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Singapore meeting might return us to those thrilling days of yesteryear.

helen%20branswell.gifHelen Branswell is regarded as a kind of Edward R. Murrow of infectious disease.  She is what I would call a Tier One infectious disease journalist, a person who gets a kind of reception at a bird flu summit normally reserved for celebrities and world-famous politicians, or other medical correspondents such as Laurie Garrett and Gina Kolata.

She also convinces her bosses at the Canadian Press to fly her all over the world covering H5N1, so we benefit from the relationships she has cultivated among the bird flu intelligentsia over the years.  Truly, the world is her "beat."

Currently, she is in Singapore, covering a not-too-well-publicized gathering of scientists and public health policy leaders, sponsored by the World Health Organization.  Dr. David Heymann, the leader of the WHO infectious disease effort, is chairing the meeting. 

Ms. Branswell reports in her by-lined article that the WHO's meeting is attended by representatives of 24 nations, including the Big Four for H5N1 infections in humans: China, Egypt, Indonesia and Thailand.

2007%20may%20indonesia%20speech%20health%20minister.jpgThe issue is extremely dicey.  This past January, as we all know, Indonesia's health minister (left) suddenly withheld vital H5N1 genetic samples, claiming intellectual property on the RNA.  Since H5N1 was evolving/mutating in Indonesia, she claimed, the rights to all research should flow back to her nation.  In fairness, it should be noted that this came - bada-BING! -  immediately after an Australian vaccine maker produced a prepandemic vaccine made with WHO-certified Indonesian H5N1 antibodies, apparently without the host government's permission or consent. 

We should also know that the nations whispering into Indonesia's ear with counsel to upset the apple cart of H5N1 sample distribution are none other than -- drumroll and sabre-rattling, please -- Venezuela, Cuba, North Korea and Iran.  So geopolitics and "nonaligned" (my foot) nations are being H5N1 provocateurs against what they see as the unwillingness of the West to share vaccine.  Give us vaccine, Indonesia says, and we will give you samples.  Of course, this is inside-out logic.  You can't make a vaccine without the samples.  So Indonesia also took the step of signing a contract with Baxter Pharmaceuticals of the USA.  Baxter gets the samples; they get to produce the vaccine; and the Indonesian government gets its way and gets its vaccine.

But while we castigate the Indonesian government for its shortsighted decision, we should also recognize its concerns.  The poor of the world don't get vaccine on a good day, for all the usual and apparent reasons.  That is one reason why the Bill and Melinda Gates Foundation has suddenly and very publicly entered the H5N1 prepandemic vaccine fray, to its enduring credit.

But read Ms. Branswell's article closely.  There is another, perhaps more insidious force at work here.  Quoting from her story:

"That the ensuing vaccine would be beyond the reach of developing countries in a pandemic is the main source of the conflict, though complaints about the sharing of credit on scientific publications have also fuelled the fire."

Excuse me, but I thought we were all working on the same team here.  It is one thing to have (varying degrees of) legitimate national concern about protecting its citizens.  It is another to squabble about credit.  We all know the axiom, "Publish or perish," meaning if you don't publish, you won't get coveted government and endowment/foundation grants. But considering the magnitude of the potential pandemic -- and the fact that governments are throwing research grant dollars around like beads at a Mardi Gras parade -- I think everyone can get a slice of the pie, right?

china%20syndrome%20book2.JPGOne of the best books I have read about infectious disease was Karl Greenfield's seminal work on SARS, China Syndrome. If you have not read that book yet, pick up a copy and read how back-door politics denied one researcher the chance to get his name in lights as the co-discoverer of the unique coronavirus that causes SARS.  Apply the lessons learned to this situation.  "Fight over academic credit stalls H5N1 breakthroughs", Branswell's headline might read, were it not for the fact she needs those sources to keep her abreast of what is actually going on "out there." 

televisionin1950.jpgIf the Singapore meeting falls apart without reaching consensus on how samples are to be distributed and analyzed, we could be thrown back to the world of the 1950s, when the Lone Ranger was on radio and that newfangled idiot box known as television was just coming out and the rich neighbors down the street were the only ones who could afford it.  How so?  We will revert back to Cold War-era sample sharing. Nations that choose not to share samples will hamper much-needed research on the virus.  The world's researchers will be unable to collaborate, credit or none, on much-needed breakthroughs in the understanding of influenza itself (let alone The Next SARS, etc.). 

