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

UNCLAS SECTION 01 OF 06 JAKARTA 005701

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SUBJECT: May 4 AVIAN INFLUENZA UPDATE (AI): VISIT OF AI
SPECIAL REPRESENTATIVE AMBASSADOR LANGE

REF: Jakarta 5308 and previous

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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

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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

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--------------


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

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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

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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:


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-- 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