The WHO pandemic influenza preparedness framework: a milestone in global governance for health.

AFTER YEARS OF NEGOTIATIONS, THE WORLD HEALTH Organization (WHO) reached agreement on a pandemic influenza preparedness (PIP) framework for the sharing of influenza viruses and access to vaccines and other benefits in April 2011. The framework addresses a troubling controversy—should lowand middleincome countries share influenza virus specimens with WHO without assurances that benefits derived from sharing will be equitably distributed? During the avian influenza A(H5N1) outbreaks in late 2006, Indonesia refused to share virus specimens with WHO, claiming it was unfair to give pharmaceutical companies access. Industry would use viruses to patent vaccines and antiviral medications that Indonesia could not afford. Indonesia asserted sovereignty over viruses isolated within its territory, grounded on the Convention on Biological Diversity. Indonesia also argued that the 2005 International Health Regulations did not require states to share H5N1 viruses. The international community feared that Indonesia’s refusal to share would impede surveillance and response, particularly because Asia was the epicenter of the global H5N1 outbreak. Serious health and political repercussions could result if states failed to cooperate when confronting a common threat. In May 2007, WHO member states commenced negotiations on virus and benefit sharing to strengthen influenza surveillance and response. Negotiations in intergovernmental meetings and an open-ended working group proved difficult—the problems were complex and states had divergent interests, particularly on intellectual property rights. The 2009 influenza A(H1N1) pandemic deepened developing-country mistrust because vaccines were not equitably shared. In October 2010, Convention on Biological Diversity parties reasserted state sovereignty over biological materials within their territories. Finally, after nearly 4 years of arduous negotiations, WHO’s director-general announced the WHO pandemic framework on April 16, and the World Health Assembly approved it in May. PIP Framework