May 4 AVIAN INFLUENZA UPDATE (AI): VISIT OF AI

UNCLAS SECTION 01 OF 06 JAKARTA 005701 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 ALSO PASS TO J07 E.O. 12958: N/A TAGS: TBIO AMED CASC EAGR AMGT PGOV ID KFLU SUBJECT: May 4 AVIAN INFLUENZA UPDATE (AI): VISIT OF AI SPECIAL REPRESENTATIVE AMBASSADOR LANGE REF: Jakarta 5308 and previous JAKARTA 00005701 001.2 OF 006 ¶1. (SBU) Summary: The Department of State's Special Representative for Avian and Pandemic Influenza Ambassador John Lange met with senior Indonesian officials, including Coordinating Minister for Peoples' Welfare Aburizal Bakrie, on May 1 to discuss U.S. efforts to address the AI pandemic threat and support the GOI's efforts to combat the virus. Bakrie told Ambassador Lange that although the Government of Indonesia (GOI) has AI "under control" with its limited resources, Indonesia still needs USD 900 million over the next three years to overcome the disease. Ambassador Pascoe highlighted NAMRU-2's contributions to Indonesia, and contrasted the Ministry of Health's (MOH) improving AI response to apparent inaction at the Ministry of Agriculture (MOA). At a luncheon with donor representatives, participants said bilateral funding channels remain preferable to a multi-donor trust fund for AI. A representative from the United Nation's Food and Agricultural Organization (FAO) worried about inadequate compensation for culled chickens and a World Health Organization (WHO) representative expressed concern about the implications of the continuing flow of human AI cases in Indonesia. Senior MOA and MOH officials admitted to Ambassador Lange that coordination at the national level is wanting, but said it is quite good at the local level. During a local TV interview, Ambassador Lange stressed the importance of coordination at all levels, praised the President's creation of the National AI Committee, and highlighted NAMRU-2's role in helping the GOI fight AI. NAMRU-2 reports no new human H5N1 cases in the past week. End summary. ¶2. (U) The State Department's Special Representative for Avian and Pandemic influenza (AI) Ambassador John Lange met May 1 with senior Indonesian officials, including Coordinating Minister for Peoples' Welfare Aburizal Bakrie, Dr. Nyoman Kandun, Director General for Disease Control and Environmental Health at the MOH, Dr. Triono Soendoro, Director General for the National Institute for Health Research and Development (LITBANGKES) of the MOH, and Dr. Syamsul Bachri, Director of Animal Health at the MOA. Ambassador Lange described U.S. efforts to address the AI pandemic threat and offered support for the GOI's own efforts to combat the deadly virus. Ambassador Lange also toured the facilities of the Naval Medical Research Unit (NAMRU-2) and discussed its diagnostic and research activities with senior staff. Meeting with Coordinating Minister Bakrie -------------- ¶3. (SBU) In the meeting with Coordinating Minister for Peoples' Welfare Bakrie, the GOI's lead on AI, Ambassador Lange noted U.S. concern about AI, as reflected in his appointment as Special Representative for Avian and Pandemic Influenza and the reorganization of various U.S. agencies to face the AI threat. He also congratulated Minister Bakrie on his appointment as the GOI's lead on avian influenza as JAKARTA 00005701 002.2 OF 006 stipulated in the Presidential Decree creating the National Committee on Avian Influenza (reftel). ¶4. (SBU) Bakrie acknowledged the importance of his ministry's role in combating AI, especially in coordinating between the MOH and MOA, which he said could still use improvement. In response to Ambassador Lange's query about the effectiveness of coordination between the two ministries and problems caused by decentralization, Bakrie said his ministry would use its authority under the Presidential Decree to resolve the issue. In response to Ambassador Pascoe's comparison of the MOA's apparent inaction with the MOH's improving response to AI, Bakrie said a lack of funds and information is the root cause, but that both should become more available. He also blamed the MOA's inaction on the ministry's lack of authority over local governments, which he believed the Presidential Decree would resolve. ¶5. (U) Bakrie outlined the five core functions of the National AI Committee: 1) research; 2) animal health; 3) human health and preparedness; 4) public relations; and 5) medical products such as anti-virals and medicine. He provided an update on AI in the human and animal sector, claiming that human deaths had ceased at 22 (actually 26 as of May 1) and poultry infections were now restricted to small enterprises and backyard holdings (sectors 3 and 4), which cannot afford vaccines. Bakrie also claimed the GOI's vaccination program enjoyed apparent success despite criticism about the danger of rising immunity levels in vaccinated chickens. He admitted, however, that restructuring the poultry sector is a top priority and a difficult challenge. World Bank President Wolfowitz's visit to the Jakarta suburb of Tangerang (the site of a number of human AI cases) confirmed the difficulty of such restructuring. Ambassador Lange concurred, and noted the