Friday, January 13, 2006

Fiddling while Rome burns

The new information about the genetic sequences in the Turkish bird flu cases brings to the forefront again a long simmering and contentious dispute about viral samples from China (see here, here, here and here). While genetic sequence information is vitally important, it is not a substitute for having the actual viral isolates because there is much about the biology of the virus (host range, transimissibility, virulence, etc.) that cannot yet be predicted from the sequences with confidence. But to date, China has yet to share isolates from over 30 poultry outbreaks, despite international agreements to do so.
Behind the increasingly urgent international bird flu threat, an international dispute over viral samples and national pride appears to be hampering the global response.

At the heart of the issue is China's unwillingness to turn over viral samples from more than 30 animal outbreaks of bird flu, World Health Organization representatives told Interfax. The delayed delivery of those samples surfaced publicly at a Dec. 23 news briefing in Beijing.

At the time, Dr Shigeru Omi, WHO Regional Director for the Western Pacific Region, said at the briefing, "From the more than 30 reported outbreaks in animals in 2005, no viruses have been made available so far. Ministry of Agriculture officials have told me they understand the importance of sharing viruses. But time is of the essence."

Yet, so far, WHO officials told Interfax late this week there has been no change: the samples, which scientists urgently need to predict the evolution of the virus in humans, have not been delivered. This situation continues despite new bird flu animal outbreaks and human deaths reaching into Turkey, and European jitters increasing about the virus spreading there, Roy Wadia, WHO spokesman in Beijing told Interfax this week. (Interfax, Chinese News Agency)
But as always in disputes of this nature, the back story seems more complicated. China does not have a unitary organization for its bird flu efforts, and the Ministry of Health has shared isolates from the recent human cases. But the poultry viruses are the purview of the Ministry of Agriculture. MoA has an economic function tied up with not only the health of the nation's vast 5 billion animal poultry industry but also research and development on vaccines and other animal biosecurity measures. Behind the scenes, China is complaining about failure to receive credit for advances made with samples it provides (an issue of both national pride and patent and licensing issues) and further that other countries don't provide their viral samples to China. Live viruses are needed also for vaccine prototypes.

WHO has no jurisdiction but is essentially a sample broker for the collaborating network of national laboratories that make up its bird flu surveillance system. It can only cajole the various countries to provide samples to the system and to each other, arrangements which must be made bilaterally, according to Interfax.
Behind the scenes, however, China is complaining about the lack of international cooperation and the failure of the international health community to share virus samples and give proper research credit, a source inside the United Nations Food and Agriculture Organization (FAO), who asked to remain anonymous, told Interfax.

Since 2004, when the Ministry of Agriculture provided five virus samples to WHO labs in 2004, China has not received virus samples from other countries in return, despite requests to the WHO, the source said.

The Chinese government also has complained about a study done of the viruses China provided by Robert Webster, a prominent virologist at one of the WHO collaborating laboratories, that did not credit China as the source of the samples.

"That was something that made China very upset indeed," said [WHO's] Wadia.

Although the WHO receives virus samples, it can only distribute them to a network of collaborating research centers, which research vaccine prototypes that are freely available. It cannot provide virus samples to countries directly, and can only help facilitate bi-lateral talks between the country that wants the sample and the country where the outbreak originated. The originating country is under no obligation to agree.

"It seems obvious that if we are saying to China they must supply viruses to the network, it's completely reasonable that the network should supply viruses to China," Dr. Rick Brown, an epidemiologist with the WHO, told Interfax.

Tracking what goes on in animals allows researchers to get an overall pattern of what is happening in the mutation and evolution of the virus.
This all appears to be part of an overall theme of Chinese independence on outside sources of science and technology. From one perspective it is understandable. But from a global public health perspective it points to the inadequacy of viewing these problems through the lens of the "national system" (the internal autonomy of nation states; for more background see here). The virus doesn't care about national borders.

It sounds as if there is much room for better behavior on all sides here. Rome is burning and the scientists and bureaucrats are fiddling. It isn't a nice sound.