"Promise them anything, but give them Arpege" was a famous perfume ad campaign of the 1960s. Indonesia is free with promises, but what it is actually handing out doesn't smell like Arpege. After promising (for at least the third time since January) to resume sharing of viral isolates, we find only three clinical specimens, not isolates, have arrived in Japan but the provision of specimens or isolates from another 12 known and confirmed cases from Indonesia is unclear.
After refusing to share H5N1 avian flu viruses with the World Health Organization since the start of the year, Indonesian officials revealed Tuesday the country sent clinical specimens to a WHO collaborating laboratory earlier this month.But the shipment was small, containing only three samples from two patients. Indonesia has confirmed 15 or so human cases since the start of the impasse, which is over affordable access to pandemic vaccines.
It was not clear whether more clinical specimens would be sent later, or if this was a one-off gesture. (Helen Branswell, Canadian Press)
Virus has still to be grown from the samples sent to the WHO reference lab in Japan, although there is hope some will be produced within the week, because the samples were not viral isolates, but patient specimens. And as New Scientist reports, genetic sequences from the 15 cases that have occurred since sharing was stopped are not available either, since Indonesia doesn't have sequencing capability.
As we keep saying here, the vaccine problem is a real one, partly related to the unequal distribution of existing production resources between the rich and poor nations, and partly related to grossly inadequate global vaccine production capacity. The Indonesian health minister complains that when her country was experiencing mounting cases in 2005 and she asked Roche for an emergency supply of Tamiflu she was told all existing Tamiflu all spoken for by rich countries. This is a good example how the world is reaping the whirlwind of a system that is broken.
But the Indonesian position on virus sharing is unworkable and their actions indefensible. Even with a set aside of 40 to 60 million doses for the developing world, there is too little to go around, and Helen Branswell reports Indonesia is demanding 22 million of that for itself (10% of its population). Even if others acquiesced to Indonesia getting a third of the stockpile, it has an impotent and inefficient government which, even in the absence of corruption (which is far from absent), it would be unable to distribute equitably and effectively.
More importantly, Indonesia's solution wrecks the longstanding system of free sharing of vital information for preparing seasonal and possibly pandemic influenza vaccines. Contrary to implications of the Indonesian Health Minister, the viral vaccine seeds are not patented or subject to license. Only the vaccines prepared from them are. That system of distorted and predatory use of intellectual property rights creates a problem but not one that would be solved by distorting it further and demanding property rights for viruses, which would make things even worse. As we pointed out yesterday, Indonesia is quick to claim proprietary rights for a deadly virus isolated within its borders but not the liability that ensues from that virus creating havoc in the rest of the world. We continue to advocate the opposite strategy, taking vaccines outside the market system and manufacturing them at cost and under a public license.
So Indonesia's ploy isn't a clever tactic to reform international vaccine production and policy. It's more like Samson pulling the Temple down around everyone's ears, but just for spite.
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Revere,
I thought that was an excellent commentary. I hope the wire services pick up on it (I saw it was on the NewsNow feed)and it gets circulated more widely than your blog so that (a) Indonesia sees there is widespread disapproval of their tactics and (b) some momentum starts to build behind your idea of taking vaccine production outside of the market economy.
We can only hope. Remember the campaign to get the WHO &their reference labs to share sequence data with open datasources i.e. Genbank etc?
While I agree that at cost, public domain, vaccines would be wonderful, it seems a prohibitively expensive operation for healthcare systems already pushed to the wall by demographic change and budget cuts. One of the reasons for the inadequate production capcity, that you have touched on before, is that influenza vaccine production is an unprofitable business (except when pandemics arrive), largely because of small uptake rates on the seasonal vaccine. If there was much higher uptake on the seasonal vaccine wouldn't big pharma be forced by their bottom line to have the capcity we need?
Do you think that a concerted campaign by the government (or alternatively a pandemic) would increase rates of seasonal vaccine consumption to the point where a much larger production capacity existed?
It might even spur research into more efficient "egg-less" manufacturing techniques. (wow, I don't normally sound that neo-liberal ;))
Jon: I don't think the cost is prohibitive for this. Compared to what we now pay and the savings from preventing flu, it might even come out ahead. Why try to force the market to work when it doesn't? Let's just face it and say we need a substitute for the market, something we do all the time for global public goods (like roads) or air traffic control.
I dont know really what to say about Indon except that they are as full of crap as Xmas Turkeys. That crap flows downhill on everyone. We are supposed to sit idly by while they run BF as a monetary petting zoo. Oh, they'll say its for the people that they have to hold our feet to their fire, but its really about the money. Step up to the plate and tell them that there isnt going to be anymore money coming in for culls which arent happening, training that is supposed to be taking place, and above all informing people what not to do.
There is NO money in BF vaccine for anyone so it has to be subsidized and there is no subsidy yet because the workable vaccine doesnt exist. The R&D money is out there but you cant make a vaccine without knowing your target. The Indonesians are sitting in spite of the world and looking for payola. Where do they think the vaccine is going to come from?
We talk about timelines and withdrawals all the time here. Give them one. Give up the sample or we remove our money and people. The Aussies should do the same because its such a playground for them. Not one single person beyond the first couple of H2H's needs to die if they prepare and the governments of the world do their jobs. Indon needs to step up and understand that there ISNT going to be a vaccine unless a miracle steps forth. I dont think it will, I also think that it will maintain at least a 30% CFR worldwide. Now I wonder who the Indons think its going to hit worst?
Definition of acceptable losses in every war. That definition is starting to be created.... it will be modified again if and when BF steps forward.