importance of changing culture and behavior. He warned that changing practices in the poultry sector could take a long time and would requiring an active communication campaign down to the village level. ¶6. (SBU) Touching on his favorite theme, Bakrie told Ambassador Lange that although his government has AI "under control" with limited resources (an AI budget of USD 50 million for the next few years),Indonesia actually needs USD 900 million for the next three years to overcome the disease. He complained that Indonesia would reportedly receive only USD 150 million of the USD 1.9 billion pledged at the January 2006 donors' conference in Beijing. Bakrie concurred with Ambassador Lange's assessment of the importance of NAMRU-2 and the Indonesia-Singapore-U.S. trilateral project. The Minister said he would recommend expanding the project to include the entire district of Tangerang since poultry was more plentiful there than in the municipality of Tangerang. Ambassador Lange closed the meeting by urging Bakrie to ensure senior GOI representation at the second International Partnership on Avian and Pandemic Infuenza (IPAPI)meeting June 6-8 in Vienna. Ministry of Health Meeting JAKARTA 00005701 003.2 OF 006 -------------- ¶7. (SBU) In his discussions with Director General (DG) for Disease Control and Environmental Health (CDC/EH) Dr. Nyoman Kandun and the newly-appointed DG of the National Institute of Health Research and Development (Litbankes) Dr. Triono Soendoro, Ambassador Lange reiterated the impressive contribution of NAMRU-2 to the MOH's mission, the importance of good MOA and MOH interaction, the critical role of communication in overcoming AI, and the need for changes in behavior and animal husbandry practices. Regarding the latter point, Kandun stated frankly that such changes are highly unlikely, since they are steeped in tradition. ¶8. (U) Kandun claimed MOH outreach to the village level is already improving, but would improve further through revitalizing simple technology, biosecurity and risk communications. Dr. Triono concurred, noting that the mass successful mass communication efforts for four recent rounds of mass polio vaccinations proved this. Dr. Triono emphasized the importance of research in the fight against AI given the absence of hard evidence of AI transmission between humans. He pointed out that Indonesia has received funding to build several BSL-3 labs, but that bringing BSL-3 labs online would entail not only construction issues but also human capacity and adequate regulations. Triono admitted that the MOH lacked BSL-3 qualified scientists and hoped the U.S. could provide required training. Ministry of Agriculture Meeting -------------- ¶9. (SBU) Ambassador Lange met Dr. Delima Azahari, Assistant to the Minister and the Head of MOA's AI Task Force, Dr. Syamsul Bahri, MOA's Chief Veterinary Officer, and Dr. Bagoes Poermadjaja, Head of MOA's Animal Disease Surveillance Branch. Ambassador Lange said he fully appreciates the complexity of the AI challenge, praised the establishment of the National Committee to coordinate efforts across departments, and commended MOA for its efforts. He said the U.S. looks forward to continued cooperation with MOA. Dr. Delima described the purpose of MOA's AI Task Force, which is to coordinate activities across the three MOA Directorates General responsible for AI: the Directorate General for Livestock Services (DGLS), which implements surveillance, reporting, vaccination, culling and compensation programs, and also overseas the Regional Disease Investigation Centers that perform testing and diagnostics; the Directorate General for Quarantine, which controls animal movements and imports; and the Directorate General for Research and Development. She also noted that DGLS had created a Campaign Management Unit specifically for AI and staffed only by veterinarians. Dr. Delima acknowledged that the lack of compensation funds and qualified vets hampers MOA's AI efforts. ¶10. (U) Dr. Delima explained that AI hit Indonesia in two waves: the first in 2003/04, which primarily struck large- scale chicken farms and resulted in high mortality; and a JAKARTA 00005701 004.2 OF 006 second wave in 2005-06 that has impacted primarily on small- scale producers and back-yard flocks and has spread to more avian species (more water fowl and quail). She also said that MOA was implementing a nine-point strategy to deal with the disease, with vaccination, selective culling, biosecurity, and enhanced laboratory capacity as the backbones of the strategy. When asked what the long-term goal of the strategy was, MOA officials acknowledged that eradication would be very difficult if not impossible to obtain in the near future. Dr. Azahari said they had a "vision" for "minimizing" incidence of the disease in three years. ¶11. (U) MOA officials noted that the USAID-funded FAO project to develop surveillance and rapid response teams has been very successful, and is strengthening the Ministry's AI reporting and response capacity. They said the recent creation of the National Committee had strengthened their hand in dealing with local governments, and in getting them to implement the