KEY POINTS:
Health ministers, officials and medical experts around the world have reached a potentially important accord. They agreed to share samples of influenza viruses and to provide poor, as well as rich countries, with vaccines if the bird flu strain continues to cause deaths among humans and poultry in Asia, and changes into a form that can pass easily from person to person, triggering a global pandemic.
They asked the World Health Organisation to establish an international stockpile of vaccines for the virulent H5N1 bird flu strain and other influenza viruses that could sweep around the world.
This all sounds promising. The WHO estimates that each year, seasonal flu alone causes between 3-5 million cases of severe illness, and between 250,000 to 500,000 deaths, worldwide. It has warned that another outbreak of pandemic flu could have far more devastating consequences on public health, economic growth and social stability than seasonal flu.
But the deal reached at the WHO in Geneva last month is only a framework agreement. Its guidelines may well be treated as voluntary by some of the 193 member states in the United Nations. Hard details have yet to be negotiated and agreed before a stronger arrangement emerges.
Indonesia brought to a head the issue of who really benefits from sharing the viruses. Last December, it stopped sending H5N1 samples to the WHO, saying they were being passed to collaborating laboratories in developed nations, which in turn made deals with big pharmaceutical companies to produce vaccines that poor countries could not afford.
The health organisation has co-ordinated the international sharing of flu viruses for more than 50 years. Samples of both seasonal viruses and novel strains like H5N1 are used to monitor viral evolution and drug resistance. They are also used to develop vaccines and medicines to aid recovery.
The H5N1 virus keeps changing in minute ways. And it differs from country to country in Asia, and even from region to region in large nations like China. Without all the latest strains, scientists cannot produce vaccines effective in countering a new outbreak of pandemic flu.
Indonesia is particularly important in preparing global defences against a possible H5N1-type pandemic because the virus has caused more deaths among humans there (over 70) than in any other country since the highly lethal, but still relatively rare, illness emerged in Southeast Asia in late 2003, before spreading to Northeast Asia, Central Asia, Russia, Europe and Africa.
While Indonesia holds a big key to the puzzle of H5N1, so does China, where the health ministry last month reported its 25th human case of bird flu. China, too, has been reluctant at times to share H5N1 samples with the WHO. Its reasons are less clear, since China, unlike Indonesia, makes flu vaccines for humans and birds.
However, the debate over who really benefits from virus sharing exposes a huge shortfall in global production capacity for pandemic vaccines. This capacity is concentrated mostly in nine industrialised countries: Australia, Canada, France, Germany, Italy, Japan, Holland, Britain and the US.
But many other countries want to establish or expand their own vaccine manufacturing plants.
The WHO reported last October that it would take a huge international effort and cost as much as $US10 billion ($13.7 billion) to improve vaccine production.
Without this programme, a group of experts assembled by the agency found that under the most optimistic assumptions, maximum world capacity by 2009 for pandemic flu vaccine would be about 2.34 billion doses. Given a world population by then of 6.7 billion, there would be a shortage of over 4 billion doses.
Australia and New Zealand have a flu vaccine-sharing agreement. But in a crisis, it is not hard to imagine how the countries that dominate vaccine production would react. They would give priority to their own population.
This would inflame the rich-poor divide, as developing countries without the money or resources to get the vaccine watch helplessly as the pandemic cuts a swathe through their people and economies.
But even in the countries that have major production facilities, the amount and effectiveness of vaccine available to ward off an H5N1-type pandemic would almost certainly fall far short of what is needed to provide protection for the whole population. There would be great bitterness and anger among those unable to get vaccinated.
The WHO's answer seems sensible enough. It has called for wider distribution of seasonal flu vaccine to get the manufacturers to produce more. It has also called for construction of new plants and intensified research to develop better vaccines more quickly and efficiently.
The question is, will the international community take up the challenge to meet a threat that seems less imminent than terrorism or climate change?
* Michael Richardson is a security specialist at the Institute of Southeast Asian Studies in Singapore.
