'Just imagine the ethical, political and security implications of a world where only rich countries have access to lifesaving drugs or vaccines, and the rest of the world stands while they march toward death,' says Mexico's health minister.

Paul Martin was addressing 30 international health ministers and the heads of the World Health Organization and other UN agencies, gathering in Ottawa for a two-day brainstorming session on how to prevent and prepare for a global flu pandemic.

"All of us recognize that the risk of a flu pandemic requires the world to act now. That is why the world is gathered at one table here today," Martin said. "Our planning and preparation for pandemic will inarguably help to put us in a better position to respond to other emerging diseases, to natural disasters and to threats of bioterrorism we may face in the future."

First Line of Defense

All officials attending the conference agree on one thing: The first line of defense is at the poultry farms of Southeast Asia.

"The simple fact is that many impoverished families and farmers may consider it too risky to report sick animals -- they're the source of their food as well as their livelihood, so it's often customary to kill animals that get sick, to be eaten or sold." said Martin.

A Hong Kong lab confirmed Tuesday that a 23-year-old Indonesia man died from the deadly H5N1 strain of bird flu, which has swept through poultry populations across Asia since 2003, resulting in the deaths or culling of 140 million chickens and ducks. The World Health Organization reports that 62 people have died from the disease, mostly in Vietnam and Thailand.

Though most human cases have been linked to contact with sick birds, experts fear the virus could mutate into a form that is easily transmitted from person to person, possibly causing a pandemic that could kill millions. The last major pandemic, the Spanish flu in 1918, killed up to an estimated 50 million people worldwide.

Sales of Tamiflu

Canada has been credited with having one of the best national pandemic plans in place. It's the first country to have a domestic contract with a private pharmaceutical company to create enough flu vaccines for Canada's 32 million people in the event of a pandemic and has an action plan among its city, provincial and federal health officials.

Dr. David Butler-Jones, Canada's chief medical officer, said Tuesday that Canada would be increasing its stockpile of antiviral drugs, with provincials intending to buy an additional 5 million pills of Tamiflu, the coveted anti-flu drug that is believed to be the only known antiviral that could minimize the impact of a pandemic.

That would bring holdings in the country up to 40 million pills -- enough drug to treat 4 million people if the current regime of two pills a day for five days is sufficient to combat the influenza strain that causes a future pandemic.

However, Roche Canada on Monday took the highly unusual step of temporarily halting sales of Tamiflu, concerned about its diminishing stock in Canada.

Proactive Management

In a letter sent to Canadian pharmacies on Monday, the Canadian arm of the Swiss drug giant said shipments of the drug would end immediately until flu season begins in December. It said that nursing homes and hospitals would get priority when sales resume.

"Roche Canada has decided to proactively manage the Tamiflu inventory," it wrote in the letter, according to Lothar Dueck, a pharmacist and president of the Coalition of Manitoba Pharmacy, who was in Ottawa on the sidelines of the bird flu conference Tuesday. "This flu season, the company will prioritize distribution of Tamiflu to those patients most at risk of developing serious influenza-related complications once the influenza season begins."

The drug is one of only two believed to be effective against the H5N1 strain of bird flu.

Dueck said he'd never seen a drug maker suspend sales of its own product in his 28 years in the business. He said some Internet pharmacies have been boasting about filling 400 orders of Tamiflu a day from panicked Americans.

"So no wonder Roche is doing this action," Dueck told the AP. "They're doing the work that our federal government should be doing: no exports and protecting our drug supply."

Panic and Stockpiling

It's this type of panic and stockpiling that has the poorer nations concerned that the wealthier ones will win out in the event of a pandemic.

On Tuesday, Mexico's health minister Julio Frenk was expected to call on developed nations to set aside 10 percent of their stores of antivirals for poorer ones, a proposal backed by Canada and several other nations.

"Just imagine the ethical, political and security implications of a world where only rich countries have access to lifesaving drugs or vaccines, and the rest of the world stands while they march toward death," Frenk told The Canadian Press. "That is an unsustainable scenario."

Canada's Health Minister Ujjal Dosanjh said Monday that a showdown over Tamiflu may be in the works and that some countries, such as India, might be forced to ignore international patent regulations and develop their generic versions of the expensive drug patented by Roche.

"It may not be resolved here, but there are countries out there that are saying they will defy patent protections -- and we couldn't be judgmental if people are dying," Dosanjh said.

The World Trade Organization in 2003 decided to allow governments to override patents during national health crises, though no member state has yet invoked the clause.