In breaking with the existing practice of freely sending flu-virus samples to these laboratories, Indonesia's health minister expressed dissatisfaction with a system which obliged WHO member states to share virus samples with WHO's collaborating centres, but which lacked mechanisms for equitable sharing of benefits, most importantly affordable vaccines developed from these viral source materials by patent-seeking commercial entities.

On March 29, immediately following an interim agreement for Indonesia to resume sending flu-virus samples to WHO, health ministers of eighteen Asia-Pacific countries issued the Jakarta Declaration which called upon WHO "to convene the necessary meetings, initiate the critical processes and obtain the essential commitment of all stakeholders to establish the mechanisms for more open virus and information sharing and accessibility to avian influenza and other potential pandemic influenza vaccines for developing countries" . These proposals were tabled at the 60th World Health Assembly in Geneva (May 14-23) as part of a resolution calling for new mechanisms for virus sharing and for more equitable access to vaccines developed from these viral source materials.

This issue remained contentious and unresolved until the final hours of the gathering when a resolution was adopted mandating WHO to establish an international stockpile of vaccines for H5N1 or other influenza viruses of pandemic potential, and to formulate mechanisms for equitable access to these vaccines.

The Indonesian government's stance in particular 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.

- 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 systems.

Notwithstanding the World Health Assembly's resolution to establish an international stockpile of vaccines, the limited vaccine production capacity globally, not to mention the financial needs for establishing and maintaining such a stockpile, are key issues that remain to be addressed.

A persuasive case could therefore be made that Asean Plus Three might provide a potential institutional framework for mobilising the financial and technological resources in the region to enhance regional preparedness and response capabilities in a likely epicentre of an emergent flu pandemic.

The Asian financial crisis in 1997 gave impetus to a regional effort at managing financial instability caused by volatile capital flows and speculative currency attacks. Recognising the increasing integration of East and Southeast Asian economies, the Chiang Mai Initiative emerged in May 2000, initially as a network of bilateral swap agreements among Asean Plus Three member states, which might yet evolve into a de facto Asian Monetary Fund following a decision in May of this year to multi-lateralise a multi-billion dollar pool of foreign exchange reserves of Asean Plus Three member states. Beyond the risk of financial contagion in globalised capital markets, the Sars epidemic of 2002-2003 forcefully demonstrated the regional economic consequences of a life-threatening infectious epidemic, effects which would pale in comparison with the devastating human and economic impact of an outbreak of highly transmissible and lethal human flu on the scale of the 1918-1919 pandemic.

An Asean Plus Three avian-flu initiative would go beyond the existing coordination of surveillance networks to include the development and acquisition of vaccine manufacturing capabilities, to augment regional stockpiles of avian flu vaccines which can be made available as public goods on a priority needs basis.

Set in this context, the Indonesian initiative on new virus-sharing arrangements is therefore noteworthy and its exercise of donor leverage may presage a consideration of trusteeships which could serve as public (international or regional) repositories of genetic resources, genomic information, and other biological materials.

Beyond the immediate concerns of timely and affordable access to pandemic flu vaccines, the Indonesian initiative has also raised the intriguing possibility of other analogous instances where individuals or groups of donors of biological materials and personal data could utilise the leverage of their gift relationship in clinical trials or other research settings in furtherance of the common good (rather than succumb to mercenary tendencies encouraged by a neo-liberal ethos).

Chan Chee Khoon is a professor and convenor at the Health and Social Policy Research Cluster at the Universiti Sains Malaysia's Women's Development Research Centre.

Chan Chee Khoon

Special to The Nation

Penang, Malaysia