In 2003, the WHO Global Influenza Surveillance Network (GISN) identified a novel strain of the influenza virus among poultry in Indonesia: H5N1 Influenza A. The first human case was identified in 2005 and by 2007, Indonesia had the highest number of (116) cases of this devastating virus in the world. The fatality rate was over 80% and fear of a widespread pandemic was starting to mount.
The necessity for a vaccine was of paramount importance and a pharmaceutical company in Australia rose to the challenge and created a vaccine based on the Indonesian strain. So the vaccine was widely dispersed and spread of the disease stopped? Well no, not exactly. In fact, the Australian company had developed the vaccine using Indonesian samples completely unbeknownst to Indonesia. So in January 2007, Indonesia refused to continue sharing their virus samples. Their argument: the samples were their sovereign property and the production of the vaccine without their consent was neither fair nor transparent. Additionally the fact that the vaccine had been produced but was too costly to be made available to the Indonesians themselves was deemed totally unfair by the Indonesian Ministry of Health at the time, Siti Fadilah Supari. Instead, Indonesia used their virus samples as a bargaining point to try to gain access to the vaccine.
But by not releasing their samples, was Indonesia holding the rest of the world hostage or were they merely using their only bargaining point to gain access to a vaccine that they should have rightful access to?
Well subsequent to the major breakdown in global health diplomacy, meetings were held between the WHO and Indonesian officials. Indonesia resumed sharing their samples and compromises were made by the WHO to help increase global vaccine production capabilities, address national stockpiling of vaccine and to buy any vaccine that was made available by the industry. Nevertheless open sharing of information did not resume and despite the WHO making changes to its guidelines, Indonesia continued to feel a lack of transparency around the vaccine production process. Yet Indonesia haven’t kept to their side of the deal either and since the meeting in 2007 they have remained reluctant to share virus samples, not sharing any in 2009 at the height of the swine flu pandemic.
The virus sharing negotiations have continued and as of yet have not been fully resolved. Whilst some of the urgency and political will has been lost over time, there is no question of the issue being off the health agenda. It will be important in future global health negotiations to remember the lessons from the Indonesian case, especially as viruses are able to cross borders faster than ever before. As we are seeing with the current outbreak of Zika in Latin America, international cooperation is key to halt the spread of such devastating viruses and it is vital for the WHO to act in the best interest of all nations and not turn its back on the poorest in their time of greatest need.