Battle for a Vaccine

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h year 1.4 million children under the age of 5, almost all from the developing world, die from diseases that could be easily prevented with a vaccine. For most of us, those needless deaths prick our consciences and motivate us to open our wallets, but they don't threaten our own health. Avian influenza is different. Though the H5N1 virus is spreading and killing mainly in Indonesia, Vietnam and Thailand, the possibility that bird flu could mutate and become a pandemic is a serious threat to us all. That's why Jakarta's fight with the World Health Organization (WHO) over how an avian-flu vaccine should be developed and distributed is so important.

For 50 years, countries around the world have shared new flu strains with the WHO, to help scientists track genetic changes in the fast-mutating virus. The WHO uses that information to create a seed strain to drug companies, at no cost, which then manufacture and sell commercial flu vaccines. That process continued with avian flu until late last year, when Indonesia—the country that has suffered the most bird-flu deaths—suddenly stopped sharing virus samples and instead signed an agreement with the U.S. drug company Baxter to provide virus strains in exchange for help in eventually producing its own vaccine. Jakarta health officials argued that it was unfair for them to give away viruses that might be used to make a pandemic vaccine Indonesia—and other developing countries—would never be able to afford. With global flu-vaccine production capacity topping out at 500 million doses a year and everyone in the world clamoring for a shot should a pandemic occur, a vaccine would almost certainly be priced out of their reach.

By the grim logic of virology, Indonesia's decision was unconscionable and self-defeating. We need surveillance in every nation to track bird flu as it changes. But Jakarta got the attention of WHO officials, who came to the Indonesian capital earlier this week for an emergency meeting at which Health Minister Siti Fadilah Supari called the current distribution system "more dangerous than the threat of an H5N1 pandemic itself." On March 27 the two sides reached a temporary compromise: Indonesia would resume sharing virus samples with the WHO, but for now that access wouldn't be extended to the drug industry. That means scientists can once again track the virus as it mutates, but companies can't use it to make a vaccine without Indonesia's permission. Further negotiations will be needed, but for now, Indonesia's intransigence has made the rest of us take notice of essential global health inequalities in a way that 1.4 million needless deaths doesn't seem to do.