WHO MEETING MAKES SLOW PROGRESS ON PREPAREDNESS FOR AVIAN FLU PANDEMIC

Government health officials made limited progress in an attempt to find common ground on avian flu preparedness, despite four days of talks under the direction of the World Health Organization last week. Negotiations on improving surveillance and promoting vaccine research and development bogged down amidst procedural concerns and differing views, leaving many countries unhappy.

Following the meeting's failure to develop a better virus sharing system, Indonesia, the country hardest hit by avian flu, declared on 23 November that it would suspend sharing avian flu virus samples with the WHO's Global Influenza Surveillance Network (GISN).

While opening discussions on 20 November in Geneva, WHO Director-General Margaret Chan said that "shared vulnerability means shared responsibility." She warned that in the event of a global pandemic, the entire international community must "brace themselves for a meltdown of public services… with no unaffected parts of the world."

By the end of the week, she said that final decisions were "so close and yet so far away," though she praised the process and told negotiators "no one can fault you for not trying."

The intergovernmental meeting (IGM) was mandated by the World Health Assembly earlier this year to "identify and propose frameworks and mechanisms that aim to ensure fair and equitable sharing of benefits" in efforts to ensure preparedness for pandemic avian flu.

The IGM set out to discuss the international stockpile of influenza vaccines against strains of the virus. Concerns about vaccine production and the international stockpile are growing, because the avian flu is a rapidly changing virus that could mutate into a form easily spread by human-to-human transmission.

Chan stressed that sharing samples of the virus within a global system was "the only way to monitor the emergence of drug-resistant strains."

A majority of delegations agreed that there are faults with the current GISN, which was created by the WHO in 1952 to provide analysis, recommendations, and surveillance regarding "influenza viruses with pandemic potential." Several countries, particularly from Asia, expressed dissatisfaction with how virus samples within the system had been used. Sources say that there have been repeated violations of WHO operating procedures in recent years. Samples donated by governments within the GISN framework are supposed to be used at WHO-approved laboratories and influenza centers. Labs must receive permission from a country before sending specimens outside the system -- a requirement that aims to provide countries with some control over their biological materials. However, WHO collaborating centres have reportedly transferred samples from Vietnam, Indonesia, China and Mongolia to non-GISN research institutions as well companies interested in pandemic vaccine development without the respective governments' permission. Both WHO approved labs and commercial firms outside the system have sought - and in some cases received - patents on these materials.

In response to claims that the flu monitoring network had been violating WHO rules, the IGM planned to revise the terms of reference for labs and centers within the GISN, and develop standard sharing practices and strengthened oversight mechanisms. Delegates emphasised that they should develop a fair, transparent, and equitable influenza preparedness system.

Indonesian Health Minister Siti Supari on 20 November told delegates that private companies had used Vietnamese virus samples to produce vaccines that Vietnam itself could not afford. Such improper use of specimens given to the WHO "could threaten global health security," and constituted "a new type of oppression to developing nations by developed countries," she said. "We are here today to show the world that we care for the health of all people in the world, not to negotiate a profitable deal for companies," she added, calling for the issue to be solved in a manner that is transparent fair, and equitable. Supari emphasised that the global system should provide benefits to developing countries because it is their right, and not make it appear to be "charity" from rich nations.

Guy Willis from the International Federation of Pharmaceutical Manufactures and Associations said that the "GISN is incredibly important." He claimed that there had been some "headway aiming to make transparency with regards to viral samples" but that "key details remain to be put in place." The transparency progress he referred to is a mechanism that will track a virus specimen as it moves through the GISN, and recognises how specimens are shared.

In contrast, the Indonesian delegation told Bridges that "the current system has failed" and that it should "no longer be used in the international community."

Over 56 civil society organisations sent a joint statement to WHO member states last week, calling the current system "imbalanced" and highlighting the absence of guarantees that developing countries would have access to influenza vaccines because of "high prices and lack of supplies."

Indonesia accounts for 91 of the 206 deaths from avian flu worldwide. An Indonesian proposal presented during the WHO meeting called for a direct link between virus sharing and access to medicines, as well as stronger recognition of countries' sovereign rights.

Sovereign rights was one of eight principles that member governments and IGM Chair Jane Halton (Australia) identified as priorities for the meeting, along with benefit sharing, virus sharing, collective action, intellectual property, financing, obligation of involved parties, and oversight mechanisms. Talks focused primarily on benefit sharing and virus sharing, even though officials had been expected to negotiate text on all eight. While some progress was made on benefit sharing principles, the text agreed to was already present in past resolutions.

The IGM did yield some concrete new outcomes, such as a request for WHO chief Chan to appoint an advisory group on the GISN in preparation for the May 2008 World Health Assembly meeting. With assistance from the WHO Secretariat, negotiators developed a list of technical definitions relating to the GISN, such as for the various types of laboratories associated with the system, forms of virus specimens, research and development procedures, and relevant scientific processes. They also agreed that the scope of the meeting is limited to principles and mechanisms relating to avian flu pandemics within the broader context of preventing a global health emergency. An interim statement, reflecting limited consensus in some paragraphs, is being prepared by the WHO Secretariat as it awaits acceptance from the African regional bloc.

Acep Somantri, a first secretary at the Indonesian mission in Geneva, told Bridges that progress was slow because so many issues were sensitive, and that views differ on North-South lines. However, he said "there was some progress because comprehensive views are together in one consolidated… concrete document to be negotiated in the future."

The US was pleased with the IGM's work. Ambassador John Lange, Washington's special representative on avian and pandemic influenza, issued a statement recognising progress to improve the GISN and stating that discussions continue "on a detailed framework for… virus sharing and benefit sharing."

At the close of the four day meeting, IGM chair Halton acknowledged that there had been a breakdown of trust in the influenza preparedness system. All delegates agreed that there is a need for fairness, transparency and equity throughout the system. Nevertheless, with little in the way of tangible agreement, discussions will continue prior to the 2008 World Health Assembly.

ICTSD reporting.