W.H.O. are you?

Bird flu, AIDS, heart disease: Thailand and Indonesia have lots of problems, but does the World Health Organization have the right answers?

Published February 8, 2007 6:19PM (EST)

Less than a month after being installed in office, Margaret Chan, the new director-general of the World Health Organization, riled public health advocates when, during a visit to Bangkok in early February, she criticized Thailand's government for its aggressive policy of issuing compulsory licenses for patented drugs.

"I'd like to underline that we have to find a right balance for compulsory licensing," Chan said, adding, "We can't be naive about this. There is no perfect solution for accessing drugs in both quality and quantity."

Meanwhile, on Wednesday, the New York Times quoted another WHO official, Dr. David L. Heymann, the agency's chief of communicable diseases, as saying the WHO was "clearly concerned" about Indonesia's decision to stop handing over samples of avian flu viral strains to the WHO free of charge. Instead, Indonesia had signed a deal to sell the virus samples to a private pharmaceutical company.

Dr. Heymann ... said he was not blaming the company involved, Baxter Healthcare of Deerfield, Ill. "But now that this has happened," he said, "we have to sit down and figure out how to rectify it."

Huh. Damned if you break a patent, damned if you don't. It's tough this week, being a Southeast Asian nation trying to do right on the public health front.

Because while on the surface the two situations seem like polar opposites, they are both manifestations of the same problem. Thailand is challenging the intellectual property status quo, because it is concerned that its sick citizens can't afford expensive AIDS and heart disease drugs. But Indonesia is upset that the strains of bird flu virus it gives to the WHO are then turned around and handed, free of charge, to pharmaceutical companies who manufacture vaccines that Indonesians can't afford. (Thanks to Felix Salmon for providing the pointer to background information on Indonesia's stance.)

Dr. Heymann, judging by his comments in the New York Times, appears cognizant of the subtleties of the situation: "To assure countries like Indonesia a supply of vaccine, Dr. Heymann favors helping them get plants where they can produce it themselves at low cost." But it is director-general Chan who is going to come under the most scrutiny. Where is the World Health Organization going to position itself on the gnarly question of how best to safeguard public health while protecting Big Pharma's intellectual property? The U.S.'s position has been clear: As I wrote in November, when the WHO was electing a new director:

In March, the U.S. reportedly forced the transfer of William Aldis, WHO's country representative in Thailand. Aldis had made the grave mistake of publicly criticizing a proposed free trade agreement between the U.S. and Thailand on public health grounds. More recently, Bush administration hack William Steiger demanded that WHO retract a study it had commissioned on the impact of intellectual property on public health in developing countries.

Margaret Chan made her comments in Bangkok after giving a keynote address at the Prince Mahidol Award Conference 2007, an international conference devoted to issues of global public health. According to one critical report she "praised the pharmaceutical industry lavishly" during the speech.

So early reviews from the activist public health community are not favorable. Sure, they're a hard group to please. But shouldn't they be?

UPDATE: This just in: SciDev.net is reporting that Thailand is "backing off" its threat to break two drug patents, and has entered into price negotiations with the pharmaceutical companies involved.

According to SciDev.net, "The World Health Organization pursuaded the Thai government to negotiate with drug firms before issuing a compulsory license."

By Andrew Leonard

Andrew Leonard is a staff writer at Salon. On Twitter, @koxinga21.

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