VZCZCXYZ0000
PP RUEHWEB

DE RUEHGV #0275/01 1020655
ZNR UUUUU ZZH
P 110655Z APR 08
FM USMISSION GENEVA
TO RUEHC/SECSTATE WASHDC PRIORITY 6322
INFO RUEHBY/AMEMBASSY CANBERRA PRIORITY 6421
RUEHJA/AMEMBASSY JAKARTA PRIORITY 2225
RUEHPH/CDC ATLANTA GA USA PRIORITY
RUCPDOC/DEPT OF COMMERCE WASHINGTON DC PRIORITY
RUEAUSA/DEPT OF HHS WASHINGTON DC PRIORITY
RHEHNSC/NATIONAL SECURITY COUNCIL WASHINGTON DC PRIORITY
RUCNDT/USMISSION USUN NEW YORK PRIORITY 2709

UNCLAS GENEVA 000275 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR G/AIAG, IO/T, OES 
PASS TO HSC 
 
E.O. 12958: N/A 
TAGS: KFLU TBIO EAID WHO
SUBJECT: U.S. GOVERNMENT OFFICIALS MEET WITH INDONESIAN 
MINISTER OF HEALTH 
 
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. 
 
SIPDIS 
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 
viruses. 
 
¶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 
 
SIPDIS 
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 
goals. 
 
¶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 
Baxter. 
 
¶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. 
 
 
 
STORELLA