Cablegate: U.S. Government Officials Meet with Indonesian


DE RUEHGV #0275/01 1020655
P 110655Z APR 08





E.O. 12958: N/A

REF: GENEVA 2507 (07)

1. Summary. Ambassador John Lange, Special Representative
of the Secretary of State for Avian and Pandemic Influenza,
and Dr. William Steiger, Special Assistant for International
Affairs to the U.S. Secretary of Health and Human Services,
met with Indonesian Minister of Health Siti Fadilah Supari,
at her request, in Geneva, on April 2, 2008. They discussed
issues related to the World Health Organization (WHO)
intergovernmental process on pandemic-influenza preparedness,
particularly the sharing of influenza viruses and access to
vaccines and other benefits. The conversation covered
possible material-transfer agreements, traceability
mechanisms, a new name for the WHO Global Influenza
Surveillance Network (GISN), and access to benefits that
might result from the sharing of influenza viruses. Although
the discussion covered familiar ground, Minister Supari
introduced a specific idea that monetary benefits should flow
directly to the countries that provide virus samples to the
WHO network, based on a percentage of sales of commercially
viable vaccines produced from those samples, a mechanism
commonly known as a royalty. The meeting ended
inconclusively, although the two sides did appear to share
common ground on several aspects of the debate around
sample-sharing. End Summary.

2. Ambassador John Lange, Special Representative of the
Secretary of State on Avian and Pandemic Influenza, and Dr.

William Steiger, Special Assistant for International Affairs
to the U.S. Secretary of Health and Human Services (HHS), met
with Indonesian Minister of Health Siti Fadilah Supari, at
her request, in Geneva, on April 2, 2008. David Hohman,
Health Attache at U.S. Mission Geneva, accompanied Steiger
and Lange. Dr. Widjaja Lukito, Minister Supari's adviser on
influenza issues; Dr. Indriyono Tantoro, an adviser to the
Minister; and Cecep Herawan of the Indonesian Mission in
Geneva, accompanied Minister Supari.

3. Steiger, who had earlier met with Minister Supari in
Geneva on January 22, 2008, on the margins of the WHO
Executive Board, opened by expressing appreciation both for
the suggestion of the meeting and for the leadership Minister
Supari has demonstrated on the issue of injecting more
transparency, fairness and clarity in the system for sharing
influenza viruses. Lange expressed appreciation for
Indonesian participation in the recent Sydney discussions,
and noted that the WHO negotiations later in the week would
be in a multilateral context. The Minister thanked the
United States for agreeing to the meeting, and asked Dr.
Widjaja to discuss four issues: material-transfer
agreements, traceability mechanisms, a new name for the WHO
global influenza surveillance network (GISN), and access to
benefits that might result from the sharing of influenza

4. Dr. Widjaja noted the progress he believed the United
States and Indonesia made in informal discussions facilitated
by Australia on these issues, held from March 17-19, in
Sydney. He then discussed the improvements Indonesia sees as
needed to the traceability mechanism for virus samples the
WHO secretariat had developed in response to a request from
the WHO intergovernmental meeting (IGM) on pandemic-influenza
preparedness, which last met in November 2007. Widjaja
stressed countries needed a more user-friendly mechanism that
provided data in real-time. He cited the Global Initiative
on Sharing Avian Influenza Data (GISAID) as a possible model,
and indicated he had learned more about this system at the
Swiss Institute of Bioinformatics on his last visit to
Geneva, in January 2008. He also suggested an effective,
robust traceability mechanism might eventually make
unnecessary the advisory, or oversight, group called for by
the November IGM.

5. Turning to the subject of material-transfer agreements
(MTAs), Widjaja said the IGM discussion was "stuck" on the
issue of transferring seed viruses to commercial vaccine
manufacturers, which would require prior, informed consent of
the originating country (a familiar Indonesian priority). He
agreed that countries could send viruses to WHO collaborating
centers for risk-assessment purposes, and acknowledged that a
standard, universal MTA was a possibility, but the elements

of such an agreement needed further work. The Minister
intervened to stress that Indonesian law required that any
biological sample shipped out of the country carry an MTA.

6. In concluding, Widjaja proposed to re-name the current
Global Influenza Surveillance Network (GISN) as the "WHO
Influenza Network," or "WIN," and said the terms of reference
(TORs) for each element of the "WIN" (especially the WHO
collaborating centers on influenza, the H5 reference
laboratories, and so-called "essential regulatory
laboratories," a category discussed at the Singapore
Interdisciplinary Meeting and at the IGM in November 2007)
needed revision.

