Three months after their initial visit with Supari, Heymann and Fukuda were back at Indonesia’s health ministry, a large, modern structure on a downtown boulevard lined with bank towers, embassies, and hotels. The meeting was off to a late start. That day in February 2007 was a Friday, the Muslim Sabbath, when everything in Jakarta runs even slower than usual. Supari and her staff had temporarily
disappeared to make their midday prayers while the visitors kept their eyes on the clock. They were scheduled to fly out of Jakarta later that same day. When they were finally ushered into the minister’s spacious second-floor office, there were far more people gathered around the large wooden coffee table than three months before. The dispute over virus sharing had escalated.
Supari had been stunned weeks earlier to learn that an Australian drug maker, CSL Limited, had used an Indonesian virus strain provided by WHO to manufacture an experimental human bird flu vaccine. “I never gave permission to any Australian company to produce a vaccine based on the Indonesia strain of the virus,” she protested.
Even before that, she had opened talks with U.S. drug maker Baxter International over acquiring 2 million doses of bird flu vaccine for Indonesians. Baxter had offered to sell the vaccine, which was based on a separate H5N1 strain from Vietnam, but at the steep market price. That was when Supari gained her first glimpse of what she called the “neocolonialism” of WHO. “The situation is ironic,” Supari later told me. “The virus obtained by vaccine manufacturers came from dead Vietnamese people who had been grieved by their brothers and sisters and parents, and then it is commercialized by other nations without compensating Vietnam.” Supari had made Baxter a counter-offer. Indonesia would give permission to Baxter to develop a vaccine from the Indonesian subtype in return for 2 million vaccine doses and help in establishing a vaccine plant in Indonesia itself. Indonesia and Baxter signed a memorandum of agreement just days before Heymann and Fukuda returned to see the minister. The suggestion from Jakarta was that no one else would get access to the Indonesian strain, now the deadliest on Earth, unless they met Supari’s demands.
For half a century, countries had freely provided samples of circulating flu viruses to WHO’s collaborating labs under a system called the Global Influenza Surveillance Network. These routine viruses were analyzed by WHO each year to predict which would cause the next round of seasonal flu. Then the seed viruses were turned over to drug companies to make annual flu vaccines. The developed world has been home to both the labs and the drug makers. But since most of those getting flu shots were in Temperate Zone industrialized
countries anyhow, poorer nations had paid the process little mind. Now, facing a possible pandemic, Supari was challenging not only this traditional system but the integrity of WHO itself. Her attack was unprecedented in the agency’s history. Further, she was making the claim that viruses were biological resources owned by the countries where they circulate, not public health information that must be shared freely with the world. She insisted that WHO acknowledge Indonesia’s sovereignty over its viruses and sign a material transfer agreement, which would limit what could be done with Indonesia’s virus samples and potentially entitle it to compensation if they were used commercially.
But senior WHO officials feared that such conditions could wreck the global surveillance system. Flu specialists depended on unencumbered access to virus specimens to watch for menacing twists in viral mutation, keep the tests for the virus updated, and ensure that vaccine research remained current.
“WHO has become a target for Indonesia,” Fukuda later lamented. “That’s not us. We support Indonesia.”
There were already signs the Indonesian rebellion might spread. Thailand, for one, had recently signaled its sympathy in remarks at a WHO executive board meeting. Heymann and Fukuda aimed to keep the disagreement from escalating any further. They wanted to frame the debate around proposals for reform, like making the virus-sharing system more transparent and enhancing the access of poorer countries to vaccines and vaccine production technology. Heymann balked at Indonesia’s more radical demands. The meeting was deadlocked, and yet they kept talking and arguing for five hours, right until the last minute when the visitors had to leave for the airport.
As Supari escorted them from her office, they were unexpectedly confronted by a pack of reporters. She hadn’t bothered to tell her guests she’d invited the media. It felt like an ambush, and two things immediately became clear: They would miss their flight. And there was now little hope of keeping the dispute from boiling over into a heavily publicized political row that could sabotage global cooperation between rich and poor.