national strategy. They also observed that changing behaviors and basic animal husbandry practices remains a huge challenge and vaccination coverage needs to be expanded. In addition, they confirmed that AI continues to spread to new provinces, including most recently West Irian Jaya (Papua). Meeting with Donors -------------- ¶12. (SBU) At a luncheon discussion with with representatives from the FAO, WHO, and Australian and Singaporean Embassies, WHO Country Representative Georg Peterson expressed the concern that Indonesia remains the only country with steadily rising human AI cases and fatalities. He added that as long as the virus remains in endemic in poultry, this situation would not change. He also noted that that although evidence suggests some human AI cases have gone unreported, NAMRU-2's extensive influenza surveillance network would have detected a large outbreak of human AI cases if it existed. Dr. Peterson also highlighted the lack of information sharing between the MOH and MOA. ¶13. (SBU) FAO Country representative Man Ho So agreed, pointing out the MOA also needs to be empowered, notwithstanding the coordinating role of Bakrie's ministry. He said the USAID-funded FAO program will focus on the island of Java first, which contains most of the Indonesia's human and poultry population, and then scale up to Sumatra and finally nationwide. So said compensation to farmers remains an issue, with the GOI opting for Rp 10,000 per bird (USD 1.15) while the FAO recommends Rp 15,000 (USD 1.7). He stressed, however, that the timing, not the level of compensation is the decisive issue and that speedy compensation (3 days) during a recent cull in Indramayu, West Java could serve as a model. The Australian representative said the GOI and donors need to address the stigma many Indonesians attach to families affected by AI in both poultry and humans. She also pointed out that Bakrie's ministry seems to have the authority but not the resources JAKARTA 00005701 005.2 OF 006 to execute its coordinating mandate. ¶14. (SBU) In response to the USAID Director Frej's query about funding levels for AI, Peterson suggested that it was probably inadequate, given the significantly higher funding for tuberculosis and HIV/AIDS. He said spending on AI should be viewed as an investment in health infrastructure in preparation for other emerging diseases. So outlined the FAO's cooperative efforts with the U.S., Japan, Holland and Australia. Peterson recommended donors urge the government to carefully evaluate its laboratory options, resources and priorities, as well as the implications for operating high biosecurity level facilities. When Ambassador Lange sought donors' view on an AI Multi Donor Trust Fund coordinated by the EU and the World Bank, the consensus was that the donor experience in Aceh suggests that creating such a trust fund for AI is probably not worth the effort, with bilateral funding channels offering quicker and more flexible responses. TV Interview and NAMRU-2 Tour -------------- ¶15. (U) In an interview with local television station Lativi (seen by seven million viewers),Ambassador Lange stressed the importance of coordination at all levels of government, especially between health and agriculture departments. He praised the President's creation of the National AI Committee headed by Minister Bakrie, and NAMRU-2's role in helping the GOI fight AI. He also noted behavior change (i.e., the close interaction between humans and poultry) constitutes the most difficult challenge for Indonesia and other developing countries. ¶16. (U) During his visit to NAMRU-2 facilities, Ambassador Lange discussed NAMRU-2's research and diagnostic activities related to AI. NAMRU-2's key point to the Ambassador centered on the sustained nature of human AI infections since the initial case last July. Asked to explain its role in helping the GOI to fight the virus, NAMRU-2 Commander Mark Wooster said his agency's contributions included: a) providing Indonesia the only functioning influenza surveillance network; b) furnishing information to the GOI to inform policy making; c) providing training/capacity building for research and diagnostics to Indonesian staff; d) offering access to first-rate labs; and e) training University students and technicians by providing access to its labs. He also noted that NAMRU-2 also serves as a reservoir of viral research to the U.S. Center for Disease Control (CDC) by providing it hundreds of virus samples every year. Human AI Case Profile -------------- ¶17. (U) NAMRU-2 reports no new H5N1 cases in humans in the past week. NAMRU-2 data indicates the following AI-related case profile as of May 5: JAKARTA 00005701 006.2 OF 006 -- Number of laboratory confirmed (positive PCR and/or serology) human AI cases: 35, of which 26 have been fatal (fatality rate of 74 percent). -- Number of probable AI cases: 4, with 3 deaths (fatality rate of 75 percent). -- Number of cases awaiting verification by the US CDC: 1. -- Number of possible AI cases under investigation: approximately 17. -- Number of excluded AI cases: 277. ¶18. (U) Ambassador Lange did not have an opportunity to review this message. PASCOE