This guest blog is written by Rachel Irwin, a PhD candidate at the London School of Hygiene and Tropical Medicine and a member of the Global Health Council delegation to the World Health Assembly.
GENEVA — For over 50 years, countries have shared samples of their viruses via the World Health Organization (WHO)’s Global Influenza Surveillance Network (GISN). These samples are used by the WHO to determine which strains pose the most threat and make recommendations accordingly regarding control and vaccine production.
However, four years ago, at the height of the avian flu pandemic, Indonesia stopped sharing samples of its H5N1 virus with the WHO. Indonesia was accused of threatening global health security – it was the hotspot of avian flu and its strains were in demand from scientists and vaccine producers in order to ensure a global response to the pandemic.
However, Indonesia was, in fact, highlighting other aspects of global health security — equity, transparence and fair access. Low- and middle-income countries were sharing their samples with nothing in return. There were not clear agreements as to what happened to their strains when transferred to WHO laboratories and the proximal cause of Indonesia’s withdrawal was that an Australian vaccine producer had got hold of its strain, made a vaccine based on it, then tried to sell it to Indonesia at a price they could not afford.
The wider threat to global health security is that low- and middle-income countries cannot afford the vaccines and pandemic preparedness plans that high-income countries can. This is already an equity issue – but it is more insulting because the vaccines readily available in high-income countries are based on strains from the low- and middle-income countries. If a country is going to share its viruses with the world, then it should be able to share in the benefits (i.e. vaccines and anti-virals) as well.
However, the Australian delegate opened this week’s discussion at the WHA, pleased that the “issues so fraught in 2007 have been fully debated.” Over the course of the last four years, through an inter-governmental process, WHO Member States negotiated a framework to ensure the fair, equitable and transparent sharing of virus samples and resulting benefits. The challenge now is implementing this, but simply agreeing upon the framework is a massive step forward for global health.
Another agenda item this year, and perhaps the theme running though the whole Assembly is on the reform of the WHO – what is its “core business” and how, in light of other actors in public health and the increasingly involvement of the private sector, can it reclaim and assert its mandate to be the directing and coordinating authority on global health?
The negotiations on virus-sharing are a clear example of what is and should continue to be a key aspect of WHO’s “core business,” a phrase favored by Director-General Margaret Chan. The Norwegian delegate called the negotiation of the framework a “victory for global health diplomacy under the auspices of the WHO.” That is, WHO is the only democratic forum where these negotiations could have taken place and it has asserted itself as the international agency to oversee the sharing of influenza viruses and access to vaccine and other resulting benefits.
The successful conclusion of the four-year negotiation process is proof of WHO’s role in global health diplomacy and a re-assertion of its mandate to be the coordination authority in that area.