Saturday, December 10, 2005

Pride and prejudice and bird flu in Indonesia

When you're not wanted in one place, frequently the bad taste spreads. It looks like that's what's happening in Indonesia, a country under seige by Mother Nature, the bird flu virus and bad luck, not to mention self-inflicted wounds of all kinds. Like East Timor.

When the Portugese left East Timor in 1975 and before it was able to declare independence it was invaded by Indonesia. The US looked the other way. The main Timorese political party was thought to be under the influence of China, so Henry Kissinger, the US Secretary of State, was glad for the anti-communist counterweight of the Indonesian government. But the invasion and 25 years of Indonesian rule was a period of notorious violence and repression., even as all US administrations continued to supply arms and military support. Indonesia finally pulled out of East Timor in 1999 amidst violence perpetrated by anti-independence militias supported by the Indonesian military.

That's some background. Now Indonesia is one of the main breeding grounds for avian influenza. It is the world's fourth most populous nation with endemic H5N1 infection in poultry in close contact with masses of people. One of the (useful) carryovers from the heyday of US collaboration is a laboratory capable of diagnosing bird flu and important in training Indonesians:
The US Naval Medical Research Unit No. 2 (NAMRU-2) was set up in Indonesia in 1970 under a bilateral agreement with the United States. But the Indonesian military has been opposed to the centre's presence since the imposition of a US arms embargo in 1999. This followed violence involving the army during Indonesia's withdrawal from the newly independent East Timor.

NAMRU-2 has been working with the country's authorities to improve their ability to monitor and diagnose avian flu (see C. G. Beckett et al. Clin. Infect. Dis. 39, 443–449; 2004). Its crucial role is internationally recognized, particularly as Indonesia, where human cases were first reported in July, accounts for the world's largest share of new cases. (Declan Butler by-line in Nature)
But the bilateral agreement between the US and Indonesia expired in 2000 and now, for reasons that aren't clear, the Indonesian health ministry is ordering activities ended by December 31 of this year (in three weeks). This despite an apparently cordial visit of US Department of Health and Human Services Secretary Michael Leavitt in October where he promised $10 million in extra funding for the facility. But US diplomatic influence is now so weak in the muslim world because of Iraq and other issues, he seems to have had little positive effect. More collateral damage from the Iraq mistake.

By all accounts NAMRU-2 is an important and valuable resource for Indonesia and, because of the pandemic threat, for world public health. Indonesia cannot afford to lose it at this critical juncture. If this is the result of a power struggle within the Indonesian government, let's hope the Indonesians who seem intent on following the example of George W. Bush don't win out. Pride, ideology, stupidity and stubbornness are a poor basis for public health policy.