Sharing is Caring… Especially with Viruses
By: Mailo Numazu
Tags: Public Health, Health, Vaccines, Virus, Influenza

The U.S. has many trade agreements with various countries where we can export our products and services with few barriers, which enhances our gross domestic product and supports U.S. based companies. And this can go both ways, with the U.S. and other countries. Most of these trade agreements involve foods or other consumer goods, but there is one that involves the trading of viruses.

While it isn’t a formal trade agreement, such as NAFTA (North American Free Trade Agreement), the sharing of influenza viruses is coordinated by the Global Influenza Surveillance and Response System (GISRS) as part of their influenza surveillance program. The goal of the GISRS is to create a global alert system, made up of public health labs around the world, that monitor the emergence of influenza viruses with pandemic potential and this involves countries sharing their prevalent strains of influenza each year.

These viral exchanges are tracked by an even larger global arrangement called the Pandemic Influenza Preparedness (PIP) framework. 194 countries are a part of PIP, which means they are responsible for sharing viruses amongst themselves and contributing to a global benefit-sharing system. This sharing is intended to not only alert countries to influenza strains of pandemic potential, but to also help develop vaccines for those strains.

This program has very important implications for the world since influenza is one of the top candidates for causing the next pandemic. With every country participating, we have the best chance of catching a pandemic early on and the best chance of creating a vaccine to protect people from it. But what happens when not every country participates and withholds a viral strain of influenza that is already known to have pandemic potential? Well, that is what we get to find out.

Since 2017, the Chinese government has withheld their lab samples of H7N9 from the U.S. This strain is a highly pathogenic strain of the flu that started circulating in birds in 2013 but has since evolved to infect humans and kill up to 40% of its victims. While the PIP framework doesn’t specify how soon the viral samples are supposed to be exchanged, merely stating it must be done “in a timely manner”, the public health community believes it is paramount to share the samples sooner than later to offer the best protection and preparedness to the public.

If it were a less pathogenic influenza strain, there might be less pressure on the Chinese Center for Disease Control to share samples and provide explanation. However, with a recent epidemic of H7N9 across Asia, public health officials are feeling frustration and fear that they are not able to study the flu samples for vaccine research.

The question is: why? And there are two different perspectives from which this question can be answered: that of a scientist and a public health official.

From a scientist’s perspective, this might just be a misunderstanding on China’s part on how important the viral samples of H7N9 are to global security. Chinese officials might view them as no different from common cold samples. However, there is also a feeling of pressing concern because in the scientific community, information can go out of date very quickly. And with a specimen as quickly evolving as H7N9, a sample from 3 years ago just won’t do when conducting research. Without up to date information, there is no way for scientists to develop effective vaccines and treatments for the possible flu pandemic.

A public health official might not be surprised by the situation. In 2002, China withheld information on an outbreak of severe acute respiratory syndrome (SARS) and did not share their research findings on the matter. Then in 2005, they delayed sharing viral samples from an H5N1 influenza outbreak. Then the PIP framework was developed to hopefully prevent any future lack of sharing… and yet here we are. What a public health official might emphasize about the need for this viral sharing is two things: loss of life and loss of money. Without the proper preparations and (if possible) vaccines, many people are going to die around the world: not just in China and not just in the U.S. This lack of preparation will also lead to huge loss of money by the respective governments. Historically, outbreaks that did not have the necessary measures in place to stop or at least slow it spent much more money than they would have if those measures had been in place. An example of this is the H7N9 outbreak that cost China $6 billion. They could save themselves a lot of money if they collaborated with the global public health labs on influenza.

It is impossible to say the motivations behind China’s withholding of the viral strain. Could it possibly lead to bioterrorism? Could it just be a case of stubbornness? Time will only tell, but we should hope for and push for the release of the samples so as to best protect ourselves from the infectious specimens in the world.

Sources:

https://asunow.asu.edu/20190212-solutions-china-makes-keeping-tabs-bird-flu-difficult

https://www.who.int/influenza/pip/virus_sharing/en/

https://www.nytimes.com/2018/08/27/health/china-flu-virus-samples.html?rref=collection%2Fbyline%2Femily-baumgaertner&action=click&contentCollection=undefined®ion=stream&module=stream_unit&version=latest&contentPlacement=14&pgtype=collection