Ethics & Pandemics

Progress on Sharing Viral Samples

I was going to post on a New York Times editorial that appeared this morning on Indonesia's recently announced decision to stop sharing virus samples with the World Health Organization, but then I saw this announcement on the WHO's website following a meeting between Minister of Health of Indonesia Siti Fadillah Supari, and Dr David Heymann, Acting Assistant Director-General for Communicable Diseases. At the risk of being optimistic, it looks like some real progress has been made this week....

Sharing of avian influenza viruses and pandemic vaccine production

Indonesia’s leadership alerted the international community to the needs of developing countries to benefit from sharing virus samples, including access to quality pandemic vaccines at affordable prices. The Minister of Health recognizes that both short-term and long-term solutions are needed for countries such as Indonesia to strengthen their capacity to protect themselves against threats such as pandemic influenza. In the short term, Indonesia will pursue discussions with vaccine production companies to meet its vaccine needs. WHO fully supports this. In the long term, Indonesia is working with WHO to develop its local vaccine production capacity through technology transfer. Both WHO and the Ministry of Health of Indonesia agree that local capacity to produce vaccines is the long term solution to ensuring availability and access to influenza pandemic vaccine.

The Minister expressed her appreciation that WHO will continue to work with the Ministry of Health to strengthen its laboratory capacity for emerging infections such as H5N1.

The Minister agrees that the responsible, free and rapid sharing of influenza viruses with WHO, including H5N1, is necessary for global public health security and will resume sharing viruses for this purpose. WHO will continue discussions and work with the Ministry of Health and other countries to assess and develop potential mechanisms, including Material Transfer Agreements, that could promote equitable distribution and availability of pandemic influenza vaccines developed and produced from these viruses.

To this end, WHO and the Ministry of Health have jointly decided to convene a meeting of selected countries in the Asia and Pacific region to identify mechanisms for equitable access to influenza vaccine and production.

There's been near unanimous agreement that bilateral agreements between individual countries and vaccine manufacturers isn't a particularly good approach to developing a pandemic vaccine.  Even after signing the memorandum of understanding with Baxter last week, Indonesia expressed a willingness to work with other companies.  And Baxter quickly reassured the world that it would continue to collaborate with WHO on vaccine development efforts. 

But there's also been consistent agreement, even at the WHO, that the status quo--wherein countries share their viral samples without any assurance that they might benefit from the existing vaccine development, production, and distribution system--simply may not survive for long. 

Given the limited global vaccine production capacity, and the likelihood that many countries will nationalize the manufacturing plants within their own borders (i.e., "what gets made here stays here"), it seems the solution is not simply to share the vaccine that will be produced.  Better yet would be to share the technology for producing vaccines.  This approach would serve two useful purposes: (1) boosting global capacity and (2) promoting more self-sufficiency in developing countries.

Of course, in the near term, inequities in the distribution of vaccine will remain, and so the problem is by no means "solved."  But the joint statement by WHO and Indonesia seems to be cause for at least some optimism

 

World Bank Web Seminar on Compensation

Tomorrow (February 13), the World Bank is live webcasting a seminar on Compensation Policies: Issues and Good Practice.  It's scheduled for 2:00-5:00 am EST  (Note: AM, not PM).  It promises to be an intersting seminar, with remarks and presenations from David Nabarro (UN), Anni McLeod (FAO), and Alain Dehove (OIE), as well as brief presenations on successes and challenges of managing compensation by representatives in Nigeria, Romania, Vietnam, Indonesia, and Kenya.  To access the seminar via the web, visit: http://vcg01.worldbank.org/vc/.  I'm hoping to post a recap of the seminar here in the next few days. 

Avian Flu's Toll on Jakarta's Poor

Colleages and I had an op-ed piece in the New York Times today on the recent backyard farming ban in Jakarta:

Who Pays to Stop a Pandemic?

Bird flu has not yet turned into a pandemic, but it is already killing the meager hopes of some of the world’s poorest people for a marginally better life.

When poultry become infected with the deadly strain of avian influenza (H5N1), it is essential that all birds nearby be culled to prevent further spread. We all stand to benefit from this important pandemic prevention strategy, recommended by the World Health Organization and the United Nations Food and Agriculture Organization. Unfortunately, however, the world’s poor are unfairly shouldering the burden of the intervention.

Last month officials in Jakarta, Indonesia, announced a ban on household farming of poultry there. The domestic bird population of Jakarta is estimated at 1.3 million. Thousands of families were given until Feb. 1 to consume, sell or kill their birds. Now inspectors are going door to door to destroy any remaining birds.

The Indonesian government pledged to pay about $1.50 for each bird infected with the H5N1 virus, a sum that may approximate the bird’s fair market value. But most birds that have been killed under this policy are healthy, so their owners, most reports suggest, will receive nothing.

Of course, culling of flocks and restrictions on farming may be necessary to contain avian influenza.  But is is important that such policies be implemented rationally and fairly.  Sadly, Indonesia has been the target of a lot of finger pointing for not doing enough to control the spread AI (we'll save the debate about sharing virus samples for another post).  What worries us in the case of the Jakarta ban is that the government seems to be doing too much, or at least failing to take into account the livelihoods of its own citizens.  Culling to stop an active infection is essential, but to impose a blanket ban on all small-holder farming--based essentially on the perception that backyard farming is hazardous by its very nature (see previous post about why this view is misguided)--could have disatrous effects, both in the short term and the long term. 

I know I sound like a broken record on this point, but compensation is key.  And as far as we can tell, there are no plans in place to compensate farmers in Jakarta.  And even if compensation (something approaching fair market value) were offered, that would only be a partial solution if the farming ban is envisioned as permanent (which I gather is the case here).  Think about it this way: the life cycle of a chicken is about 6 months, so farmers are constantly replenishing and augmenting their livestock from hatched eggs (See this brief animation from FAO).  Compensation may be the best short-term fix, but in the case of a total ban, a just compensation scheme would have to account for the long term income deficits that farmers suffer.  But so as not to get ahead of ourselves, even a basic compensation scheme would be pretty expensive for Indonesia.  From the op-ed:

Such a program in Jakarta alone would be expensive. Just to compensate families for their culled birds would require nearly $2 million, not including the cost of administering the program. Indonesia’s domestic bird population countrywide is estimated at 300 million, so if the culling program were to be expanded beyond Jakarta, the total compensation cost could run as high as $450 million.

Indonesia’s avian influenza budget for the coming year is reported to be less than $50 million. Clearly, without donor assistance, the government cannot afford to compensate families and farmers fairly. So the burden of pandemic prevention must also fall on the world’s wealthy nations.

Last year, the United States, the European Union and other nations pledged more than $2 billion to the global war chest for avian influenza response. Developing a program to compensate poor families in countries with limited resources is an enormous challenge. But it is time that the money pledged by the donor countries reach the people who are already the first victims of the next pandemic.

Of course, donors have reason to be wary about handing over millions of dollars to a country with a highly decentralized regional administration, where accountability is difficult, if not impossible, to achieve.  But it's clear that Indonesia needs help.  And it's also clear that if the government of Indonesia feels that it's not getting the help it needs, it will take matters into its own hands, for better or for worse.