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Gerneva, 20 May 2009

Fairness, Transparency and Equity in International Public Health-Interview with Indonesian Health Minister Dr. Siti Fadilah Supari at the 62nd World Health Assembly

AUTHOR:   Current Concerns

ef. In 2007 the Indonesian Health Ministry publicly announced that it would no longer hand over their bird flu viruses to the WHO’s Influenca Supervision Network (GISN), since the system did not pay any attention to the needs and interests of developing countries. The Indonesian Health Minister Dr. Siti Fadilah Supari had revealed that the WHO had violated its own regulations on the exchange of viruses and was practicing double standards, by receiving influenza viruses by the afflicted countries via the GISN and handed them on to commercial enterprises for the development of vaccines. These vaccines, however, were much too expensive and therefore not available in the afflicted developing countries, while industrial countries hoarded them in order to be prepared if a pandemic was to break out. It is due to Dr Supari that this problem was made known to the world public and documented in her book “It’s Time for the World to Change”. (cf. Current Concerns No 7/8, 2009).
This year’s World Health Assembly (WHA) took place from 14 to 22 May in Geneva. It was planned to continue the negotiations on a fair, transparent and just exchange of viruses and the benefit sharing at this meeting, negotiations that had been initiated by Indonesia and supported by many WHO member states.
But the swine flu interfered and the WHA was abbreviated by 5 days with the justification that the health ministers of the member states were urgently required in their native countries to prepare for a possible pandemic. The consequence was that important issues could not be discussed.
Current Concerns spoke with Dr Supari at the World Health Assembly.

CC: What were the reactions to your book “It’s Time for the World to Change”? And what has happened since then?
Dr Supari: My book drew international attention after a journalist from Sydney, Australia, had reviewed the book in his newspaper, claiming that I accused WHO of conspiracy to make a biological weapon although no such accusation was written in my book. The review gained worldwide attention and drew direct and indirect reactions. Some agreed with the review, others were sceptical. Furthermore many were ready to condemn me even without reading the book. At that time, I had deep concern that these accusations levelled against me arose although they were not addressed in the book.My book became well-known in my country after it had become well-known around the world. I was overwhelmed by the issues arising from the book, including that WHO demanded the book be withdrawn from publication. But in fact it was not the case.In brief, the book contains my notes during my struggle in WHO to reach fairness, transparency and equity in the virus sharing and benefit sharing mechanism, replacing WHO’s 60-year-old mechanism on virus sharing which I considered non-transparent.

From your point of view, from the point of view of Indonesia, what are the most important issues at this year’s World Health Assembly?
This year`s WHA most important topic is the impact of the global economic and financial crisis on health. From my point of view the most important issue in this year’s WHA is the H1N1 flu pandemic originating in Mexico. The case has given me insights in how problems could have been avoided in Mexico if three principles had been applied: they are fairness, transparency and equity. Based on my observation on the H1N1 Mexican strain, I managed to recognise several controversial issues:First, WHO named the disease of the pandemic as swine flu, and then changed to a novel H1N1 influenza. I found this to be quite unusual and very strange. I do not know exactly the reason why the WHO determined the virus and the determination of the disease was very unusual. Because it should be called H1N1 Mexican strain, in the same manner as the H5N1 Indonesia strain and the H5N1 Vietnam strain, instead of Swine Flu virus or novel H1N1. But with H1N1 WHO changes the standard. It changes the nomenclature, the way of naming the virus.

This question has to be asked.
Yes, because it is very important to have the right of the name. If it is the Indonesian strain, then Indonesia has the right on the virus. If somebody creates a vaccine from this virus, they need to have permission from Indonesia. It really concerns me because we do not know who will have the responsibility for the virus. Just a new H1N1. This happened before, always H5N1, ever since then it is H5N1 Vietnam strain, H5N1 Thailand strain. So this is very strange.

Some say that Swine flu is a normal flu, an influenza which  developed recently.
It is evident. Actually it is an Influenza A. Second, the fact that WHO had set the pandemic alert level from 3 to 4 and then 5 and even to 6, all in just one week, had triggered worldwide to panic. I think to determine the pandemic alert level, WHO should not only apply transmissibility as an indicator but should also apply clinical / severity indicator (morbidity and mortality) and virological/ gene sequence indicator (high or low pathogenicity). The current novel H1N1 is low pathogenic. If you look closely at the case, the case fatality rate caused by the novel H1N1 is rather low. Currently there are 8, 000 cases spread over 39 countries, where 74 people died. This means the CFR is less than 2%, very low. This number is much smaller compared to seasonal flu. Moreover, virological analysis demonstrated that this novel H1N1 has low pathogenicity. In other words, it is not too dangerous. This should be discussed transparently in WHA: should we have a consensus on the naming of a virus? Should we redefine the criteria for pandemic alert status? This has a huge impact on a country declared in pandemic alert status, like Mexico now. Mexico is currently in a very difficult situation. But on the other side, many companies make a lot of profit, because everybody needs the drugs, needs the vaccines, disposable masks, protection clothes, and other things. It is a big business. The Mexican case is highly relevant to the case that I have been fighting for, and among this is transparency. Transparency in determining the virus and the pandemic alert level. I think this is very important to people around the world. Transparency will reduce unnecessary fear and the people still remain vigilant. The second important point (after H1N1) to me is the agreement to finalize the IGM PIP (Intergovernmental Meeting Pandemic Influenza Preparedness) process – my country’s initiative – on the establishment of fair, transparent and equitable mechanisms in virus sharing and benefits sharing. It is important to have a new mechanism in virus sharing and benefits sharing, particularly in H5N1 and other influenza viruses with human pandemic potential.