Let me remind the reader that the 1977 Russian Flu H1N1 rebirth was rumoured to have occurred because a Soviet flu lab experiment went awry.  We would not have H1N1 around today, had it not been for that sudden re-emergence thirty years ago this month.  Not too long ago, in a widely publicized "Doh!", a US flu lab mailed H2N2 (1957 pandemic) virus particles as part of its seasonal flu typing test kit.  How will a lack of sharing impact the ability of the world to recognize a potential pandemic subtype, let alone prepare for it?

So prepare to return with us to those thrilling days of yesteryear, as we implore the Lone Ranger not to send Tonto to town!  He might come back with more than a concussion and a sore jaw.

Researchers watch virus-sharing talks with trepidation, fearing science may suffer

(World News) Tuesday, 31 July 2007, 08:43 PST
by Helen Branswell   
SINGAPORE (CP) - With little fanfare or public attention, representatives of 24 countries began Tuesday to try to resolve a virus-sharing impasse that is undermining the world's ability to chart the pandemic threat posed by H5N1 avian flu.
But rather than hailing the meeting as a way to break the troubling logjam, some scientists and public health officials are watching with trepidation, worrying the process may hinder the way research into influenza and other infectious diseases is conducted.

“We're very conscious that this is a precedent-setting meeting, as are most of the delegations,” said Dr. David Heymann, head of communicable diseases for the World Health Organization, under whose auspices the five-day meeting is taking place.

That's because the talks could change the conditions under which biological materials are provided to the WHO for global surveillance of and research on influenza viruses.

Depending on what is decided, the consequences could ripple far beyond the science of flu, experts say, conceivably affecting, for example, the pharmaceutical industry's ability to make and update an eventual HIV vaccine or limiting how quickly the world could respond to the next SARS-like disease outbreak.

“I think there's a heavy responsibility on the meeting, and then on the intergovernmental meeting which will follow (in November), to make sure that above all, considerations are made for public health security,” Heymann admitted.

Four countries from each of the WHO's six regions are at the table, including Britain, Canada, the United States, Indonesia, Vietnam, Thailand and Egypt.

The need to update the rules for sharing flu viruses stems from the demand of several developing countries, led by Indonesia, for affordable access to pandemic vaccine when the next global flu outbreak occurs.

Indonesia, the country which has lost the most lives to the H5N1 virus, has for much of this year refused to provide patient samples (from which viruses can be retrieved) to the WHO laboratory network, using the viruses as leverage in this debate.

Labs at institutes such as the U.S. Centers for Disease Control or Britain's Health Protection Agency isolate and study these viruses at the behest of the WHO, looking for changes that might allow H5N1 to more easily infect people or to evade the drugs used to treat flu.

When asked to do so by the WHO, they also make seed strains from important new virus variants, providing them free of charge to pharmaceutical companies for use in the manufacture of vaccine.

That the ensuing vaccine would be beyond the reach of developing countries in a pandemic is the main source of the conflict, though complaints about the sharing of credit on scientific publications have also fuelled the fire.

Many observers fear measures devised to address these concerns could lead to restrictions on how viruses that flow into the WHO system can be used, even by scientists.

Most are not willing to speak on the record about what is at stake in these highly sensitive talks.

“People are concerned,” admitted Dr. Adolfo Garcia-Sastre, an influenza researcher at New York's Mount Sinai School of Medicine.

Some fear a system could evolve where WHO labs could only look for limited information from viruses fed into the network.

Some envisage a scenario where this information could only be fed back to the contributing country, which could choose whether or not it should be shared with the broader scientific community. If some countries agreed to amalgamate findings and others did not, that could lead to huge gaps in understanding about how a virus is evolving.

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