other country, are the fourth most populous country and have a vast reservoir of infected poultry (and who knows what else). Who knows what the actual numbers are now or if people are able to be quarantined and effectively stop the transmission or incubation of a highly potent killer.

Japan will shortly begin pre-pandemic vaccination -- based on older H5N1 strains from China, Indonesia, and Vietnam -- of up to 10 million citizens involved in maintaining crucial social infrastructure and as mentioned earlier, Australia is gearing up to provide essential citizens with a vaccine. The proverbial "pandemic ballgame" has moved to a defacto higher level.

5 years ago when calls for planning for a pandemic were raised nations looked internally, forgetting that infection and disease can't see boundaries on a map. The poor countries where these problems will arise need a plan, this action by Supari is desperate and her people will die in droves as the government crumbles if this is allowed to continue.

But even given time and money I don't know that the world can trust governments like Indonesia; after the tsunami they got the bulk of a billion dollars and they stole it. What they didn't steal they didn't use for bird flu prevention either, which is why we're in this mess in the first place.

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