I wouldn’t depend on anti-virals, there’s already evidence for H5N1 resistance in Vietnam.

The virus is free to mutate or infect any fowl or mammal it can. Irrespective of IP law.

As it stands, there isn’t a single H5N1 strain out there today that can trigger a human avian flu pandemic. Until a reassortment or other mutation event occurs that allows the H5N1 to be transmitted between humans, there is no avian flu pandemic. And, there is no indication that this event will occur in Indonesia. The primary concern is that with the large epizootic infections concentrated in countries where people keep birds for food, the probability of such an event occuring is very high.

Indonesia has done this sort of thing before. Last year it withheld both avian and human samples from the WHO for many months and then ended up giving the WHO 91 samples for sequencing. The WHO passed some of those strains to other entities, including an Australian pharmaceutical company that produced a vaccine with one of them. Indonesia is trying to recover money(not vaccine rights) from that company.

Delays in sample and information sharing have been an ongoing problem with the avian flu samples and sequences.

There are numerous companies making avian flu vaccines. In the end, however, there will not be a vaccine specific for the strain that causes a human pandemic and a wild scramble would most likely ensue. Containment and antivirals will be effective strategies at that time.

You are seriously trying to make the argument that the entirety of the concerned industrialized world is simply incapable of getting tissue samples from sick people, but that Indonesia apparently has no difficulty with doing so?

That’s just insane.

So Indonesia’s position is that it couldn’t afford to buy any vaccine (because supply would initially be limited, and thus the price high) but if it prevents the WHO getting the samples and sells it to a commercial concern then that concern will give them preferential access to the vaccine (although probably at the risk of reduced production capacity for the rest of the world because the vaccine would be proprietary). So it seems very much like a win-lose situation.

H5N1 is an airborne droplet transmitted illness with a 50% mortality rate and potential for a pandemic – of course patients will be in quarantine and informed consent will be very difficult to obtain from such sick people, let alone permission from the clinicians to go harrassing their isolated patient. Once they’re better the viral load will be low to non-existent (or they’ll be dead).

A fairly small number of people worldwide have been affected by the virus, only 81 in Indonesia (~50 last year), and confirmation that it is H5N1 requires antigen testing in a suitable lab – therefore the most practical way to obtain samples is retrospectively from the treating physicians or normally you’d send samples off to the WHO reference labs who are tracking the epidemiology worldwide (as they do with many other disease, including normal flu).

Actually, the central issue of the article under discussion did very much seem to be providing the samples, not who gets the eventual medicines or vaccines.

In this context, Indonesia’s move, while short-termist, may actually have a positive effect for its citizens if it strengthens the hand of developing countries in future negotiations. That’s not corruption, that’s defending its national interest.

So your argument is that by selling its samples to a private corporation rather than giving them to the WHO, Indonesia will place itself in a better bargaining position for getting the eventual fruits of the research (if any)? I’m not sure how that follows.

Developing countries have been trying the ‘good faith’ approach to resolving this over the last couple of years, and a crucial point was reached at the World Health Assembly last June when Thailand proposed an amendment to the international sample-sharing agreement on influenza viruses, saying they could be used for non-commercial purposes only. This was an attempt to separate out the international pooling of scientific information from the business of profiting from unequal distribution of vaccines. But it failed. There’s a report on that meeting here: http://www.twnside.org.sg/title2/health.info/twninfohealth024.htm. As it says, Thailand believed the final compromise…

“was a win-lose solution where the winner was developed countries which can produce vaccines and the loser was developing countries which cannot access the vaccine, whereas it is the developing countries that are submitting the flu strains to the WHO collaborating centers.

Thailand however said it did not want a lose-lose situation where no one has the vaccine and everyone dies.”

In this context, Indonesia’s move, while short-termist, may actually have a positive effect for its citizens if it strengthens the hand of developing countries in future negotiations. That’s not corruption, that’s defending its national interest.

Michael, I’m pretty sure WHO normally doesn’t even have its own field staff, they operate via local governments.

