This is a guest blog of Rachel Irwin, PhD candidate of the London School of Hygiene and Tropical Medicine, a research assistant at the London School of Economics and a member of the Global Health Council delegation to the 2010 World Health Assembly.
GENEVA, Switzerland – Committee A of the World Health Assembly (WHA) opened Monday afternoon. I was hoping to catch the first item agenda: “Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits.” However, I learnt the first rule of the WHA: In order to get a seat (and an earpiece) you need to get there early. Sadly, I missed the first 20 minutes of discussion, but did grab a seat in time to hear comments from Indonesia, Brazil, the U.S. and Thailand, amongst others.
So, what’s the big deal? For nearly 50 years, the Global Influenza Surveillance Network (GISN) has operated — countries share samples of their viruses, which are then used by the World Health Organization to assess which strains pose the most threat and make recommendations accordingly regarding control and vaccine production. In 2007, Indonesia ceased sharing, concerned (rightfully so) that their virus strains would be used by Western pharmaceutical companies to make vaccines that their country could not afford. The counter-argument is that Indonesia is threatening global health security by refusing to share its strains. The situation is being dealt with via an intergovernmental process, which is slow and continues three years later.
The outstanding issues are on Standard Material Transfer Agreements (SMTAs), benefit-sharing and intellectual property. Simply put, countries supporting the SMTAs want to ensure that when they transfer their virus samples to WHO labs for analysis, they know exactly what they will be used for, and that these countries can share in the benefits –i.e., access to medication and building vaccine-production capacity in developing countries. The balance then needs to be found with intellectual property rights. That is, to whom do these viruses – and associate vaccines – belong? And how does this affect incentives for innovation?
Overall in Committee A, most countries reiterated the importance of fair and equitable access to benefits and the need to increase the global production capacity. Most countries also said something about being hopeful that the situation would soon resolve itself. However, Thailand expressed its disappointment that the intergovernmental process was continuing into a fourth year and asked the WHO Secretariat to list three strengths and weaknesses of the intergovernmental process. The WHO Director-General Margaret Chan compared this to a servant criticising its boss. She stressed that it was an intergovernmental process – not the WHO – making the decisions. This brings up the dual nature of the WHO: it is both an entity in itself and a forum for member states, which then tell the secretariat what to do – a point that is easy to forget. However, Chan took the easy way out by listing the strengths of the intergovernmental process and leaving it up to us to critique it.
The Open-Ended Working Group met just prior to the WHA and put forward a resolution (that passed today) which was basically to continue the work of the Open-Ended Working Group. Whilst we all recognise the difficulty of the negotiations and the hard work of the co-chairs of Mexico and Norway, countries need to start compromising on the issue of intellectual property, which is the underlying issue holding back the negotiations. Brazil reiterated that sharing of virus-samples should be matched by an equal commitment to share benefits and that in a pandemic situation vaccine manufacturers should grant sub-licenses to the WHO and developing countries (with vaccine production capacities) and that this vaccine production should be handled via the national public health system.
It’s not as if these countries are completely throwing out IP law, but are simply asking that in a pandemic situation (i.e., when people will die), these laws are slightly bent in a controlled manner. Yet, the debate continues: As a Kenyan delegate put it “we hope this Open-Ended Working Group will not be open forever.”