13 August, 2007 (United Kingdom)—World Health Organization (WHO) made its position clear when David Heymann, Assistant Director General of Communicable Diseases, said that Indonesia had only sent the agency three specimens of the H5N1 strain of highly pathogenic avian influenza (HPAI) virus in humans since May 2007. Indonesia had agreed to resume sample sharing in May 2007 after a 5-month boycott.

Samples received in May by the WHO-collaborating laboratory in Japan did not contain any live virus – only fragments – and are therefore unusable, according to WHO. “Although the samples were PCR [polymerase chain reaction]-positive, they did not have living virus in them,” said Heymann, while briefing reporters on 6 August 2007 about a WHO-sponsored meeting the previous week in Singapore on virus-sharing issues.

Indonesia was jeopardising not only itself but the whole planet, claimed WHO. Virus samples are needed to track the virus evolution and drug resistance development and to make vaccines. This virus is considered to be the most likely precursor to a pandemic strain of influenza.

“What’s important is that all countries share the viruses they isolate from humans,” explained Heymann. “By not sharing viruses, Indonesia is putting in danger its own population because if those viruses are not freely shared with industry, vaccines will not contain the (genetic) elements of the Indonesia infections. The second thing Indonesia is doing is putting the whole world at risk”, he claimed.

China had not shared H5N1 specimens with WHO for almost a year although it did send AI samples in June 2007. Vietnam is sending samples despite some shipping problems that relate to clearance issues in Vietnam and the receiving countries.

Dr Heymann is optimistic Indonesia will come round. “They [Indonesia] understand these issues,” he said.

Indonesia hit back the following day, saying that it would not resume full co-operation with the WHO on AI virus sample sharing until a fair mechanism is in place, but denied sending unusable specimens. Triono Soendoro, head of the Indonesian health ministry's research and development centre, brushed aside Heymann's claims. “He doesn't understand about viruses. Just tell him to ask the virologists in Japan and let them explain to him,” reported Reuters who had spoken with him by telephone. Soendoro subsequently told the Financial Times on 8 August that the samples sent to the WHO in May were adequate for determining if a viral mutation had occurred.

Indonesia, the country worst hit by AI in both poultry and people, has accused WHO of misusing its H5N1 specimens by sharing them with drug companies without its (Indonesia’s) permission. Indonesia argues that these companies use specimens to develop and manufacture of vaccines that poor countries like Indonesia cannot afford. Soendoro said that Indonesia had previously shared H5N1 specimens with WHO as a gesture of goodwill, in spite of no proper mechanism of virus sharing.

“We sent the samples in May 2007 in good faith,” explained Soendoro. “It was a donation, a courtesy, in the hope that there would be a fair mechanism in the near future. But so far, no such mechanism exists. It is still being discussed. If we do it again now, we are worried that we will be deceived again,” he told Reuters. He went on to say that for the time being, Indonesia would give specimens on a bilateral basis and did not have to share them first with the WHO.

H5N1 HPAI is now so entrenched and endemic in the Indonesia that many of the regularly occurring human infections can no longer be tied to specific outbreaks in poultry because few occurrences are identified or recorded. Their full co-operation with global authorities is likely to help Indonesia bring an early end to their AI difficulties sooner rather than later.