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May 1, 2018

Viral Sovereignty: Equity and Global Health Risk Controversy

by Avery Hong (M'18)

From July 2005 to December 2007, Indonesia reported the highest number of influenza A (H5N1) human cases in the world: 116 cases, with an extremely high fatality rate of 81 percent. According to E.R. Sedyaningsih, author of "Towards Mutual Trust, Transparency and Equity in Virus Sharing Mechanism: The Avian Influenza Case of Indonesia," due to limited laboratory diagnostic capacities, all suspected human H5N1 cases were referred to one of the 100 designated Avian Influenza Referral Hospitals. Samples were collected from suspected patients and then sent to a reference laboratory in Jakarta for diagnostic testing and confirmation. Indonesian specialists also sent their clinical specimens to several international laboratories affiliated with the World Health Organization (WHO) Global Influenza Surveillance Network (GISN), but in January 2007, the government of Indonesia stopped sharing samples upon discovery that some of them had been provided to laboratories outside of the GISN without Indonesia’s consent.

In addition, the Indonesian government threatened to close down U.S. Naval Medical Research Unit Two (NAMRU-2), accused U.S. military scientists of profiteering from Indonesia’s “sovereign” viruses, and claimed that the United States was proliferating H5N1 in an alleged biological warfare scheme. According to WHO, the Indonesian Ministry of Health argued that the sample-sharing event exposed inequities in GISN: developing countries with limited resources provide information and samples to WHO-affiliated laboratories, and then pharmaceutical companies in industrialized countries obtain access to such samples without permission, and develop treatment and vaccines which developing countries cannot afford. In "Influenza Virus Samples, International Law, and Global Health Diplomacy," David Fidler notes the Indonesian government made a fairly reasonable argument that urged the World Health Assembly (WHA) to promote “transparent, fair and equitable sharing of the benefits arising from the generation of information, diagnostics, medicines, vaccines and other technologies,” but also to increase vaccine access for developing countries by providing financial support and building vaccine-manufacturing capacities.

So, what is viral sovereignty? Viral sovereignty is when individual nations assert that viruses isolated from within their jurisdictions are their sovereign property. The United Nation’s Convention on Biological Diversity (1993) is a multilateral agreement on access and benefit-sharing of genetic resources. It endorses the sovereign right of individual nations to control and make decisions about their genetic resources. Infectious diseases pose a high threat to global health security because they do not carry a passport to cross international borders, and they can cause devastating health crises around the globe. Although viral sovereignty claims could limit access to viruses for scientists who need those virus samples to conduct lifesaving research, equity between developed and developing countries is a legitimate issue that cannot be ignored.

Fast forward to the recent 2014 Ebola virus outbreak in West Africa, where there has been an international effort to advocate for the creation of an Ebola biobank in West Africa. During the outbreak, thousands of biological specimens were taken from the patients and shipped out of West Africa by foreign agencies who had arrived to test patients for Ebola. However, due to the chaotic situation and lack of Material Transfer Agreements, tracking down and returning those specimens has been a challenge. Several countries, such as Canada, are refusing to return their samples due to “biosafety and biosecurity concerns.” Whether claiming viral sovereignty or bringing back samples to their country of origin, the international community needs to develop detailed sample sharing plans.

Pandemics kill people, but inequality kills humanity. Should you support the greater good or equity?

Avery Hong (M'18) is a graduate student in the Biohazardous Threat Agents and Emerging Infectious Diseases Program and a student fellow with the Global Health Initiative.