Disunity of Purpose

In 2007, the Indonesian government announced it would stop sending samples of the H5N1 avian influenza virus detected in its country to the World Health Organization’s (WHO) reference laboratories. Its worry was that these samples, provided freely, would be used by pharmaceutical companies to develop vaccines the country could not afford. The situation prompted the establishment of a new international framework for data and pathogen sharing – but only for H5N1 and other influenza viruses with human pandemic potential.

Despite other circulating threats to human health, such as antimicrobial resistance (AMR) and emerging zoonotic diseases like the Middle East Respiratory Syndrome (MERS) coronavirus, there is as yet no comprehensive international framework for sharing biological materials and related data to address these concerns. Even the COVID-19 global pandemic has yet to motivate any change.

Dr Calvin Ho of the Faculty of Law, and Co-Director of the Centre for Medical Ethics and Law, has been looking at ethical and legal means to facilitate data and pathogen sharing for AMR and One Health research, and the development of appropriate countermeasures.

AMR, which arises mainly from misuse and overuse of antibiotics and other antimicrobials, is a major concern because drug-resistant pathogens circulate among humans, animals and the environment and are projected to lead to 10 million additional deaths each year globally by 2050. Its growing threat prompted the WHO to endorse the One Health concept in 2010 and recognise that protecting and promoting human health is closely interconnected to animal and environmental health.

The WHO also adopted a global AMR action plan in 2015 to drive concerted actions across governments and the private sector but to date, the platform has not realised its aims. A key problem is that specialist bodies remain stuck in their silos, so laws and regulatory bodies on human, animal and environmental health are largely disconnected.

Fair share

“One of the big struggles is getting people to talk to each other. We can all cover our own specific fields well, but it is less clear how things work across the various domains,” Dr Ho said.

He believes legal and regulatory levers premised on fairness and equity are necessary to break down the barriers and get all parties to share data and pathogens that are crucial to addressing AMR and future pandemics.

“We need good data to develop countermeasures and predictive modelling, so we can at least have a clearer sense of what is coming. But to get that data, and get people to share and work together, you need fairness. That’s why laws and regulatory instruments at the domestic and global levels, especially the global level, are really important,” he said.

While some places have made some progress – Hong Kong, for instance, has a strategic action plan on AMR for 2017–2022 – many governments elsewhere are stretched in terms of capacity and resources. “But AMR is not just a single-country issue, it is a global issue. Ultimately, with global travel and the world being very connected, you cannot isolate diseases – which is why collective action is really crucial.”

At the international level, laws relating to public health do exist, but they are narrow in focus and there is nothing that addresses the interdisciplinarity of One Health. The International Health Regulations, for instance, govern the sharing of human health data while the Convention on Biological Diversity applies to the sharing of plant and animal data and materials. Yet viruses like H5N1 and SARS-CoV-2 (which causes COVID-19) are very likely to be from animal sources. “This just basically reflects the silo problem that we have,” he said.

Limits of market-based solutions

Dr Ho believes reliance on the market mechanism is not sufficient for such a large and complex task, given there are often limited information and resources to work with. Without a formal plan for sharing global public health data, less-resourced countries are at a disadvantage.

Indonesia’s worry about H5N1 vaccines is a case in point. In contrast, China was able to share data on the SARS-CoV-2 pathogen because it has the scientific and production capabilities to produce its own vaccine, so it did not need to worry about being left out. And, while biotech companies responded quickly to develop COVID-19 vaccines, these vaccines represent only a fraction of their business, which at its core is based on profit not equity.

“The values of the market are premised on efficiency and a narrow notion of fairness, which is reasonable enough, but it cannot apply everywhere,” he said.

Dr Ho sees an urgent need to start getting the infrastructure in place for collective action to address not only AMR and emerging zoonotic diseases, but the health impacts of climate change. This will be a huge challenge because of short-term thinking, the difficulties of getting people to work together at the international level, and the decline in multilateralism.

“It is not a rosy picture. Unfortunately, unless people are faced with very immediate and catastrophic events, we don’t seem to know how to get our act together,” he said.