Global Trends by Martin Khor

Monday 14 May 2007

Access to flu vaccines now a hot issue 

At this week’s World Health Assembly, some developing countries will argue for a new system to ensure they have affordable access to vaccines if an avian flu pandemic breaks out.


The World Health Assembly, bringing together Health Ministers and officials, take place this week in Geneva.

One of the hottest issues will be the stark inequity between developed and developing countries in their access to vaccines in the event of an avian flu pandemic. Indonesia and Thailand are tabling resolutions to highlight the problem.  

Many rich countries have paid drug companies to stockpile pre-pandemic vaccines and made advance purchase orders to have pandemic vaccines delivered to them in the event of a pandemic.  

The rush to place orders is due to the scarcity of vaccines.  Only 350 million doses of pandemic vaccine can be made a year, but billions of doses are needed if a pandemic emerges.

As the vaccines are patented and expensive, most developing countries cannot afford to order or buy them in the amounts required.  If a pandemic strikes, they fear their populations will be unprotected, as much of the vaccine stocks will be located in and channeled to people in the developed world.

Adding to this imbalance is the fact that a crucial component – the avian flu viruses – used in research and manufacture of the vaccines comes from developing countries, where the human cases of avian influenza are located.

Under a WHO scheme, countries affected by avian flu send virus samples to the WHO’s collaborating research centers and laboratories, almost all of which are national institutions located in developed countries.

Under the WHO’s 2005 and 2006 guidelines, these WHO-linked centers are not supposed to pass on the viruses to companies without the permission of the virus-giving countries.

However, officials of some developing countries have discovered that their viruses have been made use of in activities such as patenting, commercial development and production of vaccines without their permission or even their knowledge.

The countries are being approached by drug companies to make orders for vaccines developed with the use of the viruses they supplied freely. The prices quoted are too high for the countries to afford.

Indonesia announced a few months ago that it would no longer provide bird flu viruses to the WHO’s centers as it believed the centers and the system had betrayed its trust. 

Some of Indonesia’s viruses were passed to companies for commercial activities without Indonesia’s knowledge or permission, while there was no international system in place to ensure that Indonesia or other developing countries would be supplied with sufficient vaccines at affordable prices.

Indonesia’s Minister of Health Siti Fadilah Supari called the current system “unfair”.

She will highlight this issue during the WHA.

Indonesia wants a new system to ensure that the donated viruses are not misused and that a framework is established to ensure benefits to developing countries.

The H5N1 influenza virus is highly pathogenic i.e. able to cause severe disease and deaths in humans.  From 2003 to April 2007, 291 confirmed human cases (including 172 deaths) of Avian Influenza A/(H5N1) were reported, including in Vietnam, Indonesia, Egypt, Thailand, China.

Indonesia found its viruses had been used to make vaccines without its permission when it was approached by an Australian drug company wanting to sell it a vaccine for $20 a dose.  As the country may need to vaccinate its entire population of over 200 million should a pandemic occur, the cost at this price level would be astronomical.

Shocked and angered at this situation, Indonesia suspended sending further virus samples to the WHO centers.  This raised an international storm of controversy, with some countries accusing Indonesia of holding back research activities, while many others (including some mainstream media) expressed sympathy for Indonesia’s position. 

Indonesia’s strong response was partly due to its belief that the WHO and its centers have been violating the WHO’s own guidelines. Though the guidelines state that the viruses received would not be given to third parties, in fact the centers have been providing viruses and data on them to companies without the permission of Indonesia.

Under the Biological Diversity Convention, genetic resources like viruses belong to the countries of origin, which can set conditions for benefit-sharing for allowing its resources to be used.

What upsets the developing countries is that they are donating their genetic resources, but developed countries’ companies are making patented vaccines which are being booked by these rich countries, leaving the developing countries vulnerable if and when a pandemic strikes.

However, it is also expected that at the WHA the developed countries, and perhaps the WHO itself, will resist the call for a new system.  It will thus be an interesting two weeks ahead in the WHA.