INDONESIA - MARCH 10 AVIAN INFLUENZA UPDATE

UNCLAS SECTION 01 OF 04 JAKARTA 003199 SIPDIS SIPDIS SENSITIVE DEPT FOR EAP/IET, A/MED AND S/ES-O 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/BILL STEIGER AND AMAR BHAT PARIS FOR FAS/AG MINISTER COUNSELOR CANBERRA FOR APHIS/DHANNAPEL ROME FOR FAO NSC FOR JMELINE BANGKOK FOR RMO, CDC, USAID/RDM/A USPACOM PASS to JO7 E.O. 12958: N/A TAGS: TBIO AMED CASC EAGR AMGT KFLU ID SUBJECT: INDONESIA - MARCH 10 AVIAN INFLUENZA UPDATE REF: A) Jakarta 02915 and previous JAKARTA 00003199 001.2 OF 004 ¶1. (SBU) Summary. A USAID Washington avian influenza (AI) team met with a range of stakeholders during a March 1-5 visit to Indonesia, including the Ambassador and the Embassy's Avian Influenza Working Group (AIWG),to discuss USAID's USD 11 million FY 2006 AI allocation for Indonesia. Officials from Singapore, Indonesia, the United States, and other multilateral donors met March 3 in Singapore to discuss the proposed Avian Influenza Trilateral Project in Tangerang. Media reports indicate continuing GOI interest in locally developing an AI vaccine for humans, although the U.S. firm Baxter International has reportedly denied it is cooperating with the GOI. Indonesia has also reportedly expressed interest in producing the generic version of Tamiflu as part of a push to secure 22 million doses of the drug by 2007. The Ministry of Agriculture (MOA) reportedly plans to start a 2-month mass vaccination program later in March under which it would distribute 55 million doses of poultry vaccine to 27 AI-affected provinces. The total number of confirmed human AI cases in Indonesia rose to 29 (with 21 deaths) on March 10 when the U.S. Centers for Disease Control and Prevention (CDC) confirmed the H5N1 virus in a recently deceased 3-year-old boy from Semarang, Central Java. End Summary. USAID AI Team Visit -------------- ¶2. (U) USAID Washington Avian Influenza Director Dennis Carroll led a team to Indonesia March 1-3 to review and finalize USAID's draft spending plan for USD 11 million in FY 2006 supplemental resources. The 2006 funds will help expand on-going animal and human health sector activities, including (a) support for the government's "National AI Commission" responsible for overseeing Indonesia's integrated national AI prevention and preparedness strategy; (b) the expansion of key agricultural sector prevention and control activities; (c) the scale-up of mass media outreach on AI; and (d) supporting operational costs for the critically needed investigation of human cases. USAID Indonesia programmed USD 3.15 million in AI funds in 2005. ¶3. (U) The AI team met with a range of key AI stakeholders, including the Mission's Avian Influenza Working Group (AIWG),the Food and Agricultural Organization (FAO),the Academy for Educational Development (AED) and the Naval Medical Research Unit (NAMRU-2). They team also joined the FAO on a trip to investigate the latest report of poultry infections in Banten Province, and participated in a 3-hour meeting with the GOI and donors to discussed the status of AI strategy implementation in Indonesia. Finally, the team provided out briefs to the Ambassador and USAID senior management. AI Trilateral Meeting in Singapore -------------- ¶4. (U) Officials from Singapore, Indonesia, the United JAKARTA 00003199 002.2 OF 004 States, the World Bank, the WHO, the FAO and the World Organization for Animal Health (OIE) met March 3 in Singapore to flesh out details of the proposed Avian Influenza Trilateral Project in Tangerang Municipality, Banten Province, Indonesia. Dr. Nyoman Kandun, Director General for Disease Control and Environmental Health at the Indonesian Ministry of Health (MOH),and Ms Yong Ying-I, Permanent Secretary of the Singaporean MOH co-chaired the meeting. The U.S. delegation was lead by Dr. Chuck Lambert, Acting Under Secretary of Marketing and Regulatory Programs at the U.S. Department of Agriculture and Dr. Amar Bhat, Director of the Office of Asia and the Pacific in the Department of Health and Human Service (HHS). Representatives from Embassies Jakarta and Singapore and NAMRU-2 also participated. ¶5. (U) As noted in the joint press release issued immediately after the meeting, Kandun said the goals of the pilot project are "to translate the GOI's national plan to control AI "in a defined, localized geographic area; reduce the prevalence of H5NI AI; replicate project from lessons learned; and strengthen local capability and capacity." Kandun stressed that the project was timely and should be dynamic (i.e., subject to revision). He continued that it was not separate from the national AI plan and in fact should serve as a model for its implementation. Kandun also provided an update on the AI situation in Indonesia, highlighting key challenges such as coordination, early warning systems, public awareness, funding, animal and human surveillance, poultry