Thursday, June 21, 2007

Furthering the common good

Furthering the common good
Chan Chee Khoon
May 30, 07 10:36am

On Feb 16, Indonesian Health Minister Siti Fadilah Supari informed senior World Health Organisation (WHO) officials that her country would continue withholding its bird flu virus samples from WHO’s collaborating centres pending a new global mechanism for virus sharing that had better terms for developing countries.

In breaking with the existing practice of freely sending flu virus samples to these laboratories, she expressed dissatisfaction with a system which obliged WHO member-states to share virus samples with collaborating centres, but which lacked mechanisms for equitable sharing of benefits, most importantly affordable vaccines developed from these viral source materials by patent-seeking commercial entities.

To consolidate regional support for this initiative, a meeting of Asia-Pacific developing countries was convened in late March to explore mechanisms for more equitable access to vaccines produced from virus sharing arrangements. The Indonesian decision elicited unease, but also sympathy from a cross-section of the global community, including an editorial from The Lancet.

On March 29, immediately following an interim agreement for Indonesia to resume sending flu virus samples to WHO, health ministers of 18 Asia-Pacific countries issued a Jakarta Declaration which called upon WHO “to convene the necessary meetings, initiate the critical processes and obtain the essential commitment of all stakeholders to establish the mechanisms for more open virus and information sharing and accessibility to avian influenza and other potential pandemic influenza vaccines for developing countries”.

These proposals were tabled at the 60th World Health Assembly in Geneva (May 14-23) as part of a resolution calling for new mechanisms for virus sharing and for more equitable access to vaccines developed from these viral source materials.

In the course of the deliberations, it emerged that WHO had violated the terms of the 2005 WHO guidelines on sharing of viruses which required the consent of donor countries before its collaborating centres could pass on the viruses to third parties such as vaccine manufacturers. Indeed WHO’s collaborating centres themselves, as well as third parties, had sought patents covering parts of the source viruses used in developing vaccines and diagnostics.

The Indonesian stand-off with WHO comes on the heels of Director-General Margaret Chan’s admonishment to the Thai public health ministry in February over the issuance of compulsory licences for HIV/Aids and heart medications. In the course of a visit to the National Health Security Office in Bangkok, she had publicly urged the Thai health authorities to seek instead a negotiated compromise with pharmaceutical companies over high drug prices. This perceived tilt drew strong criticism from health advocates in Thailand and elsewhere.

They pointed out that the Thai ministry “has been in regular contact with the industry over high prices of its drugs in Thailand, but these negotiations have led nowhere. The best price for originator's efavirenz is still twice the price available from Indian generic sources (US$500 per patient a year vs US$224). The best offer for originator's lopinavir/ritonavir is US$2,000 per patient a year, five times more than WHO's estimate of manufacturing costs. The Thai healthy ministry estimates that the price of clopidogrel would fall by over 90 percent if made generically. These are substantial price differences in a country where the average annual wage is US$1,400 a year”.

Implications for equity

It is unclear whether these episodes amount to tactical shifts, let alone a more fundamental re-alignment between WHO, member-states, corporate actors, and health activists on the issue of access to essential medicines. The ramifications are clear however for the interlinked concerns of global health equity and international health security.

The Indonesian government’s stance in particular was notable on three counts:

• It was explicitly a critique of WHO’s balance of pragmatism which it felt was overly accommodative of corporate priorities , to the detriment of the health and well being of a key constituency that WHO was mandated to defend, the under-served communities among its member states.

• It was an exercise of leverage by a source country of biological materials seeking to redress the inequities of access to what may be vitally important health inputs (avian flu vaccines) developed from these source materials.

• It was seeking equitable benefits from commercial developers not just for its nationals but for other communities as well who were likely to be sidelined by commercially-driven product development and distribution systems.


I'm posting this article here for we are somehow never given a very good impression of our neighbour, the Indonesians.

Kudos to Indonesian Health Minister Siti Fadilah Supari for standing up against the all-powerful WHO!