By Chan Chee Khoon
18 June, 2007
The Straits Times

EARLIER this year, Indonesia decided to withhold its bird flu virus samples from the World Health Organisation's collaborating centres, pending a new global mechanism for virus sharing that had better terms for developing countries. The decision is noteworthy for a number of reasons.

In breaking with the practice of sending flu virus samples to these laboratories, Indonesia's Health Minister expressed dissatisfaction with a system that obliges WHO member states to share samples with collaborating centres, but which lacked mechanisms for equitable sharing of gains. Perhaps the most important of these are affordable vaccines developed from these materials by patent- seeking commercial entities.

On March 29, just after an interim agreement for Indonesia to resume sending flu virus samples to the WHO, health ministers of 18 Asia-Pacific countries issued a Jakarta Declaration. This calls upon the WHO 'to convene the necessary meetings, initiate the critical processes and obtain the essential commitment of all stakeholders to establish the mechanisms for more open virus and information sharing and accessibility to avian influenza and other potential pandemic influenza vaccines for developing countries'.

These proposals, tabled at the 60th World Health Assembly in Geneva last month, were part of a resolution calling for new mechanisms for virus sharing and for more equitable access to vaccines developed from these materials.

Still, this issue remained contentious and unresolved until the final hours of the gathering. Then, a resolution was adopted mandating the WHO to set up a global stockpile of vaccines for H5N1 or other influenza viruses of pandemic potential, and to formulate mechanisms for equitable access to these vaccines.

The Indonesian government's stance in particular was notable on three counts:

It was explicitly a critique of the WHO's balance of pragmatism that it felt was overly accommodative of corporate priorities to the detriment of the health and well-being of a key constituency that the WHO was mandated to defend: the underserved communities in its member states.

It was an exercise of leverage by a source country of biological materials seeking to redress the inequities of access to what may be vitally important health inputs (avian flu vaccines) developed from these source materials.

It was seeking equitable benefits from commercial developers not just for its nationals, but for other communities as well that were likely to be sidelined by commercially driven product development and distribution systems.

Notwithstanding the assembly's resolution to establish an international stockpile of vaccines, the limited vaccine production capacity globally, not to mention the financial needs for establishing and maintaining such a stockpile, are key issues that remain to be addressed.

A persuasive case could therefore be made that Asean+3 might provide a potential institutional framework for mobilising the financial and technological resources in the region to enhance preparedness and response capabilities in a likely epicentre of an emergent flu pandemic.

The Asian financial crisis in 1997 gave impetus to a regional effort at managing financial instability caused by volatile capital flows and speculative currency attacks. Recognising the increasing integration of East and South-east Asian economies, a Chiang Mai Initiative emerged in 2000. Initially a network of bilateral swap agreements among Asean+3 members, it might yet evolve into a de facto Asian Monetary Fund following a decision in May to multilateralise a pool of foreign exchange reserves of Asean+3 states.

Beyond the risk of financial contagion in globalised capital markets, the Sars epidemic of 2003 forcefully demonstrated the regional economic consequences of a life- threatening infectious epidemic. Still, this would pale in comparison with the devastating human and economic impact of an outbreak of highly transmissible and lethal human flu on the scale of the 1918-1919 pandemic.

An Asean+3 avian flu initiative would go beyond the existing coordination of surveillance networks. It would include the development and acquisition of vaccine-manufacturing capabilities to augment regional stockpiles of avian flu vaccines that can be made available as public goods on a priority-needs basis.

Set in this context, the Indonesian initiative on new virus-sharing arrangements is noteworthy. Its exercise of donor leverage may presage a consideration of trusteeships that could serve as public - international or regional - repositories of genetic resources, genomic information and other biological materials.

Beyond the immediate concerns of timely and affordable access to vaccines, the Indonesian initiative has also raised other intriguing possibilities. For example, individuals or groups of donors of biological materials and personal data could use the leverage of their gift relationship in clinical trials or other research settings to further the common good.

Indeed, the initiative has opened up a range of new possibilities worth further investigation and consideration.

The writer is a professor and convenor of a health and social policy research cluster at Universiti Sains Malaysia. He was a founding executive board member of the International Society for Equity in Health.

This article was published in The Straits Times on June 18, 2007.

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