Poor Nations to Confront WHO on Vaccines

Children rarely die from measles or other preventable diseases in the West, but in the developing world lifesaving drugs and vaccines are still out of reach for many. Will access to bird flu vaccines be any different?

That's the question Indonesia is asking by refusing to share its H5N1 bird flu virus samples with the World Health Organization until it gets a guarantee that it can obtain vaccines if a flu pandemic emerges.

Indonesia - the nation hardest hit by bird flu, with 66 human deaths - has dug in its heels, refusing to bow to international pressure from scientists desperate to check whether the virus is mutating into a more dangerous form.

"This is the inevitable consequence of trying to privatize knowledge, and of a poor country saying the system is unfair," said Joseph Stiglitz, a Nobel economics laureate who has written about patents and globalization. "There are so few examples where a poor country has some bargaining chips on its side, and that's what makes this case so interesting."

Indonesia is not opposed to monitoring in general, but Health Minister Siti Fadilah Supari has stressed that she is against giving vaccine makers free access to the country's viruses under WHO's 50-year-old system of virus sharing. She fears any bird flu vaccine created from the viruses would be too expensive for developing nations.

Rich and poor countries were set to meet with WHO on Monday in Jakarta to try to hammer out a compromise. But the standoff has raised a much bigger issue: equal access to drugs and technologies.

"The price is too high for the developing countries to have access" to patented drugs, said Dr. Suwit Wilbulpolprasert, senior adviser on disease control at the Thai Ministry of Health, who agrees with Indonesia's stance.

In January, Thailand broke the patents on a commercial AIDS drug and a heart medicine by using a World Trade Organization rule that allows countries to use generic drugs when faced with a national public health emergency.

UNAIDS estimates nearly 600,000 people are infected with HIV in Thailand, where the government has promised treatment for everyone.

Poor countries still do not have access to many vaccines, including seasonal flu shots often developed from viruses collected in Asia and shipped to the WHO database. Other vaccines routinely available in the West, including hepatitis B, are also too expensive for people in many countries.

An estimated 1.4 million children younger than five die every year from vaccine-preventable diseases, about a third from measles, according to WHO.

"Wealthy countries are always in a better position to be able to produce vaccines, to buy them and to distribute them," said Dr. James Campbell, a leading bird flu vaccine researcher at the University of Maryland.

Bird flu has killed at least 169 people since it began ravaging Asian poultry stocks in 2003, according to WHO. It remains hard for people to catch, and most human cases have been linked to contact with sick birds. But experts fear it could mutate into a form that spreads easily among people, potentially sparking a pandemic that could kill millions.

Currently, only up to about 500 million doses of flu vaccine can be produced annually - far short of what would be needed in a pandemic. WHO hopes to develop strategies for increasing production over the long term, while giving developing countries some safeguards in case a pandemic emerges soon.

To ensure it has access to a bird flu vaccine, Indonesia has reached a tentative agreement with U.S. drug manufacturer Baxter Healthcare Corp. Under the deal, Indonesia will provide the virus in exchange for Baxter's expertise in vaccine production.

Building a global vaccine stockpile and working to produce cheaper vaccines in developing countries are two strategies that will be proposed at this week's meeting, which brings together health officials from countries affected by bird flu, WHO officials, and representatives of developed countries where vaccine companies are based.

"We've got a lot at stake - the world - at this meeting and we all have to work together," said WHO's top flu official, Dr. David Heymann. "If (virus samples) are being given for the global good, then products have to also somehow be made available for the global good at acceptable prices."

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