WHO: DECEMBER 8-13 2008 WHO MEETING ON INFLUENZA

UNCLAS SECTION 01 OF 03 GENEVA 001112 SENSITIVE SIPDIS DEPT FOR G, AIAG, OES, IO, L COMMERCE FOR USPTO PASS TO USTR E.O. 12958: N/A TAGS: PREL EAID KFLU TBIO WHO SUBJECT: WHO: DECEMBER 8-13 2008 WHO MEETING ON INFLUENZA SAMPLE/BENEFITS SHARING MAKES SUBSTANTIAL PROGRESS, BUT ISSUES REMAIN REF: GENEVA 2537 (2007) ¶1. (SBU) Summary: During December 8-13 negotiations at the Intergovernmental Meeting (IGM) on Pandemic Influenza Preparedness in Geneva, delegates made substantial progress on complex issues -- including concrete steps to enhance the World Health Organization (WHO) system to assess and respond to pandemic threats -- but were not able to conclude negotiations. With a boost from cooperation between the United States and Indonesia, WHO Member States agreed they were committed to sharing influenza viruses with human pandemic potential and equally committed to sharing benefits, such as access to pre-pandemic and pandemic vaccines. The IGM will reconvene for a final time in connection with the May 2009 World Health Assembly (WHA). In the meantime, interested governments will engage in informal consultations facilitated by the Australian Chair and Vice Chairs from other regions. End summary. Challenges to WHO Global Influenza Surveillance Network ¶2. (SBU) Since early 2007, Indonesia has refused to share human influenza virus samples (including those from human cases of avian H5N1 influenza) with the WHO Global Influenza Surveillance Network (GISN). Indonesia insists on what some term "viral sovereignty" and demands benefits, such as access to affordable vaccines, in return for future sharing. Some other developing countries, such as Brazil (with support from India and Thailand),have been trying to use the controversy to undercut intellectual property rights (IPR),and to require permissions for onward transfer and use of samples outside the network. The United States, in coordination with Australia, the European Union, Canada and Japan, supports rapid and unencumbered sharing of samples, and provision of benefits to developing countries on a multilateral, voluntary basis, but has not accepted the Indonesian claim to ownership/control of a pathogen. The World Health Assembly (WHA) in May 2007 set forth a process to resolve issues that included the IGM, which held a second meeting December 8-13, ¶2008. Between the first (November 2007) and second IGM meetings, there was an April 2008 Open-Ended Working Group meeting and a process of drafting chair's text as the basis for negotiation by drawing on previous documentation, Member State comments and the IGM bureau. Concurrently, over the last seven months the United States and Indonesia have engaged in bilateral meetings, facilitated by Australia, in an attempt to reach agreement on principles that could facilitate the multilateral discussion. ¶3. (SBU) In lead-up to the IGM, the Australia Chair shared with the U.S. delegation data provided by WHO that highlighted the continuing challenges to the WHO Network. Between November 2007 and November 2008, WHO received reports of 44 cases of H5N1 avian influenza in humans worldwide, but received clinical specimens from only 8 of those cases. By country, the number of cases reported (specimens shared) are: Indonesia 20 (2),Egypt 12 (4),Vietnam 5 (0),Pakistan 3 (1),China 3 (in process),and Bangladesh 3 (1). Pandemic Threat Persists; Joint Intervention by U.S. and Indonesia ¶4. (U) On the first day of negotiations, WHO Director-General Margaret Chan reminded delegates of the pandemic threat and urged them to approach the meeting with a sense of urgency. In response to a query from the USDel on the difficulty of maintaining preparedness in light of "flu GENEVA 00001112 002 OF 003 fatigue" in some quarters, she told the IGM, "Pandemic influenza preparedness is the first priority for the organization." ¶5. (SBU) Given the complexity of the issues and the deep divisions among Member States, negotiations bogged down on disagreements over language on IPR; which clinical and virus samples should be covered by a universal, standard materials transfer agreement (SMTA) which would accompany samples throughout the system; and debate over voluntary vs. mandatory sharing of samples and benefits and whether there should be a requirement for prior informed consent for onward transfer. On the fourth day, the U.S. and Indonesia, drawing on the mutual understanding developed during their consultations, jointly introduced language (originally suggested to Indonesia by the USG and modified based on USDel discussions with a few other delegations) that noted how sample sharing fit into a multilateral system of sample and benefit sharing but made clear that sharing of a sample was not related to receipt of a benefit. When combined with a subsequent U.S. suggestion that focus be shifted from the never-ending debate over voluntary vs. mandatory sharing of samples/benefits to commitments to share samples and to share benefits, the meeting dynamics changed dramatically. Although some delegations had been critical of the U.S.