Biosecurity Briefing

Subscribe | About | Current Issue | RSS | Archive

Indonesia Health Minister Explains Halt in Virus Sharing Practices

By Matthew Watson, July 18, 2008

In June 2008, the journal Annals of the Academy of Medicine of Singapore published an article by Indonesia Health Minister Siti Fadilah Supari and three colleagues which provides an account and justification of events that led the Indonesian government to cease its long standing practice of sharing viral isolates with World Health Organization (WHO) laboratories in early 2007.¹ The Health Ministry position on withholding biological samples has generated controversy in the global health community.

Brief Timeline of Events
From July 2005 until January 2007, the Indonesian government utilized two of the WHO’s reference laboratory facilities to confirm potential cases of highly pathogenic avian influenza (HPAI) in humans. WHO labs were used, in part, because Indonesia lacked its own laboratory infrastructure in country. Viral samples were also sent to the U.S. Centers for Disease Control and Prevention (CDC) and the Hong Kong University.

The Indonesia Health Ministry claims that beginning in April 2006, studies that utilized Indonesian H5N1 viral samples were published without first gaining permission from Indonesia, as required by WHO regulations.

Nature reported that in May 2006, a cluster of human H5N1 infections was identified in Indonesia, causing some experts to fear the start of a pandemic. Although a pandemic did not emerge, criticism was aimed at Indonesia for its perceived lack of preparedness and its reluctance to cooperate with the WHO.² Criticism from the international community coupled with an Australian pharmaceutical company’s plans to use an Indonesian strain of H5N1 (from a WHO lab) to develop an influenza vaccine were factors in Indonesia’s decision to withhold viral samples.¹

Indonesia’s Position
The article asserts that the root cause motivating the Indonesian government’s decision to halt virus sample sharing is an opposition to policies and practices designed to exploit the “biological resources” of poorer countries. Supari, et al, hope to avoid a situation where vaccines that are produced by the developed world from Indonesia’s samples are too expensive for Indonesians to afford. The Annals of the Academy of Medicine of Singapore article concludes with the recognition that robust surveillance and access to biological materials are essential aspects of “global health security.” Supari then calls for the creation of a virus sharing mechanism that emphasizes equity for all nations.¹

The International Response
According to a May 10 TIME article, the international scientific, public health, and medical communities have been critical of Indonesia’s decision to not share H5N1 virus samples. The controversy centers on the fact that the influenza virus mutates very quickly, and vaccine production is highly attuned to the currently pathogenic strain. Without access to virus samples, the facilities that manufacture vaccines are unable to keep up with the rapidly changing virus.³

As reported in a previous Biosecurity Briefing article, the WHO has responded to Indonesia’s concern about equitable access to vaccine by establishing a vaccine stockpile which will be available for the developing world.⁴

References

1. Sedyaningsih ER, Isfandari S, Soendoro T, et al. Towards mutual trust, transparency and equity in virus sharing mechanism: the avian influenza case of Indonesia. Ann Acad Med Singapore. 2008;73:482-488. http://www.annals.edu.sg/PDF/37VolNo6Jun2008/V37N6p482.pdf. Accessed July 17, 2008.
2. Butler D. Pandemic “dry run” is cause for concern. Nature. 2006;441:5545. http://www.nature.com/nature/journal/v441/n7093/full/441554a.html;
   jsessionid=28BAE44B2D2858E619DE891C623EBE71. Accessed July 18, 2008.
3. Walsh B. Indonesia’s bird flu showdown. TIME. May 10, 2007. http://www.time.com/time/health/article/0,8599,1619229,00.html. Accessed June 17 2008.
4. Rambhia K. H5N1 news: Australia approves vaccine; sanofi to donate to WHO stockpile; HHS contracts to develop rapid diagnostic tests. Biosecurity Briefing. June 20, 2008. http://www.upmc-biosecurity.org/website/biosecurity_briefing/archive/avian_pandemic_flu/2008/2008-06-20-h5n1newsaustraliasanofihhs.html. Accessed July 18, 2008.