The problem of Indonesia
What to do about Indonesia? The fourth most populous country in the world, where 26 of 33 of the provinces have reported poultry outbreaks with H5N1, swine may be infected asymptomatically and 40 confirmed cases with 31 deaths, all make Indonesia the current epicenter of bird flu. Its government is struggling and is so far incapable of doing the investigations needed to keep a close eye on the evolution of this fast mutating virus. A well-equipped and technically sophisticated US Navy laboratory (NAMRU2) is operating in country, but a diplomatic spat complicated by the muslim world's backlash against Bush's Iraq war debacle have made it difficult for scientists there to lend a needed hand. The Indonesian government can't get its story straight, is issuing conflicting reports and seems to be intent on muddling through, meaning getting to the next day without everything blowing up in their face. At the same time they are effectively barring international scientists from rolling up their sleeves and finding out what's going on there.
Dr. Andrew Jeremijenko, an epidemiologist formerly with NAMRU2's influenza surveillance unit in Indonesia, remains concerned about the Indonesian government's inability to conduct needed investigations. He points out that the Indonesians have not been able to match an H5N1 virus in animals with the virus in the patients in any case to date. Thus the source of all the cases remains unknown. Moreover, in the latest cluster in north Sumatra two of the patients were allowed out of the hospital into the general population until they were too sick and readmitted. As an example of vigorous containment this is obviously defective.
Jeremijenko wants animal viruses as well as human viruses sent to CDC and WHO for sequencing, but so far the Indonesians have not allowed this. He observes the rather sparse offering of bird and other animal viruses available from Indonesia are not from the same geographic areas as the human cases. It is also important the sequencing of the human viruses be done promptly and the sequences released (WHO and CDC take note!).
NAMRU2 remains active in isolating, identifying and sending the human viruses to CDC. They are the only functioning influenza surveillance program in the country, but are not invited on field investigations. All international scientists in Indonesia are "walking on eggshells" lest the Indonesian government further obstruct their activities. While WHO and CDC epidemiologists are now there and reportedly engaged in investigating the large family cluster in north Sumatra island, my other in-country sources say they are not being allowed into the village.
So what to do about Indonesia? It appears the Indonesian government has to be handled with kid gloves. Whatever it takes. An international spotlight on them wouldn't hurt, however. While we don't want them digging in their heels because of high handed demands by outsiders, we do want them to feel the pressure of the international community.
Two things are now quite clear. (1) The bird flu situation in Indonesia is serious and better scientific information is urgently needed but it collection is being obstructed by the Indonesian government. (2) The Indonesian authorities are not competent to handle this.
This is no longer a matter that can be made subordinate to national pride, diplomatic pique or a habit of passive aggression by bureaucrats. The Indonesians need to feel the heat of the international community because their behavior is a danger to their own people and to everyone else. Many countries have been overwhelmed by the bird flu crisis and have thrown their doors open to international experts. Time for Indonesia to do likewise and act as a responsible and civilized member of the community of nations.
While the bird flu pot bubbles and threatens to boil over in Indonesia, there is no one in the kitchen.
Update, 5/19/06, 9:30 am EDST: A news conference called by Indonesian authorities to discuss the pig serology has just been canceled. Rumor on the ground is that the results showing antibodies in pigs are incorrect, or at least in serious question.
Dr. Andrew Jeremijenko, an epidemiologist formerly with NAMRU2's influenza surveillance unit in Indonesia, remains concerned about the Indonesian government's inability to conduct needed investigations. He points out that the Indonesians have not been able to match an H5N1 virus in animals with the virus in the patients in any case to date. Thus the source of all the cases remains unknown. Moreover, in the latest cluster in north Sumatra two of the patients were allowed out of the hospital into the general population until they were too sick and readmitted. As an example of vigorous containment this is obviously defective.
Jeremijenko wants animal viruses as well as human viruses sent to CDC and WHO for sequencing, but so far the Indonesians have not allowed this. He observes the rather sparse offering of bird and other animal viruses available from Indonesia are not from the same geographic areas as the human cases. It is also important the sequencing of the human viruses be done promptly and the sequences released (WHO and CDC take note!).
NAMRU2 remains active in isolating, identifying and sending the human viruses to CDC. They are the only functioning influenza surveillance program in the country, but are not invited on field investigations. All international scientists in Indonesia are "walking on eggshells" lest the Indonesian government further obstruct their activities. While WHO and CDC epidemiologists are now there and reportedly engaged in investigating the large family cluster in north Sumatra island, my other in-country sources say they are not being allowed into the village.
So what to do about Indonesia? It appears the Indonesian government has to be handled with kid gloves. Whatever it takes. An international spotlight on them wouldn't hurt, however. While we don't want them digging in their heels because of high handed demands by outsiders, we do want them to feel the pressure of the international community.
Two things are now quite clear. (1) The bird flu situation in Indonesia is serious and better scientific information is urgently needed but it collection is being obstructed by the Indonesian government. (2) The Indonesian authorities are not competent to handle this.
This is no longer a matter that can be made subordinate to national pride, diplomatic pique or a habit of passive aggression by bureaucrats. The Indonesians need to feel the heat of the international community because their behavior is a danger to their own people and to everyone else. Many countries have been overwhelmed by the bird flu crisis and have thrown their doors open to international experts. Time for Indonesia to do likewise and act as a responsible and civilized member of the community of nations.
While the bird flu pot bubbles and threatens to boil over in Indonesia, there is no one in the kitchen.
Update, 5/19/06, 9:30 am EDST: A news conference called by Indonesian authorities to discuss the pig serology has just been canceled. Rumor on the ground is that the results showing antibodies in pigs are incorrect, or at least in serious question.
posted by Revere at
5/19/2006 07:48:00 AM
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