This is the story that never dies--nor, I suppose, should it.
After some apparent progress last month, it seems like things are back to square one (or close to it). The agreement reached between the Government of Indonesia and the WHO about resuming the sharing of viral samples seems to have been an agreement more in principle than in actuality (at least so far). Soon after the agreement was announced, there were suggestions from both sides to the effect of "that's not quite what we agreed to." This Canadian Press article by Helen Branswell sums it up nicely. It's dated March 1st, but it's the most complete account I've seen to date:
[Indonesian MoH] Supari said she had received verbal assurances from WHO director general Dr. Margaret Chan that the viruses would be used only to study the evolution of H5N1 and not for production of vaccine. Once those assurances have been put in writing, she said, Indonesia will again ship H5N1 viruses with international laboratories.
A spokesperson for the agency, Dick Thompson, told the Associated Press that Supari's suggestion she'd been given a guarantee that the viruses would not be shared for vaccine development was incorrect. Thompson later said that a letter to Indonesia from the WHO was still being drafted and he had been wrong to imply anything about its contents.
The WHO's influenza czar, Dr. David Heymann, refused to disclose what Chan had told Supari.
"The communications between WHO and ministers are confidential. We can't give any information out about them," Heymann said from Geneva.
It seems unlikely, however, that the international health body could agree to permanently place a limit on how viruses from Indonesia could be used. Doing so would violate a resolution approved by the agency's executive board in January.
[Update: Here's a 3/14 update from CIDRAP that says essentially the same thing.]
It all seems to hinge around an as yet unwritten "Material Transfer Agreement." So far as I understand it, Indonesia's primary criterion for approving the MTA seems to be that no viral samples that leave Indonesia will be used for commercial purposes. They could be used for research (genetic analysis, possibly for vaccine research, etc.) or for producing a vaccine from which no profit is derived, but probably not for anything else.
From the WHO's point of view, it's doesn't seem like such an agreement would be agreeable. In fact, it looks like WHO might not even be authorized to reach such an agreement if they wanted to. So the impasse seems not to have gone away. That said, I expect that diplomatic efforts, shielded from the media, are ongoing. A regional meeting of Asia-Pacific health ministers and others (I don't know who the "others" are) on March 27-28 may point to a way forward. Call me hopeful.
I'm just speculating here, but I wonder what the ultimate impact would be if Indonesia didn't resume sharing viral samples. Crofsblogs' H5N1 blog (which I cannot praise enough) has an insightful post and reader comments about the same subject here.
My personal take is that, with global trade and travel being what they are, if a pandemic were to begin in Indonesia, it would only be a matter of weeks (or perhaps even days) before a pandemic-capable virus crossed the border into a 'virus-sharing' country (Malaysia, Singapore, the Philppines, Australia). This is not to say that failure to share samples won't have any effect. Clearly it will limit research in the interim, e.g., preventing us from understanding how the virus is mutating. But it's not clear how long it would delay production of an actual pandemic vaccine.
The other question lingering in my mind--again, purely speculative--is whether NGOs (Red Cross/Crescent, Doctors Without Borders, and the like) will have any role here. Presumably, they're not bound by the same rules that the Indonesian government claims it is bound by. They cannot afford to flout the government or its policies, but since their mission is truly global in scope, might they see value in discreetly transporting samples out of the country? And would the WHO be willing to receive samples provided by NGOs instead of governments?
I don't mean to suggest that Indonesia's position is something that just needs to be circumvented. I think it poses important questions of global health equity that we cannot afford to ignore. Nor are these questions specific to influenza. A not wholly unrelated debate is raging about governments' rights to issue compulsory licenses for essential medicines like antiretrovirals for HIV. In fact, I'm worried that if we find 'work-arounds' that allow us to resume business as usual, the important issues will remain unresolved.