Heymann struck a diplomatic note for reporters, telling them,
“Indonesia’s leadership alerted the international community to the needs of developing countries to benefit from sharing virus samples, including access to quality pandemic vaccines at affordable prices.” He said he hoped Indonesia would soon resume sending its specimens to WHO.
Supari turned and glared at him. “Without the new regulations,” she said, “until our last drop of blood, the answer is still no, no, no!”
It was time for Margaret Chan as director general to weigh in. She could speak with unquestioned authority for WHO and, by virtue of her position, demonstrate to Supari that she was being accorded all due respect. Chan, moreover, could connect with Supari as an Asian woman. But if Supari wanted to rumble, Chan was an adroit inside fighter well seasoned by Hong Kong’s contentious politics.
At the end of February 2007, the women spoke by telephone. The conversation seemed to end in agreement, with Supari pledging to begin sharing samples. But within hours, they were disputing what they’d agreed to. Supari told the press that Chan had acceded to demands that specimens be used only to monitor the evolution of the virus and not for making commercial vaccines. WHO officials adamantly denied the account. No samples were sent.
A month later, Chan made an unscheduled detour from Singapore to pursue the issue with President Yudhoyono himself at the Istana Negara palace in Jakarta. The Indonesian leader stressed that international drug companies had to make affordable, high-quality vaccines available to developing countries. Chan agreed, vowing to do what she could. Afterward, Supari, who had attended the talks, came out and announced the disagreement was essentially resolved. “We will resume the sending of virus samples for the sake of global interests,” she told reporters. “The delivery will take place this year, within two months from now at the latest.” Again, it didn’t happen.
And so it continued over the months, with each side accusing the other of bad faith. One grueling negotiating session followed the next, often grinding far into the night and deep into the fine print of international law. In public Chan would at times express sympathy for Indonesia. “I believe the developing countries are right to ask us to
address the issue of equitable access now,” she told a meeting of drug industry executives and laboratory directors. “To date, developing countries have suffered the most from this virus.” But in private, she was increasingly exasperated. Sometimes she let it show. “If you do not share the virus with us, I want to be absolutely honest with you, I will fail you,” Chan warned ominously during a speech at the annual meeting of WHO member states in May 2007. She didn’t name Indonesia, but she didn’t have to. “I will fail you because you are tying my hands. You are muffling my ears. You are blinding my eyes.”
The prospect of a flu pandemic had deepened the fissure between rich and poor, which in turn was subverting international efforts to head off the coming plague. Poverty had always hamstrung the fight against disease, leaving humanity vulnerable to epidemics that arise in the developing world. The emergence of AIDS from Africa was but one tragic example. But now the world was also at risk because Indonesia had realized that viruses were a resource potentially more prized than oil and could be used to press its claims against the wealthy. The challenge represented such a threat to global health that some veteran observers suggested the UN Security Council might ultimately be asked to break the impasse.
When the two women met next, in November 2007, the Indonesian minister was coming off her impassioned speech in Geneva’s Palais des Nations. The jet lag and drama were taking their toll. “I was exhausted,” she recounted. But at the moment, it was Chan she pitied. “I knew I made her feel uneasy,” Supari later said. “My move had made her tremendously busy.”
Supari steeled herself for their private encounter, telling herself to be strong. The two women hugged tightly. Then they started in, speaking in little more than whispers.
Chan urged the minister to trust her.
She did, Supari answered. “But I don’t trust the WHO system.”
Chan appealed for understanding, explaining that she and Heymann were trying to transform the antiquated system they’d inherited. She needed Supari’s help to do it.