7. Responding to Widjaja's points, Steiger agreed replacing
"GISN" with "WIN" would likely find general acceptance, and
stressed every element of the network required TORs,
including the National Influenza Centers (NICS), which
Widjaja had not mentioned. Steiger emphasized that the TORs
must provide clear guidance for everyone involved in the
network, and suggested the IGM should consider supporting the
establishment of new WHO collaborating centers on influenza,
particularly in developing countries, provided the
institutions could meet and maintain the rigorous standards
the WHO Secretariat sets for such designations.

8. Turning to the governance of the WHO network, Steiger
suggested an advisory group might be necessary, especially in
the short term, while member States and the WHO Secretariat
improved the traceability mechanism. He agreed the tracking
system had to be simple, fast, internet-based (with password
protection), and user-friendly. He said the U.S. Government
did not know whether GISAID was the right system, but
stressed U.S. technical agencies were willing to look at a
number of candidates. In any case, he said the scientists
within the WHO influenza network, especially from affected
countries, should determine their needs, and test the GISAID
system and other models. Steiger said Ambassador Lange would
announce at the upcoming meeting of the IGM Working Group
that the United States, through HHS, would reprogram $500,000
of a cooperative agreement already awarded to the WHO
Secretariat to support work on improving the traceability

mechanism, including through the hiring of a dedicated
project manager.

9. Discussing the sharing of possible benefits, Steiger
stressed that well-defined benefits should be available for
all countries in need, not just those who had cases of the
H5N1 virus today. He said the WHO Secretariat had more work
to do on developing a vaccine stockpile, which now consisted
only of a pledge from GlaxoSmithKline of 50 million doses of
an as-yet-unlicensed vaccine. He also pointed to the
technical assistance provided by WHO member States and the
WHO Secretariat on containment measures; training;
non-pharmaceutical interventions, such as
community-mitigation strategies; and technology transfer to
improve the production of influenza vaccine in developing
countries. He also said vaccine manufacturers have a
voluntary responsibility to contribute to WHO-managed
stockpiles, and to support safe vaccine-production capacity
in developing countries, one of Secretary Leavitt's strategic

10. Minister Supari, noting Steiger had touched on a
sensitive issue, repeated her concern that vaccine
manufacturers receive free material to develop vaccines but
source countries do not benefit. The Minister then
introduced a specific idea - she said source countries should
receive a percentage of the sales of commercially viable
vaccines developed from their viruses. When Steiger asked if
she was talking about royalties, the minister said, "No, I do
not want to touch (intellectual property)." She stressed,
however, that the material provided by source countries had
value, and she wanted the world community to recognize that
value. (Comment: although the royalty idea is not new, we
have not heard it for at least a year. When Ambassador Lange
later asked Widjaja why he had not raised this at the Sydney
meeting, Widjaja said he only had permission to discuss
non-monetary benefits, and it was the Minister's purview to
discuss monetary benefits. He also said he would not raise
monetary benefits in the IGM Working Group meeting. In

previous discussions with U.S. Government officials,
including with Steiger in January 2008 and with HHS Secretary
Leavitt at the World Health Assembly in 2007, Minister Supari
denied she was seeking royalties. End comment.)

11. Returning to the subject of possible material-transfer
agreements, Steiger stressed there must be one, universal
agreement, negotiated once, applicable to all, linked to the
traceability mechanism, web-based, and that would track
viruses in and out of the WHO system. He agreed that MTAs,
or standard terms and conditions, should indicate the
provenance of viruses, and include provisions that would
recognize the contributions of scientists in source countries.

12. Minister Supari then asked when Steiger thought
Indonesia would have its own WHO collaborating center on
influenza. Saying he could not answer that question, Steiger
noted the Eijkman Institute, with its laboratory certified at
biosafety level three, had the potential over time to earn
this designation from the WHO Secretariat.

13. Noting the Minister had asked him at their meeting in
January why vaccine-manufacturer Baxter was not fulfilling
the terms of its agreement with the Indonesian government
related to the development and testing of an H5N1 vaccine,
Steiger said he had learned the sticking point for the
company related to indemnification. He urged the Minister to
have her lawyers explore the indemnification proposal from

14. In concluding the meeting, Steiger told Minister Supari
that HHS Secretary Leavitt very much looked forward to his
visit to Indonesia later in the month, and to meeting with
President Yudhoyono, Coordinating Minister Bakrie, and her.


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