Indonesia Blocking Access To Bird Flu Virus

WASHINGTON — International health officials will try this month to persuade officials of Indonesia to lift a virus embargo that is hampering efforts to prepare for a possible bird flu pandemic.

The Indonesian Ministry of Health told the World Health Organization late last year that it would no longer provide samples of the H5N1 virus until it receives assurance that it will have access to pandemic vaccines.

Since then, a WHO official said Tuesday, the organization's international network of collaborating laboratories at the Centers for Disease Control and Prevention in Atlanta and three other cities has not been able to obtain samples of the virus from Indonesia, the country hardest hit by bird flu, with 81 laboratory-confirmed cases and 63 deaths. The disease has sickened 278 people worldwide, according to WHO, killing 168 of them.

Without the samples, flu experts are unable to track changes that are building up in the genes of H5N1, the influenza virus health experts fear could evolve into a human strain and cause a pandemic.

No one knows when — or if — that will happen.

In addition to studying the virus, the laboratories provide free "seed virus" to vaccine manufacturers, several of which have already started making vaccine for the H5N1 strain, even though it has not developed the ability to move freely from human to human — the trigger for a possible pandemic. So far, human infection has been caused mostly by exposure to infected poultry or wildfowl.

Officials in Indonesia say they are worried that virus samples they provide to the WHO system are being used to make vaccines that are too expensive for their citizens to buy.

WHO official David Heymann, who has worked since December to resolve the crisis, is to meet in Jakarta on March 27 and 28 with Indonesian officials, representatives of CDC and others to get the virus samples moving again.

"All I can tell you is at the moment they (the Indonesians) are not providing virus, and the meeting in Jakarta will look at the twin issues of virus sharing and vaccine production," said WHO spokesman Gregory Hartl.

"The problem, from our understanding, is based on the fact that they put the virus into this international system and all of a sudden it is used to produce a vaccine that they can't afford to buy," he added.

The entire world manufacturing capacity for influenza vaccine is sufficient to immunize only 500 million people, and perhaps only half that if more than one dose is required.

Most vaccine for H5N1 has been sold to developed countries before it is produced — or even completes clinical trials — to be stockpiled in case of a pandemic.

Indonesian Health Minister Siti Fadilah Supari has been quoted in press accounts as saying her government wants to "create a balance between developed and developing countries in facing catastrophe."

"The WHO has been siding with capital owners, which sometimes forget the good of the people," she said. "We want to change that."

Her action has been hailed by officials of other developing countries and in some quarters of the developed world.

"Good for Indonesia. There, it's been said," declared the British magazine New Scientist in an editorial. "In a fair world, Indonesia would send its virus to the best labs and share in any vaccine made from it. In our world, Indonesia sends off its virus, companies make vaccine from it and sell it to countries that can pay. Indonesia is not one of them, and neither are the other countries suffering badly from H5N1."

Maurice Middleberg, a vice president of the Global Health Council, a group that advocates efforts to improve the health of people in developing countries, said the practice of sharing virus is essential to confronting the influenza threat — but the needs of developing countries must be considered also.

"The exchange of scientific information is essential to preventing the emergence of a global pandemic, but a way also must be found so that countries that cannot afford vaccine at commercial rates will be able to get it," Middleberg said.

The matter has been complicated by a "memorandum of understanding" Indonesia has signed with the U.S. drug manufacturer Baxter International, which manufactures influenza vaccine at a plant in the Czech Republic.

Baxter spokesman Chris Bona declined to make details of the memorandum public, but said that as a result of signing it in February, the company has received samples of "wild" H5N1 influenza virus from Indonesia.

However, he said Baxter had urged the Indonesians to resume providing virus samples to the WHO network.

He said the memorandum was a "framework" for collaboration between the company and Indonesia, which has said it wants its own vaccine manufacturing capability.

Bona said the sample was delivered to Baxter through WHO. This would have been during the time that Indonesia has refused to provide WHO samples for use in the laboratories.

A WHO spokesman said he knew nothing about that.