Supari was struck by Chan’s apparent good will. But the minister refused to bow. “I tell you once again, Madame Chan, my trust in the
WHO will resume only if they materialize a new mechanism which is equitable and transparent. We, the Third World, have long been suffering from the inequity, Madame Chan. It is time to change.” Supari felt compassion for Chan, an Asian sister who she believed had been forced to do the bidding of rich, powerful countries like the United States. “She was a brave warrior, like me, actually,” Supari thought. “But she had to give up her principles, her conscience, to keep her position in the WHO.”
The minister apologized, repeating that Indonesia would not compromise on its demands.
“I need a total and fundamental transformation, Madame Chan. And I will continue to speak about this all over the world,” she continued. “I am your friend and I do not deliberately put you into this difficult position. However, the bigger concern of humanity made me do this. I am very sorry, Madame Chan.”
The dispute metastasized much as senior WHO officials had feared. The distrust engendered by the clash over virus sample sharing and associated benefits infected other facets of the effort to contain bird flu. Moreover, during 2008 and on into 2009, Indonesia’s grievance grew into a crippling distraction. Jakarta continued to press its campaign on behalf of the world’s underprivileged while largely ignoring a virus that was assiduously putting down ever deeper roots across the Indonesian archipelago. Other governments were entangled in the diplomatic quarrel with Indonesia while frittering away years crucial for their own pandemic preparations.
As the negotiations dragged on, the United States became Indonesia’s main interlocutor. In their respective capitals, the thinking was that if two governments that were so far apart on the issue could find a resolution, everyone else would agree. But other countries, such as Brazil, India, and Thailand, were now starting to agitate for sovereign control over their viruses, suggesting that a deal with Indonesia alone would no longer settle the matter. At the same time, the disagreement between Washington and Jakarta was becoming ever more shrill. Then Supari released her book.
In early 2008 she published
It’s Time for the World to Change: In the Spirit of Dignity, Equity, and Transparency, Divine Hand Behind Avian Influenza
. Drawn from her diary, the book was a blistering critique of the industrialized world and WHO’s global system for virus sharing. The most sensational attack was saved for the United States: her claim in the first chapter that the U.S. government could use bird flu samples to fashion weapons of mass destruction. Her evidence was that genetic data from some virus samples was stored in a database at Los Alamos National Laboratory, a U.S. government lab that conducts advanced research on such diverse subjects as national security, climate change, traffic management, and disease dynamics.
“It was the same laboratory that designed the atomic bomb to destroy Hiroshima in 1945,” Supari wrote. “It is likely that they utilize the same facility to research and develop chemical weapons. What a terrifying fact! The DNA sequence data had been the privilege for the scientists in Los Alamos. Whether they used it to make vaccine or develop chemical weapon would depend on the need and the interest of the U.S. government.”
The notion that the United States would weaponize bird flu is ludicrous to most Americans. “I think it’s the nuttiest idea I ever heard,” quipped U.S. Defense Secretary Robert Gates. But in developing countries, some were inclined to believe the worst, and in some quarters of Jakarta, Supari’s book got a rapturous reception.
The dispute over virus sharing also spilled over into negotiations over the status of the NAMRU lab. The U.S. and Indonesian governments, which were quietly discussing a new agreement to authorize its activities, had been hung up over the finite question of how many U.S. personnel at the lab would be accorded diplomatic immunity. Full of fury, Supari abruptly announced in 2008 that it was time to expel the lab altogether. “NAMRU-2’s presence is of no use to us,” she averred in June of that year. “In fact, its operations are an encroachment on our country’s sovereignty.” She urged the Indonesian parliament to close it down. One lawmaker called for a probe into reports circulating among Indonesians that the navy lab was a front for spying. The fate of the most advanced disease lab in Indonesia grew even more uncertain.
Next Supari disclosed that the government would no longer announce human cases of bird flu on a routine basis as before. Days after she made that declaration in June 2008, she assured me Indonesia would still report the cases to WHO. But no more would the government release details to the public with each new infection. “The families of victims of avian flu have very, very fresh wounds,” she explained, and the practice of announcing cases had been “very insensitive to them.”