-Indonesia discussions because they feared a separate bilateral agreement had been underway, at the closing session the Vice Chair for the African region, from Nigeria, specifically commended the U.S. and Indonesian delegations "for making everything possible." ¶6. (SBU) Delegates also reached general agreement on guiding principles for development of terms of reference for laboratories in the WHO GISN and on terms of reference for an advisory group to the WHO Director-General which will focus on functioning of the network. IPAPI Core Group Plays Important Donor Coordination Role ¶7. (SBU) During the negotiations, daily meetings of the U.S.-chaired Core Group (Australia, Canada, EU Presidency/EC, Japan, UK and the United States) of the International Partnership on Avian and Pandemic Influenza (IPAPI) proved to be critical for donor government coordination. At the IGM, WHO presented the preliminary results of a Gates Foundation-supported analysis of options and related costs for the operation of a multilateral H5N1 pre-pandemic vaccine stockpile, a key benefit agreed upon at the previous IGM. The feedback drafted by the Core Group and presented by Canada at the plenary session provided further background information and called for a separate meeting of interested parties to review the policy and cost implications of various options. In addition, the Core Group drafted a list of pandemic preparedness "milestones" (in the categories of risk assessment, capacity building, access to vaccines, antiviral stockpiles and rapid containment, technology transfer, and resource mobilization th rough international ministerial conferences) that outlined past and current commitments and will help guide future discussions. Enhanced Global Vaccine Manufacturing Capacity ¶8. (SBU) At a side meeting, the International Federation of Pharmaceuticals Manufacturers and Associations (IFPMA) reviewed contributions manufacturers have made to pandemic preparedness and provided global estimates for pandemic GENEVA 00001112 003 OF 003 vaccine production capacity. Assuming a single strain pandemic vaccine, continued increase in demand for seasonal influenza vaccine, and antigen sparing through the use of adjuvants, IFPMA estimated the pandemic vaccine production capacity in 2007 was 3.6 billion doses per year and in 2010 will be 18 billion doses per year. (NOTE: These estimates are higher than previous estimates, and if accurate represent substantial progress in the ability to meet vaccine demands in the event of a pandemic. END NOTE). International Health Regulations and Sample Sharing ¶9. (SBU) In informal discussions prior to the IGM, WHO Secretariat staff shared with U.S. delegation members that preliminary guidance from WHO legal counselors is that Members States must share influenza samples with the WHO GISN according to the International Health Regulations (IHRs). The rationale is that to determine if an H5N1 influenza case is a public health emergency of international concern, samples must be shared to assess pandemic potential. While the WHO staff qualified that IHR relevance to sample sharing remains to be discussed by the WHA, they indicated that this interpretation is potentially helpful, since IHR implementation and Member State compliance are within WHO's purview, in contrast to other agreements or conventions sometimes mentioned in the sample sharing debate such as the Trade Related Aspects of Intellectual Property Rights agreement or the Convention on Biological Diversity. Nevertheless, IHRs were mentioned infrequently at this IGM session. To date the United States has not taken the position that sharing of samples is mandatory under the IHRs. Difficult Issues Remain ¶10. (SBU) Unresolved issues generally fell into two categories: attempts to undercut IPR (with Brazil and India in the lead) and various matters related to the connection between virus sharing and benefit sharing (with Indonesia and some other developing countries trying to create linkage and developed countries opposing such linkage). Because the negotiated framework for sample and benefit sharing, when approved by the WHA, will be considered a non-binding agreement, there was strong indication that Brazil, India, and Indonesia intend to impose restrictions through language in the model SMTA that will be an annex - the SMTA being a legally binding contract between two parties. The IGM is suspended until a date to be determined around the time of the WHA, May 18-27. In the meantime, interested Member States will attempt to resolve remaining issues through informal consultations facilitated by the Australian Chair and Vice Chairs from other regions. (COMMENT: The remaining issues are significant and may be difficult to resolve. The May 2009 IGM report to WHA is likely to contain bracketed text reflecting those divisions. END COMMENT). ¶11. (U) Special Representative on Avian and Pandemic Influenza John E. Lange has cleared this cable. TICHENOR