By Cheryl Pellerin
USINFO Staff Writer

Washington – After a two-day meeting in Jakarta, Indonesia, among officials from the World Health Organization (WHO) and 18 nations that have had animal and human outbreaks of the highly pathogenic avian influenza virus, the government of Indonesia has agreed to resume sharing H5N1 virus samples for the first time since January.

Indonesia Health Minister Siti Fadilah Supari focused global attention over the past few months on the fact that developing countries supply H5N1 samples to WHO collaborating centers for analysis and preparation for vaccine production but are unlikely to have access to the vaccines. (See related article.)

“Previously, WHO used a mechanism that was not fair for developing countries,” Supari said at a March 27 press conference in Jakarta. “This mechanism was not fair and transparent in terms of the expectations of developing countries. We think that mechanism was more dangerous than the threat of pandemic H5N1 itself.”

To address these concerns and maintain sample sharing for risk assessment, WHO organized the meeting in Jakarta.

Among the participants were senior scientists, including four directors of the WHO collaborating centers; potential funding sources, including representatives from the Asian Development Bank and the Gates Foundation; and others.

The agreement comes as the Egyptian Ministry of Health and Population announced a new human case of H5N1 avian flu in a 3-year-old girl from Aswan governorate who had contact with backyard poultry. She developed symptoms March 22, was hospitalized March 24 and is in stable condition.

“The current global capacity to produce a vaccine to respond to an influenza pandemic is insufficient to meet the global need, especially in developing countries,” said U.S. Health and Human Services Secretary Michael Leavitt in a March 23 statement. “The WHO deserves continued support and commendation for its leadership in guiding the global effort to prepare for and respond to a potential human influenza pandemic.” (See full text of statement.)

SHARING SAMPLES

Withholding viruses from WHO collaborating centers posed a threat to global public health security and the ongoing risk assessment conducted by WHO collaborating laboratories.

WHO collaborating centers perform several key flu-related activities, including determining if the virus acquired human genes or made other significant changes, identifying potential vaccine strains, testing to determine if the virus is vulnerable to recommended anti-virals, tracking the virus’s evolution and geographic spread, and updating diagnostic tests because flu viruses constantly mutate.

After the meeting, Supari reviewed recommendations made over two days and said Indonesian viruses once again could be shared with the WHO. The meeting concluded that WHO collaborating centers will continue risk assessment on H5N1 virus samples and turn virus into seed virus suitable for vaccine production, and terms of reference for the WHO labs will be revised.

The terms of reference will describe exactly what a collaborating center can do with the viruses provided through surveillance, said Dr. David Heymann, WHO assistant director-general for communicable diseases. WHO will develop the standard document with input from member countries.

VACCINES AND DEVELOPING COUNTRIES

The meeting endorsed WHO's efforts to link vaccine manufacturers in developed and developing countries to speed the transfer of influenza vaccine manufacturing technology.

"We have struck a balance between the need to continue the sharing of influenza viruses for risk assessment and vaccine development,” Heymann said, “and the need to help ensure that developing countries benefit from sharing without compromising global public health security.”

Individual countries will negotiate how vaccine is made available to them.

“WHO is not involved in financial negotiations, either in selling viruses or buying vaccine,” he added. “Countries will negotiate bilaterally with vaccine manufacturers. We will certainly facilitate if countries are asking for support, but it won’t be standard.”

WHO best practices for sharing flu virus were developed for seasonal influenza vaccine, which has a market in developed countries but in only a few developing countries.

“H5N1 vaccines are a different issue,” Heymann said. “We will now modify our best practices to ensure that they are transparent to the developing countries which are providing samples and which have requested to share in the benefits resulting from those viruses.”

The director-general of WHO is committed to working with pharmaceutical companies  and donors to develop a possible stockpile of vaccine for developing countries if they need vaccine, he added, but this is at an early stage of feasibility study.

For more information on U.S. and international efforts to combat avian influenza, see Bird Flu (Avian Influenza).