By Kevin Noonan

On first blush, it might appear that Indonesia’s decision
to stop supplying avian influenza virus samples to global public health organizations, such as the U.N’s World
Health Organization (WHO), is short-sighted or greedy or both (see "Virus for Sale").   However, the "rest of the story,"
at least in part, is supplied in today’s New York Times.

An Op-Ed piece by Ruth R. Faden and Patrick S. Duggan
from the Johns Hopkins Berman Institute of Bioethics and Ruth Karron from the
Center for Immunization Research at the Johns Hopkins Bloomberg School of
Public Health describes more about the economic consequences of bird flu in
Indonesia. The biggest economic impact has been the result of Indonesia’s only current response to a bird flu outbreak – killing the infected birds. The killing
of birds is necessary because it is believed that persistence of the virus in bird
populations, especially ones close to human populations, increases the chance
that a strain capable of human-to-human transmission will arise, due to the
high mutation rate of influenza viruses. Obviously, the benefits of these prophylactic measures are global
insofar as they forestall a pandemic of this lethal flu strain (70% mortality
for infected Indonesians).

According to the Hopkins authors, Indonesian Health Ministry
officials have imposed a ban on household poultry farming in Jakarta, the
capital. Indonesians were given a
deadline of February 1 to
"consume, sell or kill" approximately 1.3
million birds, and the ban was enforced by door-to-door inspections by officials
empowered to kill any remaining birds.

While the government promised to pay a ransom of about
$1.50 for each flu-infected bird (which is approximately its fair market
value), the government will pay nothing for any healthy birds (the overwhelming
majority).  Thus, thousands of
Indonesians lost an inventory of substantial value from this edict. Moreover, it is the small local farmers,
rather than multinational companies with poultry farms in Indonesia, that
suffer disproportionately, since they cannot replace the destroyed birds.

Although the authors are part of a group attempting to
influence governments, international organizations, and multinational
corporations to provide compensation for the world’s disadvantageous populations
when the costs of avoiding (or at least postponing) a bird flu pandemic fall on
their shoulders, there is no compensatory plan now in place.

The costs are daunting – about $2 million for the
current program, which could expand to as much as $450 million should a similar
program be needed throughout Indonesia. Indonesia has less than $50 million in its budget for all aspects of
bird flu, so some form of assistance is necessary.

Under the circumstances, Indonesia’s attempt to be
compensated for providing avian flu samples to Western scientists,
organizations, and in particular, vaccine-producing companies, may be
justified. It is true that Indonesia,
and many other Third World countries will be disproportionately affected by a
flu pandemic, or even a localized epidemic. However it is also true that governments, global organizations and the
world’s population needs to be more willing to provide the funding necessary to
prevent the pandemic. Poor countries
like Indonesia cannot do it, and we are all in danger if the rest of the world
does not step up to do our share.

    By Kevin Noonan

Indonesia is a country of over 200 million encompassing more than 17,000 islands in
the Malay archipelago.  It also has the largest number
(81) of humans infected with the H5N1 strain of influenza virus (commonly
called "bird flu"), with 63 fatalities.  And until recently, it was a
principle source of virus and samples from infected humans for
international agencies such as the World Health Organization (WHO), which provided Indonesia with no financial consideration for the samples.

But no more.  The Indonesian Health Ministry has decided
that the country "cannot share samples for free."  A Ministry
spokesperson, Ms. Lily Sulistyowati, said "There should be rules of the
game for it.  Just imagine, they  [i.e., Westerners] could research,
use and patent the Indonesia strain."

Some of the Indonesian government’s concern relates to
negotiations with Baxter Healthcare of Deerfield, IL for rights to the
Indonesian strains.  Baxter asserts that it has not asked Indonesia to stop
cooperating with the WHO, and the Baxter agreement is
non-exclusive.  However, the contract is a commercial contract, and the company
will pay the Indonesian Health Ministry for virus and related samples.

This issue is related to so-called "biopiracy," the practice of Western companies and
governments obtaining biological materials from Third World countries and
developing drugs, seeds, and other valuable products, typically with no
compensation to the country’s people or government.  It is also related to demands
from aboriginal peoples for repatriation of relics and other valuable artifacts
taken by Western explorers and adventurers over the past half-millennium.

The issue is also related to ownership concepts relating
to whether compensation is due to patients when scientists use patient
materials to develop treatments and therapeutic agents (for example, the
dispute over Canavan disease) and Richard Epstein’s position that individuals should have
the right to sell their organs (and Lori Andrews’ related property-right
analysis: Body Bazaar: The Market for Human Tissue in the Biotechnology Age).

Fundamentaly, however, the
underlying problem is the economic inequities between First World and
Third World access to drugs, especially in cases such as AIDS where Third World
populations are overwhelmingly affected by the disease.  These inequities
are exacerbated with regard to influenza, since Western
companies are able to produce enough vaccine in a
"normal" year for less than a quarter of the world’s population, and
Indonesia’s poverty prevents it from obtaining an affordable supply for its
people.  But Indonesia’s decision is particularly troubling because the bird flu
virus, like all influenza viruses, mutates so rapidly that contemporaneous
samples are critical to developing effective vaccines.  The most important
mutation, permitting human-to-human transmission, has not yet occurred in this
strain, and having virus with the enabling mutation is essential for developing
a vaccine effective in preventing a pandemic.

A potential silver lining in this age of genomic sequence
analysis is that the genetic complement of the H5N1 influenza strain is known,
and this information is not dependent on any Indonesian demand for payment.  Moreover, Indonesia has in the past sent samples to the WHO, and these
strains survive and can be the basis for on-going work.  If a
human-to-human  transmission strain arises, Indonesia may change
its mind in the face of the growing pandemic.  But for now, Western companies
need to address what may be an increasingly-common tactic of Third World
countries having biological resources essential to developing new agricultural
and pharmaceutical products: a demand to be compensated for both their
biological materials and their cooperation.  Western governments and the international
community will need to decide whether such arrangements will be left
to private commercial entities, or will be the subject of international
agreements between governments.  It is unfortunate but likely that such
arrangements will not be in place in time to effectively address these
issues as they apply to an influenza pandemic.