How does this proceed? After you had this big success in 2007?
We achieved about 85% in the IGM process, results of my efforts to change the mechanism in WHO. But during this process is underway, H1N1 came along...

Most of the speakers this morning included transparency, equity, “for all countries”. This is new and I think this is the success of your work, to change the mechanism and to give new insights. It was very obvious that all countries were demanding this.
Yes. But so far WHO has not had clear and integrated public health measures in facing an imminent pandemic phase. There should be coherent public health measures such as affordability and accessibility of anti-viral medicines, vaccines and other essential products like masks, etc. Whenever pandemic alert is beyond level 4, WHO is not helpful in a timely and systematic manner in recommending countries with the production capacity to produce generic supplies.

What other countries support Indonesia's position?
The majority of member states participating in the IGM PIP support Indonesia's position, as demonstrated in the December 2008 IGM PIP, also on May 15-16 2009 and during the 62nd WHA, in particular the countries of SEARO (South East Asia Regional Organization) and ASEAN regions (Association of Southeast Asian Nations) and most of the NAM (Non-Aligned Movement). This means a majority of the member states.

In the constitution of the WHO it says: “Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger.” In addition, Article 1 says, “The objective of the World Health Organization [...] shall be the attainment by all peoples of the highest possible level of health.” What does it need so that these principles are realized? What is the prerequisite for this principle to be realized?
In my view, what is needed is commitment and good will of all member states of WHO, especially of developed countries to create a system that is fair, transparent and equitable – principles implicitly contained in WHO rules, but which have not been implemented in practice.

How can people of good will in our western countries support your warrantable concerns?
By calling on governments to support efforts to finalize the Standard Material Transfer Agreement and establish a fair, transparent and equitable virus sharing system, with benefit sharing for the country of origin of the virus – this is very important now for Mexico – and the establishment of a virus tracking system and advisory mechanism, through public forums, mass media and petitions.

One argument was when Indonesia stopped sharing the virus with WHO, that the virus does not stop at the border, there is no virus sovereignty.
If I send the virus somewhere, I do not know where the virus goes. This is more dangerous than the virus itself. In my country I keep my virus safe, very safe. Indonesia is a big country and we have a lot of scientists keeping the virus. If I send the virus somewhere and I do not know where the virus goes, this is very dangerous, very dangerous. We keep our strain in my country, because many things can happen. And you can see, I have been fighting now for three years. There is no H5N1 Indonesia strain anywhere else than in my country and now the number of cases is very low. And we can study the virus like other countries and we can make comprehensive observation. And until now there is no mutation of H5N1 Indonesia strain.

Why is the US so interested in getting your virus?
I do not know exactly. If they want to have our virus they can contact me, they can contact us in a proper way, at an equal level – transparency. They can ask my country, then we can speak, we can ask them, what do you need the virus for and why. Will the results be beneficial for my country and my people?  We have to sit at the same level – equity.
Actually we want to change the mechanism for all people of the world, not only for the Indonesian people, not for me, not for developing countries only, but for all people. We want it through fairness, transparency and equity. It is the only way to achieve a more peaceful world and improve welfare.

Thank you very much, Dr Supari, for giving us the opportunity to talk to you.

Dr Siti Fadilah Supari is the Minister of Health of the Republic of Indonesia. She graduated from the Medical School at Gadjah Mada University in Yogyakarta and she began her career as a General Practitioner in the populous city of Jakarta. In her busy duties as a professional doctor, she continued her Postgraduate Specialist Training at the Faculty of Medicine, University of Indonesia in Jakarta. She completed her specialist training, and became Heart and Blood Vessel Specialist. She pursued her full-time research-based Doctorate Program at the Faculty of Medicine, University of Indonesia where she obtained her Ph.D. in cardiology. Recognition of her academic performance and works has led her to the post of the Minister of Health of the Republic of Indonesia in the United Indonesia Cabinet 2004-2009 period led by the President of the Republic of Indonesia, Dr Susilo Bambang Yudhoyono.
As Health Minister of the fourth largest country, Dr Supari is responsible for the health of over 230 million people.

Dr Siti Fadilah Supari, PhD: It’s Time for the World to Change – In the spirit of dignity, equity and transparency – Divine Hand Behind Avian Influenza, ISBN 978-979-17357-0-4; the book is best obtainable with the publishing house: PT. Sulaksana Watinsa Indonesia (SWI), Tel./Fax: +62 21 86614125, Mobile phone: +62 818813154, Email:swi_ptina@yahoo.com     

   Asia’s New Self-Confidence

thk. The fact that Kishore Mahbubani so impressively describes in his book „The New Asian Hemisphere. The Irrisistible Shift of Global Power to the East“, namely the growing of a new self-confidence of the Asiatic states, is confirmed by the Indonesian Minister of Health, Dr Siti Fadilah Supari. The developing countries, in this case the Asian states in particular, are fed up with being led by the nose by certain industrial nations who dictate the terms of how peoples have to live, via international organizations.
Mrs. Supari has enforced new standards in the WHO by her fearless commitment for the peoples of this earth. She claimed genuine equal treatment of all states with respect to the dealing with illnesses, disease agents and vaccines. To this end, she consequently demands the equality of all states.
It cannot be that a state, in which a disease in form of a new virus has developed, must deliver the viral strain to an industrial nation to the end that this nation can produce the vaccines. Later, this industrial state sells the vaccine to the afflicted state to a horrendous price, although this state has long since been able to produce the vaccine itself. With good reasons, these countries want to free themselves from the dependency on the West and rule their matters independently.

Source: Current Concerns No 11, 2009

Original article published on June 10, 2009

About the author

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TYPHOON ZONE : 11/06/2009