Indonesia's Avian Flu Holdout

Published: February 16, 2007

Indonesia sent a chill through the World Health Organization recently when it refused to supply any more samples of the avian flu virus that has killed scores of its people. The move, which seemed aimed at gaining access to vaccines at an affordable price, threatens the global effort to track the virus and develop vaccines. But Indonesia has raised a valid point that needs to be addressed: if a pandemic should strike, poor countries would be left without protection.

The W.H.O. relies on a global network of laboratories to provide virus samples so experts can determine which are most likely to spread. These strains are then used to develop the seed stocks that are given - at no cost - to manufacturers to use in making vaccines.

In a typical flu season, the key strains emerge from Asia, while the vaccines are sold primarily in the West. This has not caused a ruckus because most developing countries consider influenza one of their lesser health threats. But with rising fears of an avian flu pandemic, the dynamic has changed.

Indonesia decided to act after a foreign company announced work on a vaccine that would be based on its samples. Indonesia stopped cooperating with the W.H.O. and started negotiations to send future samples to another vaccine maker in return for technology that would allow Indonesia to make its own vaccine.

That may be good for Indonesia but could be harmful to global health - especially if other countries follow. Clearly Indonesia, which is in discussion with W.H.O. officials, needs to rejoin the global network. Unfortunately, the W.H.O. has no good answer to the inequities Indonesia has spotlighted.

If a pandemic struck, the current vaccine makers could produce only 500 million doses of vaccine per year if they ran 24 hours a day. That is far short of what would be needed to vaccinate all 6.7 billion people in the world. Thus there seems no doubt that in a crisis, the countries that are home to the vaccine makers would tend to their own citizens first - or those willing to pay the highest prices - leaving little or no vaccine for everyone else.

The W.H.O. needs to work much harder to encourage the transfer of vaccine production technology to countries, like Indonesia, that have the technical ability to use it. That will increase the supply of vaccine and presumably bring prices down. Even then, we fear, there still won't be enough.

Just here proffering my pearls to swine, my throat to wolves and my trousers to the flagpole.