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Improvements In Flu Surveillance Goal Of Meeting

By Cheryl Pellerin

Improvements in Flu Surveillance Network Goal of Geneva Meeting

Strengthening procedures for sharing samples of potentially pandemic viruses and increasing developing-nation access to the resulting vaccines were the focus of an international meeting hosted by the World Health Organization (WHO) in Geneva November 20-23.

The World Health Organization (WHO)Intergovernmental Meeting on Pandemic Influenza Preparedness: Sharing of Influenza Viruses and Access to Vaccines and other Benefits, drew an estimated 300 attendees, including about 100 member-state delegations, representatives from international organizations and invited experts.

The meeting was the fifth large gathering in 2007 on the topic. Attendees agreed that countries will share viruses with WHO while a detailed framework for sharing flu samples and benefits is developed.

The question of benefits for developing nations gained prominence in January when Indonesia -- which has confirmed 113 human cases of avian flu, 91 of them fatal -- announced it would stop sharing avian flu samples with WHO because it was unfair for rich countries to use the samples to develop vaccines that poorer nations could not afford to buy.

Despite its stated refusal to share viruses, Indonesia sent three respiratory specimens from two patients to the WHO Collaborating Centre in Tokyo in May and sent three more specimens in August to the WHO Collaborating Centre at the U.S. Centers for Disease Control and Prevention, according to WHO spokesman Gregory Hartl. H5N1 was confirmed in all the samples, and isolation of the virus was successful for at least one.


"The world needs the [WHO] Global Influenza Surveillance Network [GISN] as a predictable, reliable and efficient system for sharing human influenza virus samples, seasonal and pandemic, to analyze and monitor the threat, undertake additional research and produce vaccines," Ambassador John Lange, the U.S. State Department's special representative on avian and pandemic influenza, told USINFO after the meeting.

The GISN, established in 1952, is a global alert mechanism for seasonal flu and emerging flu viruses with pandemic potential. Its main components are national influenza centres, which sample patients with flu-like illnesses and submit samples to WHO collaborating centres for genetic analyses.

Flu vaccines must be updated often because flu viruses constantly evolve. Only a vaccine whose virus strains match the circulating flu viruses will protect people efficiently from disease and death. Since 2003, some 335 people worldwide have been infected with the avian flu virus H5N1 and 206 have died.

The first flu virus network was established in 1947, a year before WHO became fully operational. At that time, flu surveillance had three public health justifications: successful vaccination against flu depends on knowledge of circulating viruses, continuous vigilance is needed to detect new and potentially dangerous strains as early as possible and epidemiological reports can be interpreted correctly only in terms of laboratory studies of viruses.

The justifications still hold today, according to WHO Director-General Margaret Chan.

"The present situation gives us an opportunity to take a hard look at the way a surveillance system, established in 1947, operates," she added. "Some weaknesses have been revealed."

The weaknesses, Chan said November 20, "must not be allowed to undermine implementation of the International Health Regulations, or diminish the significance of the obligations they place on member states, in the interest of global health security."

In May, the WHO World Health Assembly (WHA) passed resolution 60.28, which outlines the flow of activities designed to ensure that countries received the benefits they felt they would need from virus sharing.

Singapore hosted the first meeting in that process; the intergovernmental meeting in Geneva was second and will reconvene -- probably in Geneva -- in 2008.

In the meantime, according to meeting documents not yet officially approved by delegates, the meeting chair -- Jane Halton of Australia -- will convene a working group with balanced representation from member states that will meet in Geneva (dates to be determined) to consider virus sharing and benefit issues in advance of WHA 2008.


An unapproved meeting document acknowledges that there has been "a breakdown of trust in this essential system of international collaboration and collective action," and that "the current system does not deliver the desired levels of fairness, transparency and equity."

To improve the network's transparency, Lange said, WHO member states asked Director-General Chan to move forward on two immediate measures -- a "traceability" mechanism to track the H5N1 virus and other potentially pandemic human viruses that are shared with GISN, and an advisory group appointed by the director-general to monitor and advise on strengthening the network.

"We call on all countries to share virus samples freely," Lange said, "without encumbrances, for the benefit of global public health."

"Vulnerability is universal," Chan said. "A pandemic will, by its very nature, reach every corner of the Earth and it will do so within a matter of months. ... In terms of the risk of disease, we really are all in the same boat."


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