Bioethics and health

The Ninth Asian Bioethics Conference
Keynote speech by the Minister of Health of the Republic of Indonesia
Yogyakarta, Indonesia, 5 November 2009


At the outset, let us praise Allah for His blessing so that we can gather here attending this very important conference, the Ninth Asian Bioethic Conference. On this occaion, I would like to convey my sincere gratitude for your presence. Your attendance in tis meeting indicates our collective efforts and serious intention to foster the resposible implementation of bioethics in Asia. Your attendance in this forum provides opportunities to revisit and review the practices of bioethics in Asia, explore lessons to be learned, and using these lessons, build on a roadmap for the way forward in our deliberations, with one ultimate goal – the Asian equiable scientific contributions i making a better world for us to live.

On this valuable occasion allow me to provide you with two international cases, which I have experienced since my ascending to the current ministerial post. Since the beginning of the year 2007, I started raising an international debate on the WHO mechanisms for sharing of human avian influenza viruses. As an organization which governs health care of the wold, WHO needs a fair, transparent and equitable mechanism. On the contratry, since avian influenza hit in Indonesia, we have been experiencing unfair, non-transparent and inequitable mechanisms in virus sharing which has been linked to vaccine prouction. Affected countries, which are usually represented by developing and poor countries, are requested to send H5N1 virus from avian influenza victims to WHO-CCs under a surveillance framework. This means developing and poor countries are requested manatory release of their viruses, but once these viruses arrive at WHO-CCs, affected countries do ot have any right about the destiny of the shared viruses. The moment when developing or poor countries need vaccines, they have to purchase them at high prices, and, one of the financial consequences is that they may need loans from other developed countries.
I have at least three points of unfair, non-transparent and inequitable WHO’s mechanisms which need to be taken as lesons learned by this conference.
1. By the time Indonesia needed urgently to procure Tamiflus (soon after the Karo cluster hit Indonesia), they were all stockpiled by the developed countries.
2. Unfairness on H5N1 sequence data information, DNA sequence for risk assesment and vaccine production was held exclusively by a number of scientists within WHO-affiliated institutions and were not freely accessible by other scientists. I have corrected this practice by making H5N1 sequene data accessible by public.
3. Several companies offered me vaccine and diagnotic kit, which were developed from the Vienamese strain of H5N1.

The existing mechanisms can lead to serious economic complications. If we still continue implementing the current mechanisms, then what will happen is that poor countries will become poorer, and the industrialized countries will become richer. This incresing gap is not favourable to the world peace and human welfare, and will contribute to the delay in the achievement of MDGs. With respect to sharing of benefits, Indonesia holds the notion that benefits for developing countries should be a structured responsibility raher than a ‘charity’ or ‘good will’ of developed countries, where vaccine manufacturers are located. This should be the mechanism in place for benefit sharing if we want to achieve a balanced developed and developing countries and cut the vicious cycle of poverty and infectous diseases in the developing countries.

There is another case with bioethical concern. Monopoly of viruses has occurred in the case of smallpox. The lead Indonesian vaccine manufacturer, BIOFARMA initiated the production of smallpox vaccine in 1962. Indonesia was declared free from smallpox by WHO on 25 April 1974. Then, the world was declared free from smallpox in May 1980. WHA resolution stated that by year 1982, the world must be freed from smallpox virus, and urged member states to destroy their smallpox with its vaccine production facilities. Based on this resolution, smallpox virus and smallpox vaccine production facilities Indonesia were destroyed in 1984. In 2005, there was WHO’s announcement that the world was threatened by ‘smallpox biological weapon’. Therefore, member states are advised to stockpile smallpox vaccines by purchasing them at high price. This is another case of unfair and inequitable international health mechanisms -- Indonesia does not have smallpox virus anymore, and has to purchase smallpox vaccine at high price.

The above two cases of unair international health mechanisms have also raised bioethical issue. By simple definition, bioethics is the study of ethical problems raised by productions, uses, and biotecnological of micro-oranism, plant and animals in agriculture, pharmaceutical industry or food production. Hence, the essentiallity of bioetics is the ethics of biotechnology or and the ethics of life sciences. Bioethics has two basic principles:
1. Reflecting the ability of positive aspects of professionalisn, and
2. Avoiding negative behaviour.

By virtue of its definition, and in view of the current biological and health challenges, bioethics has apparent broad scope. There should be a new outlook to respond to the paradigm shift for the future good practice of bioethics. Bioethics should not be looked only within the framework of scientific undertakings of scientists. Policy makers are challenged to understand the implications of bioethical conducts on the overall scientidfic and health development. With the current virus sharing practice, how can we define a public health success when that having a global capacity is less than 5% to produce human influenza vaccines, and technology access and transfer have not been made available to develping nations. This stockpile program failed to meet the challenge faced by the global influenza pandemic preparedness.

Furthermore, we are now gathering here in the period of global financial crises with some knowledge about their snowball effects, and with very little knowledge on how this will eventually negatively affect the short-term, medium term, and long-term helath development in out region.

Finally, I would like to congratulate the Indonesian Institute of Sciences for its able leadership in organizing productive discussions of this conference. This is part of the overall milestones of our efforts to make a healthy world. Global health will not be achieved whenever health inequalities exist. In one way or another, health inequalities exist due to unfair, non-tranparent and inequitable international health mechanisms, which have underlying bioethical concerns. The Asian Bioethics Association is a good avenue to revisit and review the practices of bioethics in Asia, explore lessons to be learned, and using these lessons, build on a roadmap for the way forward in our bioethics deliberations. This will be achieved through this conference.


Minister of Health of
the Republic of Indonesia

Dr. Siti Fadilah Supari, Sp.JP(K)