Indonesia, easily the worst hit by bird flu is also struggling to ensure that poor countries get their fair share of any new vaccine developed to combat it.
Since the first case was reported two years ago, government officials have reported 74 deaths from the H5N1 strain in Indonesia - more than a third of the world's total.
AdvertisementBut it has refused to share its samples of bird flu virus with the World Health Organization (WHO) since January. But why? Because Jakarta fears a vaccine produced from its specimens would be out of reach for its own citizens - too expensive and controlled by wealthy nations.
Some global health officials have accused Indonesia of holding the virus hostage and keeping experts from monitoring whether the bug is mutating into a dangerous form that could potentially spark the next pandemic that kills millions.
But government officials continue to hold their ground in a showdown with WHO - despite agreeing last month to resume sending samples. They are using the viruses as leverage against a system that "caters to the developed world's whims instead of promoting access for all."
Some experts agree. "It's not just about altruistic public health," said Michael Osterholm, a University of Minnesota infectious disease specialist. "When we realize Southeast Asia and China are shut down economically from a pandemic perspective, so goes our economy. So goes many critical products and services that we count on every day."
There is capacity for producing only up to 500 million doses of flu vaccine a year - far short of what would be needed in a pandemic.
The WHO hasn't counted any Indonesian bird flu cases since the country stopped sending samples, keeping its official count at 63. Indonesian officials have recorded 11 deaths since then.
But the U.N. health agency has been careful not to criticize the government. It has worked to smooth tensions by meeting with developing countries in Jakarta last month to ensure the poor are not left out as they have been historically - ranging from a lack of access to expensive AIDS drugs to seasonal flu vaccines available only to rich nations.
At the end of the meeting, Indonesia said it would resume sending specimens, provided that drug companies be required to seek permission before using its viruses to make vaccines.
That is a major departure from the WHO's free sharing system used to develop seasonal flu vaccines. The temporary deal applies only to Indonesia, and all other governments are expected to continue providing samples unrestricted, said Dr. David Heymann, WHO's top flu official.
The bird flu has killed at least 172 people worldwide since it began its spread through Asian poultry in 2003, according to WHO. Most human deaths come from contact with infected birds, but experts fear it could mutate into a form that spreads easily among people.