traffic and vaccination, and compensation for culling. Kandun also noted that the National Committee on AI Control would soon be operational, which an Embassy contact later confirmed. He added that the GOI plans to purchase four million doses of Tamiflu in the next two months and increase the number of national referral hospitals from 44 to 100. ¶6. (SBU) Ying Li said Singapore is enthusiastic about the project and called for input from donors to refine its operational details. She added that Singapore would donate USD 1.5 million to the project, as well as technical assistance, and asked what technical and financial assistance other participants planned to contribute. USG representatives said they could not commit financial aid, but offered technical assistance as part of the overall USG assistance to the national effort to control avian influenza. For instance, Dr. Lambert noted USDA/APHIS's plan to place as soon as possible a U.S. direct hire veterinarian and four locally recruited employees in Indonesia within the next year. In addition, Dr. Bhat raised the possibility of HHS/CDC assigning someone to Indonesia in the near future. The FAO and the World Bank also promised to consider technical aid but did not commit funds. Participants agreed to implement the project in three phases beginning in April 2006. ¶7. (SBU) Comment: A number of participants, including a representative from Indonesia's MOH, noted the strong bias toward human health in the project plan, a bias reflected in JAKARTA 00003199 003.2 OF 004 MOH's heavy representation at the meeting (10 MOH officials attend compared to only once official from the Ministry of Agriculture). Kandun acknowledged this imbalance and agreed to review the project. Several participants told us on the sidelines of the meeting that they feared the project risks failure if the MOA participation is not significantly strengthened. End Comment. Confusion About Vaccine Development -------------- ¶8. (U) The Surabaya daily newspaper Surya reported March 3 the signing of a March 2 MOU between state-owned pharmaceutical firm PT Biofarma and Surabaya's Airlangga University (UNAIR) to develop an AI vaccine for humans. A source told us UNAIR will provide technical experts and PT. Biofarma a production site, including laboratory facilities. The Tropical Disease Center (TDC) in Surabaya may also be involved in this effort. In addition, MOH officials have reiterated the Ministry's intention to work with the U.S. vaccine producer Baxter International to produce a vaccine in Indonesia. In a December 19, 2005 press release, Minister of Health Siti Fadilah reported the MOH would work on vaccine production with Baxter and PT. Bio Farma. The Minister repeated this statement on February 28, when she told the press her ministry had "already signed a cooperation deal with Baxter." However, Baxter Healthcare Corp., a Baxter subsidiary, denied this claim. Tamiflu Acquisition -------------- ¶9. (SBU) With its tamiflu stockpile dwindling to 35,000 doses, the MOH announced on March 2 an ambitious plan under which it would seek to buy 22 million doses of the drug by 2007 to cover about 10 percent of Indonesia's 220 million population. MOH officials have told the press they anticipate purchasing 4 million doses by April 2006, largely through Kimia Farma, state-owned pharmaceutical firm PT Indo Farma, and Roche. Our contacts tell us that the latter is also in negotiations with the government to allow local production of Oseltamivir. Poultry Vaccination -------------- ¶10. (U) According to a March 6 article in the local Indonesian language daily Koran Tempo, the MOA plans to provide 55 million doses AI vaccine for poultry as part of a national vaccination program. The MOA will reportedly distribute the vaccine to Indonesia's 27 AI-affected provinces, with priority given to the six most affected provinces (Central Java, West Java, East Java, Banten, Jakarta, and Lampung). The MOA hopes to start a mass vaccination program later this month and complete it in April. Human AI Case Profile -------------- JAKARTA 00003199 004.2 OF 004 ¶11. (U) The U.S. Centers for Disease Control and Prevention (CDC) confirmed another human AI case on March 10, a recently deceased 3-year-old boy from the Central Java city of Semarang. The MOH has also listed a 12-year old girl from Solo as a probable case based upon serology (the girl is still alive). ¶12. (SBU) NAMRU-2 data indicates the following AI-related case profile as of March 10. -- Number of laboratory confirmed (positive PCR and/or serology) human AI cases: 29, of which 21 have been fatal (fatality rate of 72 percent). -- Number of probable AI cases: 5, with 4 deaths (fatality rate of 80 percent). -- Number of cases awaiting verification by the US CDC: 0. -- Number of possible AI cases under investigation (last 30 days): approximately 54. -- Number of excluded AI cases: 218. PASCOE