WHO releases information on viral sharing and disposition

A report late last night by Helen Branswell alerted me to a tabulation from a new tracking system WHO is putting into place to answer demands from a number of member states in the developing world that there be more transparency in how isolates of avian influenza (bird flu) submitted to WHO are used and by whom. About a third of confirmed cases have been registered in Indonesia, although that country has provided less than a quarter of the isolates, a reflection of the refusal by the country's health minister, Dr. Siti Fadilah Supari, to provide any more specimens until matters of vaccine rights have been settled (see links to some of the posts here):

Of 734 viruses currently stored in WHO labs, 171 were provided by Indonesia, the country which for the past year has been at the centre of a standoff over access to viruses.

China, thought to be the birthplace of the H5N1 virus, has provided 22 viruses to the WHO network, 20 in 2006 and two in 2007. Its special administrative region, Hong Kong, has provided another four, according to the report posted on the WHO's avian influenza web site. (Helen Branswell, Toronto Sun)

It is important to note that usually what is submitted to WHO, through its reference laboratories, is a clinical specimen. The tabulation shows there were 8,763 specimens submitted from humans or animals but viruses were only able to be cultured from 734, less than 10%:

Of those, the WHO recommended 13 be made into seed viruses for vaccine development. Those viruses came from China (2), Indonesia (1), Vietnam (3), Cambodia (1), Turkey (1), Hong Kong (4) and Mongolia (1).

Eight of those have been made into vaccine seed strains using reverse genetics, a patented technique in which the virus is modified in order to allow it to grow in hens' eggs. (Unmodified H5N1 viruses kill eggs.)

A total of 292 institutions - likely companies and university-based researchers - have taken possession of the vaccine seed strains made with reverse genetics. Another 46 have taken possession of unmodified H5N1 viruses provided by labs in the WHO network. (Helen Branswell, Toronto Sun)

In terms of specimens submitted, Indonesia looks better, having sent WHO almost half the total specimens (4774), but only 171 grew virus in culture. It isn't clear what the criteria were for which specimens to send, so this may be a reflection of less selectivity on Indonesia's part compared to other countries. At the beginning of last year (end of January, 2007) Siti Supari raised her concerns about sharing virus. For 2007 Indonesia sent only 65 specimens (compared to 368 in 2006), 62 to WHO reference laboratories at CDC and 3 to Japan. 13 of the CDC specimens grew H5N1 but none of the Japanese specimens. As Branswell notes in her excellent article, all of the 14 countries who reported human cases by the end of 2007 have submitted specimens as well as many others who have had poultry outbreaks.

Having viral isolates is an important piece of the global pandemic influenza surveillance system. It not only allows monitoring of genetic changes that may or may not be of epidemiological significance, but it also allows diagnostic testing to be kept up to date as primers used for PCR testing undergo changes. Unfortunately the broken intellectual property system and the often rapacious and reckless behavior of large vaccine and drug makers has produced a Gordian knot that so far has not found its Alexander. The result is this logjam in viral surveillance.

Tabulation of the tracking system here.