MINISTRY OF HEALTH CHANGES AI SAMPLE SHARING

UNCLAS SECTION 01 OF 03 JAKARTA 011344 SIPDIS SIPDIS SENSITIVE DEPT FOR EAP/MLS, EAP/IET, A/MED AND S/ES-O DEPT FOR G/AIAG/JLANGE AND RFENDRICK DEPT FOR OES/FO, OES/EID, OES/PCI, OES/STC AND OES/IHA DEPT PASS TO USDA/FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG DEPT ALSO PASS TO USDA/FAS/FAA/DYOUNG AND USDA/APHIS DEPT ALSO PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL DEPT ALSO PASS TO HHS/WSTEIGER/ABHAT/MSTLOUIS AND HHS/NIH PARIS FOR FAS/AG MINISTER COUNSELOR CANBERRA FOR APHIS/DHANNAPEL ROME FOR FAO NSC FOR JMELINE BANGKOK FOR RMO, CDC, USAID/RDM/A USPACOM ALSO PASS TO J07 E.O. 12958: N/A TAGS: TBIO AMED CASC EAGR AMGT PGOV ID KFLU SUBJECT: MINISTRY OF HEALTH CHANGES AI SAMPLE SHARING PROCEDURES REF: A) Jakarta 09914 JAKARTA 00011344 001.2 OF 003 1.(SBU) Summary. The Mission's Naval Medical Research Unit (NAMRU-2) has continued to be able to send samples to the Centers for Disease Control and Prevention (CDC) since Minister of Health Dr. Siti Fadilah Supari's August 3 announcement that only three in-country laboratories would conduct tests on suspected H5N1 samples and confirm H5N1 cases for Indonesia. In the August 3 announcement, Supari also stated that the Ministry of Health (MOH) will no longer send samples to the World Health Organization (WHO) Reference Laboratory at the University of Hong Kong and would only send samples outside of Indonesia if collaborating institutes agree to a Materials Transfer Agreement (MTA). While the reasons behind the announcement are not completely clear, the Government of Indonesia's (GOI) relationships with both the University of Hong Kong and WHO Indonesia have grown increasingly strained in recent months. While samples continue to flow to CDC via NAMRU-2, the MTA issue remains unresolved and could impede future shipments. End Summary. Announcements on Sample Sharing -------------- ¶2. (U) At a press conference on August 3, Minister of Health Supari made three important announcements concerning testing samples for avian influenza and sharing data internationally. At the conference, the Minister also expressed her satisfaction in the ability of local laboratories to accurately confirm newly emerging AI cases in humans. The three announcements are: --Effective immediately, three in-country laboratories exclusively will conduct tests and confirm H5N1 cases for Indonesia. These laboratories are NAMRU-2, the Eijkman Institute and National Institute of Health Research and Development (NIHRD). --The GOI will not send samples to the WHO-Reference Laboratory at the University of Hong Kong and will only send samples outside of Indonesia if collaborating institutes agree to a Materials Transfer Agreement (MTA). --The GOI wishes to be more open and transparent and will seek to release information soon related to the sequencing of H5N1 viruses. ¶3. (SBU) Upon hearing the announcement, NAMRU-2 immediately contacted MOH and received permission to continue to send samples to CDC. Since August 3, NAMRU-2 has sent samples from five patients, including three recent cases from Garut. Motivations behind MOH Announcement -------------- ¶4. (SBU) While the reasons behind Supari's decisions are not completely clear, the MOH has been unhappy with delays in JAKARTA 00011344 002.2 OF 003 receiving information from Hong Kong. At the same time, the MOH has been generally satisfied with reports from NAMRU-2 and US CDC. Various contacts have told us that the MOH has become increasingly uncomfortable with Dr. Malik Peiris, senior investigator at the University of Hong Kong WHO reference laboratory. According to our contacts, Malik has made public comments about H5N1 in Indonesia while in Hong Kong without clearing them with the MOH, and failed to inform MOH officials in advance that the Hong Kong laboratory was conducting research with H5N1 virus from Indonesia. In addition, MOH officials have complained that the Hong Kong laboratory has not forwarded data on sequences in a timely and complete fashion. ¶5. (SBU) At the same time, relations between the MOH and the WHO Indonesia office have deteriorated since the Karo District family cluster in May 2006 and the Expert Consultation sponsored by the WHO in June 2006. Some MOH officials told us that they felt publicly criticized during the Expert Consultation, and several senior MOH officials made announcements denying firm evidence of human to human transmission in North Sumatra. Jakarta-based WHO officials have also advocated that the MOH send specimens from human cases to the WHO-Reference Laboratory at Hong Kong University, while generally discounting results from the CDC. ¶6. (U) Another MOH motivation for the revised sample sharing procedures may be that, under the leadership of Director General Dr. Triono Soendoro, the NIHRD is moving to develop the full capacity to diagnose and characterize influenza samples in-country in collaboration with the Eijkman Institute. Implications for NAMRU-2 -------------- ¶7. (SBU) Dr. Triono has told us that he views the announcement as an endorsement of NAMRU-2, and in general, the MOH has been pleased with the responsiveness and completeness of reports from CDC and NAMRU-2. The MOH has granted NAMRU-2 permission to continue to send samples to the CDC, and since Supari's announcement, NAMRU-2 has sent samples from eight patients including three recent cases from Garut. ¶8. (SBU) However, the efficiency of sample transfers in the future will depend on any final MTA with the MOH. The draft MTA the Ministry of Health has given NAMRU-2 is very restrictive, with provisions that would assert full control on sample flow, sample information and their usage for the production of vaccines. It also raises complicated intellectual property rights issues, as well as topics that are to be covered in the upcoming GOI-NAMRU-2 Memorandum of Understanding. NAMRU-2 is in the process of reviewing the draft MTA and meeting with various MOH officials to better understand the implications of the August 3 announcements. JAKARTA 00011344 003.2 OF 003 ¶9. (SBU) Comment: We believe that much of the driving force behind the Minister's announcement is a nationalistic appeal for Indonesia to develop full capacity to diagnose and characterize influenza samples in country. However, no in- country laboratory currently has the capacity to perform necessary testing at the level performed by CDC. Until the MOH and collaborating laboratories sort through the MTA and associated issues, the prospects of a more restrictive sample sharing regime could dampen NAMRU-2 and other researchers' abilities to conduct studies related to H5N1. End comment. PASCOE