Tuesday, 22 May 2007

WHO must shift vaccine policy

Although it’s been overshadowed in the news by all kinds of events, there’s been a new global health dilemma brewing in recent months that’s worth talking about. Highlighted by the recent standoff between the Indonesian Government and the World Health Organisation (WHO) over highly coveted Avian Influenza samples, a long standing practice of pharmaceutical companies and the WHO has been called into question and looks like it could forever change – with many of us potentially footing the bill.

Health officials all over the world are scrambling over how best to prepare their country’s people in the event that the dreaded *Bird Flu* should mutate and unleash itself as the next killer global pandemic. With much scepticism as to the feasibility of existing response plans to something this massive, there is much hope being placed in the development of a vaccine which if engineered successfully and used appropriately would theoretically keep fatalities to a minimum. One of the challenges scientists face with this modern day hunt for the cure, however, is the nature of the virus itself … Influenza is known to be highly prone to mutation (even for a virus), and current strains are rapidly evolving into new ones – many of which are significantly different from their predecessors. What this means is that for a vaccine to be effective it is important that it is based on the most current strain(s) possible – and therein lies the opening of this can of worms.

Indonesia has thus far been the unfortunate home to most of the human cases of H5N1 Influenza, including the most recent ones. As the lead agency monitoring global progress of the bug, it has been customary practice for local health officials to send samples of newly identified strains to WHO. WHO, in turn, historically shares these samples with vaccine makers so they can get to work on the most effective concoctions for prevention and treatment. These vaccine makers, however, are for profit corporations, whose products have largely been far too expensive for most countries to afford for their people. Increasingly angry, the Indonesian Government in recent months has championed the call for the developing world and stopped sending WHO H5N1 samples until this policy changes. Donor governments (e.g. USA, Canada) have in response stated that developing an H5N1 Flu vaccine is a matter of theirs and everybody’s security, and vaccine makers have complimented such remarks by stating that without access to recent strains, it will be near impossible to develop an effective vaccine. While both of these facts are certainly true, Indonesia’s concerns are nevertheless compelling, and include:

- International vaccine makers use strains identified locally to develop and mass produce commercial vaccines at a price which Indonesia cannot afford

- Since developed nations can afford the vaccine, and developing nations cannot, the current system reinforces & propagates already large global health inequities

- Indonesia’s position is supported by many other developing nations who agree the sharing/cooperation system must change so that it becomes practical for all people to reap the benefits of medical discovery

In recognizing the potential impact of these events, WHO has moved quickly to broker a compromise, and as of Tuesday (27 March 2007) Indonesia has resumed sharing samples with WHO. WHO has promised that they will not misuse any vaccine shared with them; that while new strains will still be used for vaccine research, they will facilitate technology & assistance transfers to set up local vaccine production capabilities. It has also been rumoured that WHO is considering brokering a *guarantee* of sorts such that in the case of a worldwide Pandemic, as incentive for pharmaceutical companies to manufacture enough vaccines they will purchase a large stockpile strictly to meet developing country needs.

Though I applaud the effort to resolve this dispute and acknowledge efforts from all parties to get the pipeline moving again - it’s this guarantee that is most interesting to me and which merits further discussion. WHO and many of its donors have acknowledged the need for developing countries to be able to access vaccines, or have increased capacity to produce their own. With this new Pandemic ‘insurance’ strategy of sorts, it is appropriate to ask if this will serve as a precedent for how things are to be coordinated when another disease emerges and rings global alarm bells. Secondly, and perhaps most important is a debate around who will pay for this? If this guaranteed purchase is to go forward and be of a meaningful size, and if we are to assume the *discount* they get from vaccine makers will still be earning these companies huge profits, we are talking about a potentially multi billion dollar commitment here. As an agency of the United Nations, the WHO receives its primary funding from its membership – which generally means countries who buy into it, with the lion’s share of financial support coming from the industrialized world. What that means is that the taxpayers of the G8 and other donor countries might have just been asked indirectly to cough up billions in support of these efforts.

Now I am not saying the commitment isn’t worth it – it is – there is no doubt that isolating this virus locally and ensuring its containment everywhere including the developing world is in all of our best interests. It’s just sad that it has come to this. Like most major aspects of international development, it all boils down to the widening gap between the wealthy and the poor. Most people on Earth are living in countries which cannot afford to provide necessary health services or develop strong economies – and many of the reasons for this are a result of our own trade policies, loan conditions or other possibly-well intended development schemes. I’m no economist, but irrespective of the health and welfare of others argument – wouldn’t it also be cost effective for the developed world to assist more developing nations in becoming prosperous so they can produce more of their own solutions, instead of having to cough up billions every time an international threat could potentially reach our shores?

Flu vaccine photo taken by the US Center for Disease Control and Prevention (CDC)

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