[Updated] Biotechnology, international trade, and pandemic influenza were among the topics discussed at the outset of this year’s Geneva Health Forum.

The 2010 theme of the Geneva Health Forum is “Globalization, Crisis, and Health Systems: Confronting Regional Perspectives.” The organising committee decided to open sessions online due to travel problems caused by Icelandic volcano Eyjafjöll.

The event, taking place every other year, is a joint initiative of the Geneva University Hospitals and the Faculty of Medicine at the University of Geneva. This year it is taking place from 19-21 April. About 15 sessions are offered each day, ranging from pandemic preparedness, to health biotechnology, to emergency and essential surgery, to foreign policy and trade.

On Monday, during a panel on health biotechnology, Halla Thorsteinsdóttir of the McLaughlin-Rotman Centre for Global Health based in Canada discussed research conducted on emerging economies’ health biotechnology sector. There are large health inequities between low income and high income countries, she said. Public health measures are needed to deliver existing solutions, such as bed nets, but also new drugs and technologies, such as molecular diagnostics, recombinant vaccines, vaccine and drug delivery systems better adjusted to conditions in developing countries. Developing countries also have to become actors in the field of biotechnologies, she said.

Thorsteinsdóttir said a study showed significant developing country capacity in health biotechnology but very few publications. Scientific papers in health biotechnology are mostly coming from high income countries although contributions of developing countries are increasing, especially China and Brazil, she said.

Both North-South and South-South collaborations on health biotechnology are important, Thorsteinsdóttir said, citing a survey targeting 467 companies in six developing countries, with a 62 percent response rate, which showed that 25 percent of the companies were involved in South-South collaborations and 53 percent were involved in South-North collaborations.

Among the main impacts of collaborations were the availability of affordable products and increased capacity building, Thorsteinsdóttir said.

Guy Willis of the International Federation of Pharmaceutical Manufacturers and Associations gave the presentation prepared by GlaxoSmithKline (GSK) for the panel. He said that Africa has 24 percent of the global disease burden but only 3 percent of the world’s health workers, he said.

GSK’s response to the situation is based on both ethical imperative and business imperative. There is a need to build a new business model to address the needs of the developing world but it is important to defend the intellectual property rights framework for innovation, and the responsibility to pursue commercial opportunities.

Research and development is the only way to get new medicines and new vaccines, and only R&D will address unmet medical needs, he said. Public-private partnerships are essential, where the private sector brings R&D, manufacturing and commercialisation, among other things, and the public sector provides financing, strategic overviews, and prioritisation and downstream access.

Pandemic Flu Response

A panel on “Pandemic Preparedness and Response: Lessons Learned from H1N1” gave an opportunity to a WHO official, an in-country migration specialist, and a representative of brand-name flu vaccine producers to give their views.

Dominique Legros of the WHO said “communication is key,” and described the process over the past year since the pandemic was announced by the WHO in June 2009. He said access to information is much easier than it was years ago, that clear, accurate information is critical, and that a key source of information is the member states themselves. At the outset, typically little is known about a new disease, but it spreads quickly and to anyone, so a flow of timely information is maintained.

But it is important to find the “right balance” between too much information, which can be seen as over-hyping the situation, and too little, which can be seen as conspiratorial. An expert panel at WHO is currently reviewing the UN organisation’s performance with the H1N1 virus, the so-called “swine flu,” taking into account criticisms that perhaps WHO overplayed the danger of the virus and that vaccine producers profited enormously as a result. It also is considering WHO’s coordination of flu production and distribution, as rich UN members have ended up with a surplus of vaccine while poor members do not have enough (IPW, WHO, 15 April 2010). The expert group will report to the World Health Assembly in May.

Montira Inkochasan, head of office for the International Organization for Migration in Vientiane, Lao, described a study that showed migrants being neglected by pandemic preparedness efforts at the international, national and regional level. The 2008 World Health Assembly agreed on the need to include migrants in pandemic preparedness and response plans, which is an ethical issues, she said. But a February 2010 review of planning documents showed migrants largely neglected by various organisations, she said.

Janis Bernat, manager for biologicals and vaccines at the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), stood in for a colleague on short notice and discussed industry’s role and expectations in pandemic efforts. She said all stakeholders have a role, described the WHO surveillance network, and said that starting in June 2009, there were weekly teleconferences on H1N1 held with industry and others.

Bernat pointed to a sizeable number of vaccine doses donated by industry for developing countries, assessments of demand including determination of risk groups, and the use of distribution networks such as UNICEF to get vaccines to developing countries. But Bernat would not comment substantially on the review of the WHO response, nor on communications and the possible erosion of trust from the decision to move so quickly to massive manufacture of vaccines.

She offered support for “innovative” financing mechanisms for helping developing countries to obtain the level of vaccines they need, citing in particular public-private partnerships and advanced market commitments in which generally, governments and organisations fund industry to do the R&D. When asked how much companies producing vaccines had earned from the pandemic, she said the trade association does not keep such numbers but that they are available from individual companies. By example, Novartis reported $1.1 billion on sales of swine flu vaccine from January to March 2010 (representing nearly 50 percent increase in profits), putting its total sales at $12.13 billion, according to the Associated Press.

[UPDATE: Separately, an international Ministerial Conference on Animal and Pandemic Influenza in Vietnam today released a "Hanoi Declaration" [pdf] on the need for continued vigilance against pandemic influenza originating from animal sources, and in particular the ongoing threat of H5N1 or avian flu.]

Health and Trade, Twin Issues in Negotiations

Nick Drager, senior fellow, Global Health Programme, Graduate Institute for International and Development Studies, was left to single-handedly conduct the panel on Foreign Policy, Trade and Health, with all the speakers having been prevented to attend the event due to the paralysis of the European flights. He said that the economic impact of diseases is huge and the environment is changing.

The intellectual property debate has moved from the World Trade Organization to the World Health Organization, he said. This is a new phenomenon in terms of diplomacy, he said.

Trade and health are overlapping, he said. Trade and trade agreements have a huge impact on health. For example, the WTO Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement affects prices in international markets because it creates a monopoly situation and can put a huge burden on developing country economies. They can in turn use the flexibilities from IP rights provided by the same agreement.

Global health strategy is important as it brings in one place all international health activities that influence global health, it agrees on priorities and objectives, has an influence domestically and internationally, it can address problems that no department alone could tackle, and it builds on existing national and international partnerships.

Trade is a determinant of health, he said. “People doing health have to understand trade agreements.” For example, India is strong on trade and influences the WTO a lot but it is less strong at the WHO because they have not put as much emphasis. “But they want to be stronger so that they can start creating the rules at the WHO or at the Food and Agriculture Organization of the United Nations,” he said.

“Most of the global rules that are being crafted are crafted by developed countries, developing countries are takers,” Drager said, but developing countries are getting stronger on the trade side.

At the World Health Assembly in May, “we will see the intervention by Brazil, China, by Thailand,” he said. Ten years ago, when the Thai talked, people kept writing, he said, however, five years ago people dropped their pen, people listened, with as much as attention as for the US intervention. That is because the Thai have put a lot of effort and time into training their diplomats when they come to the negotiations. They can influence policy, Drager said.