And doesn’t that strike you as a criminal failure? I mean, let’s ignore the perfidy of many local governments, and just concentrate on their incompetence. Who strikes you as more likely to have the organizational expertise to gather disease samples: the WHO, or the Indonesian government? Or the Chad government, or the Somali (cough) “government”?

I mean, not to pick on the WHO in particular. Maybe they aren’t the organization for this, but it seems to me that relying on local governments as the sole point of access for anything international health related is just stupid.

Now, there are international organizations that do have field offices all over the world, but they certainly don’t go around on their own collecting samples or doing anything the local government doesn’t want them to do. Their work is based on cooperation with local governments, that’s Rule Number One. All it takes to stop them is one phone call.

Yeah, this is the scenario that I judge most likely, too. Someone in the Indonesian government stands to profit from Baxter having a monopoly on disease samples, and so they deny anyone else access.

And this should be handled as a human rights violation, and an egregious one. No government has any business telling its citizens “you can’t voluntarily participate in an international search for a cure to a deadly epidemic.” Frankly, no government has any business telling its citizens that they can’t sell samples of their own blood or whatever to anyone for any reason. It’s an issue of having control over your own bodily integrity, and, in this case, a high-stakes issue.

If it is the case that the Indonesian government is blocking sample collection, then governments of industrialized nations should be saying, “This is bullshit,” and pushing hard in the diplomatic sphere to get the Indonesian government to reverse its course.

Secondarily, it would be a good idea to try to prevent corporations like Baxter from inciting governments to this kind of malfeasance. But that’s secondary because, a.) it’s going to be difficult to do in a universal way, or to catch people at it, and b.) the corporate actions are not in and of themselves sufficient to cause the problem. The governmental actions are.

Now, there are international organizations that do have field offices all over the world, but they certainly don’t go around on their own collecting samples or doing anything the local government doesn’t want them to do. Their work is based on cooperation with local governments, that’s Rule Number One. All it takes to stop them is one phone call.

As to rs’s “because it’s impractical,” and abb1’s “in hospitals/quarantined,” a few comments.

1. Do you know this, or are you guessing? I mean, I could guess, too, but obviously you just confirm your own biases.

2. The shared hypothesis that you seem to be advancing is “there is no one stopping the WHO (or whomever else) from obtaining disease samples, it’s just that there are practical/logistical difficulties with doing that.” Let us assume for the sake of argument that this is true.

If that is the case, then it seems to me that the cause of this failure is that our international medical institutions can’t get a few doctors on the ground in a less-developed country to do their fieldwork. I submit that people being in a hospital somewhere (or even in quarantine) should not pose an insurmountable obstacle to sample collection on behalf of a multi-national first-world effort to get samples. If it currently is an insurmountable obstacle, we should change the WHO until it is not. How hard could this possibly be? Get them a few dozen permenant staff with medical training? Some biohazard suits? Facilitate volunteer doctors (and don’t tell me that there aren’t some altruistic doctors in Indonesia who would be willing to do sample collection for the WHO) hooking up with the organization so that it can use their expertise? Whatever the problem is, it MUST be solveable, and it’s doubtless solveable via a great deal less effort than changing IP laws or altering drug markets or whatever.

Let me throw out a few other possible causes for the WHO’s inability to deal with individual patients:

1. Their ability to do so is being actively obstructed by the Indonesian government, at the urging of Baxter, which stands to profit from having a monopoly.

In this case, the proximate cause of the failure is that a government is interfering with some basic liberties of its citizens. First world democracies should be pressuring Indonesia not to do this via diplomatic and economic means. The second-order cause of the failure is that a corporation is trafficking in human misery. It should be illegal for corporations to attempt to obstruct data collection by international altruistic organizations.

2. Some kind of wacky IP laws means that the WHO can get the physical samples, but is legally barred from using them because Baxter now owns the copyright or something like that.

In this case, the solution is straightforward: reform the IP laws which allow this. (It’s simply inane to suggest that there’s any benefit to allowing someone to own a genome that they didn’t create, anyhow).

3. There are so few people infected that really there are only enough physical samples for one organization to use.

In this case, we’d have to question whether there definitely is a failure. I mean, if only one organization can get samples, on what basis do we say, “this is the one that ought to get them”?