Global Health Policy
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February 13, 2007
Bird Flu Blues
Posted by Ruth Levine at 03:41 PM
The Economist has the right angle on the recent bird flu scare in the UK. Yes, they say, go ahead and worry if it motivates the right sort of action to mitigate the hard-to-imagine impact of an avian influenza pandemic. But that action should include larger financing commitments, and start with intensive efforts in countries where the problem is real and immediate. As they write:
Even today's small sums are paid out in the wrong place. Diseases emerge in Africa and Asia, where people mingle with animals day in, day out. That is where the monitoring and the research needs to go on. Cross-border co-operation is never easy, but if rich-world governments want to protect their citizens, the place to start is in a foreign field.
In a related op-ed in Friday's New York Times, Ruth Faden, Patrick Duggan and Ruth Karron push for more attention to those who are already feeling the pain of the potential pandemic: The families in Jakarta who raise chickens, for example, who were forced to eat, sell or kill their birds by February 1. These are poor households, that can scarcely afford to be bearing the brunt of global concern about the spread of infectious disease; their government can help some, but not enough, and shouldn't be expected to shoulder the full cost, because it is others - those in richer countries - who will also benefit.
Just to compensate families for their culled birds would require nearly $2 million, not including the cost of administering the program. Indonesia's domestic bird population countrywide is estimated at 300 million, so if the culling program were to be expanded beyond Jakarta, the total compensation cost could run as high as $450 million.Indonesia's avian influenza budget for the coming year is reported to be less than $50 million. Clearly, without donor assistance, the government cannot afford to compensate families and farmers fairly. So the burden of pandemic prevention must also fall on the world's wealthy nations.
Without more constructive international cooperation on pandemic preparedness, backed by serious money and built on genuine commitments to protect public health in poorer parts of the world, the chances are high that progress toward solutions will go off the rails. And that is indeed starting, because of the lack of mechanisms to ensure that life-saving pharmaceutical products will be made available to low-income countries. Last week, for example, Indonesia decided that it would only provide samples of the H5N1 virus for research that is not intended to develop a commercial product. Why give away a research sample, they reason, only to find that it's been used to develop a vaccine or drug that's sold at a price beyond the country's reach? Thai health authorities, who have found themselves embroiled in a battle over access to AIDS drugs, are sympathetic:
"The Indonesian health minister is wise, and sending a strong message that, unless developing countries which are at the epicenter of the pandemic can be assured access to potential pandemic flu vaccines, they should not cooperate by sending out the viruses to WHO," said Suwit Wibulpolprasert, a senior public health official in Thailand's Ministry of Public Health.
There's little doubt that the response to bird flu has to be genuinely global, and needs to include new types of commitments to protect those who are hit earliest and hardest. Who's going to step up and make this happen?
Update: Indonesia has subsequently reversed its policy, according to the New York Times and elsewhere.
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Comments
In addition, How the World Works at Salon.com has an interesting assessment contrasting the WHO's position on intellectual property rights in the case of Indonesian bird flu with their statement's on Thailand's proposed compulsory licenses.
Posted by: Jessica Pickett at February 13, 2007 04:12 PM
Of note, Indonesia seems to have quickly reversed its policy on sharing virus samples after a meeting with WHO officials last week. The broader global equity issues are far from "solved," of course, but I think the WHO has realized this debate needs attention.
Also, last week, the World Bank organized a web seminar on poultry culling and compensation guidelines. One of the topics of discussion was a forthcoming report (expected in March 2007) on the feasibility of setting up an international fund to supplement countries' own compensation funds. Given that these containment/control of avian flu is essentially a global public good, setting up such a fund would be an important advance.
Posted by: Patrick Duggan at February 19, 2007 11:37 AM