VZCZCXRO8667
RR RUEHCHI RUEHCN RUEHDT RUEHHM
DE RUEHJA #0137/01 0230857
ZNR UUUUU ZZH
R 230857Z JAN 08
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC 7729
RUEHPH/CDC ATLANTA GA
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RHHMUNA/HQ USPACOM HONOLULU HI
RHHMUNA/CDR USPACOM HONOLULU HI//J07/CATMED/CAT//
RUEHBK/AMEMBASSY BANGKOK 8299
RUEHBY/AMEMBASSY CANBERRA 1908
RUEHFR/AMEMBASSY PARIS 1078
RUEHGV/USMISSION GENEVA 7719
UNCLAS SECTION 01 OF 02 JAKARTA 000137
SIPDIS
SIPDIS
SENSITIVE
DEPT FOR EAP/MTS, G/AIAG AND OES
USAID FOR ANE/CLEMENTS AND GH/CARROLL
DEPT ALSO PASS TO HHS/WSTEIGER/ABHAT/MSTLOUIS AND HHS/NIH
GENEVA FOR WHO/HOHMAN
USDA FOR D U/S LAMBERT
USDA/FAS/OSTA AND USDA/APHIS ANNELLI
E.O. 12958: N/A
TAGS: TBIO AMED CASC EAGR AMGT PGOV ID
SUBJECT: AVIAN INFLUENZA: REQUEST FOR PROGRAMMATIC REVIEW
FROM AMBASSADOR HUME TO AMBASSADOR LANGE
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Summary
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1.(SBU) The avian influenza situation in Indonesia, although not now
a crisis, remains alarming. Our multiagency team is working hard on
avian influenza issues. We continue to press Indonesia to
recommence human sample sharing while simultaneously providing
assistance to improve the capacity to manage AI on both the human
and animal sides. We're making some progress on animal
surveillance, but Indonesia lacks the capacity and commitment to
aggressively tackle this problem. The time is right for an external
review of our more than $30 million in AI program assistance. Given
the scope of the AI problem here and the potential for a pandemic, I
do not believe our program should be cut. But we should make sure
that our money is being spent in the best possible way. End
Summary.
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Human AI: Higher Mortality and Less Access to Samples
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2.(U) Indonesia leads the world in human AI infections with 120
confirmed cases and 97 deaths. From a public health standpoint,
Indonesia has made minimal progress in early detection and clinical
management of disease. Despite efforts to increase public awareness
and the triage of suspected patients reporting to reference
hospitals, the monthly number of cases remains constant.
Indonesia's case fatality rate - 86 percent in 2007 - is the highest
in the world. Indonesia lacks basic procedures to limit public
health risk. Despite evidence of limited unsustained human-to-human
transmission, the Ministry of Health (MOH) has been slow to address
basic quarantine procedures. Last week, hospital authorities
allowed the family of a woman with confirmed AI to take her home to
die rather than move her to quarantine in another hospital. Failure
to address these issues could contribute to epidemic or possible
pandemic spread of the disease.
3.(SBU) International research on risk assessment, virus mutation
and vaccine development has been stymied since Minister of Health
Supari blocked human sample sharing in January 2007. Since then,
Indonesia has shipped samples from only four of 39 patients. Of
these, only one virus was isolated and characterized.
4.(U) USAID supports human surveillance and public education.
USAID is also providing assistance to the national avian influenza
commission, KOMNAS. USAID and the Centers for Disease Control CDC
train scientists at the national laboratory Litbangkes.
--------------------------------------------- ----
Poultry: Challenges But Signs of Progress As Well
--------------------------------------------- ----
5. (SBU) Challenges abound in the agriculture sector as well. AI has
been rampant in the country since July 2003. In the nearly five
years since the first outbreaks, little has been done to restructure
poultry production, transport, or marketing in an effort to control
the disease. International veterinary experts agree that
controlling the virus in poultry would take five to ten years of
sustained efforts. But indifferent senior leadership within the
Ministry of Agriculture has resulted in limited funding and support
for its teams of technical officers. Decentralization of government
authority and budgets to local governments, and weak regulatory and
monitoring policies across the board further limit the authority of
central government to tackle this issue. The GOI has inadequate
control over commercial poultry producers, poultry markets and
movement of poultry around the country. Veterinary capacity is also
severely limited.
6. (U) But there has been progress as well. With USAID assistance,
disease surveillance is up and running in 159 districts and
expanding to 308 districts by June 2008. With the network in place
JAKARTA 00000137 002 OF 002
and teams trained and supported to conduct field activities,
authorities can better track the virus in poultry. We now know, for
example, that the virus has been reported in poultry in 286 of 344
districts and that it is endemic in Java, Bali and parts of Sumatra
and Sulawesi, but remains sporadic in Kalimantan and other areas of
Indonesia.
7. (SBU) The Ministry of Agriculture continues to share samples
despite pressure from the Ministry of Health to stop. The Ministry
is aware that animal virus sharing is essential for the development
of an effective vaccine. USAID is funding FAO and World
Organization for Animal Health (OIE) laboratories to develop a new
vaccine for Indonesia and leading the effort to intensify an
effective control program.
8. (U) USDA/APHIS has supported training and education efforts aimed
at upgrading biosecurity and biosafety of local markets, improving
the diagnostic capability of Ministry of Agriculture laboratories
and private sector quantitative methods, and strengthening
district-level epidemiological skills. USDA/APHIS has also worked
closely with Indonesian scientists on a number of avian vaccine
challenge trials at the South East Poultry Research Laboratory in
Athens, Georgia.
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Expert Assessment Needed
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9. (SBU) Given Indonesia's position as the epicenter of avian
influenza, we must combat the spread of the disease here as part of
the President's forward strategy. But we must also ensure that our
resources are being spent in the most effective way. We need an
external review of our avian influenza program assistance to
evaluate whether to adjust current efforts to meet the challenges
ahead. I have asked the Embassy's Avian Influenza Working Group in
Jakarta to work with your office to develop the terms of reference
and to contract with an independent, external organization to
conduct such a review over the next four months.
10. (SBU) Ambassador's comment: There are now alarming signs that
the risks are growing: the disease is endemic among poultry; human
case-load (unlike elsewhere) is constant and surveillance
inadequate; effectiveness of tamiflu is unknown and mortality rate
increasing; and, the true epicenter is the township (Tangerang) in
which Jakarta's international airport is located. The Indonesian
government seems oblivious to the risks, and local authorities have
just sharply decreased funding for AI programs in Tangerang.
Perhaps we do not yet have a full-blown crisis on our hands, but we
could soon. End comment.
HUME