The news from Jarkarta, according to Reuters and the WHO, seems to be that Indonesia has agreed to resume sending avian flu isolates to the WHO. According to Minister of Health Siti Fadillah Supari, this will begin "immediately."
A report in the Wall Street Journal (subscription required), however, adds what seems to be a pretty important qualification:
The compromise, announced at the end of a two-day meeting organized by the WHO in Jakarta, means scientists around the world will be able to study the freshest and potentially most important strains of the avian-influenza virus. However, that access won't be extended to drug companies such as Sanofi-Aventis SA of France and GlaxoSmithKline PLC of Britain, both of which manufacture bird-flu vaccines and need access to new strains of the disease to make sure their products are up-to-date and effective.
This, in short, means the debate is far from over. As part of the agreement, the WHO will be revising the Terms of Reference for WHO laboratories. My fingers are crossed, but it seems to me like there's still a lot that could go wrong here. Lest we think the problem is entirely behind us, MoH Supari remarked, "We trust WHO will not violate our trust, because this is related to the WHO's credibility." In other words, they've offered to take the first step to break the stalemate in exchange for a pledge from WHO that the status quo will indeed change. But this first step is clearly a conditional one.
Some have advanced the entirely foreseeable and quite disastrous long-term consequences of not sharing samples as proof that Indonesia should never have done what it did. I would disagree--up to a point. Sadly, barely anyone would have paid attention if Indonesia had simply registered it's complaint without threatening any real consequences.
While Indonesia has a made a clear case for why the status quo for sharing virus samples is inadequate in the short term, it's also becoming clear (if it wasn't already) that no one's interests--not even Indonesia's--are advanced in the long term if different manufacturers don't have access to new samples. It's impossible for me to envision a solution that would not somehow involve for-profit companies having access to viral isolates. This makes me wonder how far the current agreement can really go.
It's true that Indonesia is collaborating with one company (Baxter) but their candidate vaccine is a 'whole-cell' vaccine, quite different from those being developed by Sanofi, GSK, and other companies. Clearly it's prudent to move forward with studies of as many different candidate vaccines, adjuvants, and production technologies as possible (and hence, to supply seed viruses to as many manufacturers as possible).
I see two reasons for this. This first relates to global supply: More manufacturers means more vaccine available globally, which I think all can agree is a good thing. The second relates to safety and efficacy of the vaccines: What if it turned out that Company X's vaccine was unsafe or ineffective (or just less safe or less effective than Company Y's)? Note: I'm not saying this is the case with Baxter's vaccine. I'm just saying that bad things can happen, even to good vaccines, as with Chiron's seasonal flu vaccine in 2004.
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