Asian Bioethics Review

67 P e a c e w i t h J u s t i c e C h a n C h e e K h o o n Peace with Justice: Equitable Access to Pre-Pandemic Avian Flu Vaccines 1 Shifting Alignments in International Health? In early 2007, the Indonesian government decided to withhold its avian flu virus samples from the World Health Organization’s collaborating centres pending a new global mechanism for virus sharing that had better terms for developing countries. In breaking with the existing practice of freely sending flu virus samples to these laboratories, Indonesia expressed dissatisfaction2 with a system which obliged WHO member states to share virus samples with WHO’s collaborating centres,3 but which lacked mechanisms for equitable sharing of benefits, most importantly, affordable vaccines developed from these viral source materials. The Indonesian decision elicited unease,4 but also support and sympathy, including an editorial from The Lancet: To protect the global population, 6.2 billion doses of pandemic vaccine will be needed, but current manufacturing capacity can only produce 500 million doses. Indonesia fears that vaccines produced from their viruses via the WHO system will not be affordable to them…. In November 2004, a WHO consultation reached the depressing conclusion that most developing countries would have no access to vaccine during the first wave of a pandemic and possibly throughout its duration…. The fairest way forward would be for WHO to seek an international agreement that would ensure that developing countries have equal access to a pandemic vaccine, at an affordable price. Such a move would demonstrate global solidarity in preparing for the next pandemic (Lancet editorial, 17 February 2007). I N S I G H T Asian Bioethics Review March 2009 Volume 1, Issue 1 67–72 A s i a n B i o e t h i c s R e v i e w M a r c h 2 0 0 9 Vo l u m e 1 , I s s u e 1 68 At the 60th World Health Assembly in May 2007, protracted negotiations between blocs of member states eventually yielded a resolution which mandated WHO to establish an international stockpile of vaccines for influenza viruses of pandemic potential, and to formulate guidelines and mechanisms for equitable access to these vaccines.5 The Indonesian government’s stance was notable on three counts: • It was explicitly a critique of WHO’s balance of pragmatism which it felt was overly accommodative of corporate priorities, to the detriment of the health and wellbeing of a key constituency that WHO was mandated to defend, the underserved communities among its member states. • It was an exercise of leverage by a source country of biological materials seeking to redress the inequities of access to what may be vitally important health inputs (avian flu vaccines) developed from these source materials. • It was seeking equitable benefits from commercial developers not just for its nationals but for other communities as well who were likely to be sidelined by commercially-driven product development and distribution. Commodification and the Gift Relationship These developments call to mind The Gift Relationship, a study of blood donation systems in the US and UK published by Richard Titmuss, a pre-eminent figure of UK social policy at the London School of Economics and Political Science. In this 1970 classic,6 Titmuss demonstrated that a blood donation system relying on unpaid donors and operated on a non-commercial basis by the public sector (UK) outperformed a system relying largely on paid donors (in cash or in kind) and on profit-driven processing and distribution (US), by the criteria of availability and affordability, quality and safety, and economic efficiency and equity. With the prevailing (and still tenacious) ethos of neo-liberalism, however, donors of biological materials not surprisingly have come to expect a share of the financial gains made possible by their donated materials. John Moore vs. The Regents of the University of California (1990), for instance, was the celebrated case of a leukemia patient who underwent surgery in 1976 at the University of California (UC) for removal of his cancerous spleen. UC was later granted a patent for a cell...