INDONESIA - JUNE 16 AVIAN INFLUENZA (AI) UPDATE

UNCLAS SECTION 01 OF 04 JAKARTA 007626

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DEPT FOR G/AIAG/JLANGE AND RFENDRICK
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DEPT PASS TO USDA/FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG
DEPT ALSO PASS TO USDA/FAS/FAA/DYOUNG AND USDA/APHIS
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ROME FOR FAO
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USPACOM ALSO PASS TO J07

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TAGS: TBIO AMED CASC EAGR AMGT PGOV ID KFLU
SUBJECT: INDONESIA - JUNE 16 AVIAN INFLUENZA (AI) UPDATE

REF: A) Jakarta 7166 and previous

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1. (SBU) Summary: The Executive Director of the National
Committee for AI and Pandemic Control (Komnas) Bayu
Krisnamurti told participants in a June 12 AI donor meeting
that the GOI would host a WHO-led technical assessment of
its AI strategy June 21-23, with participation from the
World Bank and FAO. The GOI will also hold a workshop to
allow donors to present concrete funding plans in support of
its National AI Strategy. UNICEF is helping Komnas prepare
a matrix of donor assistance and GOI funding to allow the
GOI to determine funding gaps for its 2006-08 AI control
budget. In the past week, the number of confirmed H5N1
cases in humans in Indonesia has remained unchanged, with
confirmed cases holding at 51, with 39 deaths (76 percent).
Indonesia currently ranks second in the world in both H5N1
cases (51 confirmed) and deaths (39),and leads the world in
case fatality rates (76 percent) for countries with more
than ten confirmed cases. End Summary.

National AI Committee Meeting
--------------


2. (U) The Executive Director and Chair of the National
Committee for AI and Pandemic Control (Komanas) Bayu
Krisnamukti chaired a combined interagency and donor
coordination AI meeting on June 12. Bayu called the meeting
in preparation for a scheduled session on AI at the June 14
Consultative Group of Indonesia (CGI) meeting and an AI
workshop or seminar for donors in early July. (Note: The
GOI subsequently dropped the AI item from the CGI agenda.)
Participants attended from the Ministry of Agriculture
(MOA),Ministry of Health (MOH),National Development
Planning Agency (Bappenas),Ministry of Communications
(MOC),and State Ministry of Research and Technology
(Menristek),as well as the WHO, World Bank, FAO, USAID,
AUSAID, DFID, Singapore, Korea, and Japan. Bayu said the
two goals for the meeting were to share information on the
GOI's AI strategy, and coordinate and synergize GOI and
donor AI activities.


3. (U) An official from Bappenas gave a brief synopsis of
the GOI's National Strategy on AI Control and Prevention,
highlighting its two main strategies and six goals, as well
as detailing the budgetary challenges and funding gaps in
the various ministries. He noted that the GOI's "AI Control
Cost Plan" calls for spending of Rp 1.9, 2.4 and 2.2
trillion rupiah in 2006, 2007 and 2008 respectively (USD
203, 256, and 235 million respectively at current exchange
rates). In addition, the budget for Pandemic Influenza
Preparedness amounts to Rp 738, 792 and 907 billion in 2006,
2007 and 2008 respectively (USD 79, 85, and 97 million
respectively at current exchange rates). He thanked donors
for their current and planned financial and technical
support, but urged that they quickly complete the assistance
matrix the UNDP is preparing for the GOI. (Note: UNDP is
helping Komnas prepare a matrix of donor assistance and GOI
funding to allow the GOI to determine funding gaps).


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4. (U) Bayu noted the GOI's AI strategy is on track
following the formulation of a National AI Plan in December
2005 and the launch of its implementation in January 2006.
He admitted, however, that given the notable rise in human
AI cases in 2006, the GOI needs to refocus and adjust its
strategy and was thus welcomes input from donors. For that
reason, the GOI would host June 21-23 a WHO-led technical
review/assessment of its AI strategy, with participation
from the World Bank and FAO. (Note: CDC influenza specialist
Dr. Tim Uyeki will in the review). Bayu added that the GOI
will also hold a workshop in early July to enable donors to
present concrete funding plans in support of Indonesia's
national AI strategy.


5. (U) Bayu said the GOI will emphasize the following six
priorities over the next 18 months:

--Conducting an information and public awareness campaign
focusing on children and family; the media; decision makers
such as GOI officials, politicians, doctors and
veterinarians; high-risk groups such as poultry traders and
farmers; and the general public.

--Sharpening the GOI's focus on the AI virus in poultry and
birds. Bayu said that with 194 districts AI endemic, the
GOI needs a massive surveillance program. In that regard, he
thanked the FAO for its newly launched surveillance program
funded by USAID.

--Developing a proper compensation program for culled birds,
without which required depopulation of infected areas would
be very difficult.

--Improving human surveillance and preparedness, including a
focus on personal protective equipment (PPE),isolation
rooms and anti-virals.

--Conducting pandemic preparedness simulations: The GOI
plans to conduct simulations in three areas (not specified),
although more are clearly needed.

--Increasing research and investigation to address many
answered questions, especially with respect to human AI
clusters.


6. (U) In the discussion that followed, the MOA requested
more direct operational support to supplement ongoing
technical assistance. The World Bank called for a freer
flow of information from the GOI, citing as an example the
lack of specifics and GOI conclusions about the recent large
human AI cluster in North Sumatra (ref). In reply, Bayu
said the government has been open with its communications,
especially via the WHO and FAO. He then remarked that
limited human-to-human transmission had taken place in the
Medan cluster case. Asked why this was not yet in the
public domain since several ministers discounted that
possibility, Bayu agreed that the GOI needed help to
initiate a good communication strategy, but that it would
need to be "tailored to Indonesia with its extremely free

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media."

Muhammadiyah Supports AI Prevention Efforts
--------------


7. (U) Indonesia's second largest mass Islamic organization,
Muhammadiyah, announced plans to support the GOI's efforts
to control and prevent AI at a June 7 ceremony attended by
senior officials from the Coordinating Ministry for People's
Welfare, the MOH, and MOA, and representatives of
universities and professional organizations. The Chairman
of Muhammadiyah's Health Council, Dr. Natsir Nugroho, and
the Chairman of Muhammadiyah's Central Board Dr. Sudibyo
Markus opened the event and Minister of Health Siti Fadilah
Supari formally the launched the program. Natsir stressed
the need for broad participation from the GOI, NGOs and the
wider community to prevent the spread of AI, and adequately
prepare for a possible pandemic. Markus claimed that
Muhammadiyah's nationwide community-based network would
support this effort, using its vast network of universities,
schools, hospitals and other independent organizations to
"socialize" the public about the dangers posed by AI and the
need for preventative measures. Markus later told the press
there would be a fund raising component to the project, and
a "train the trainers" program with a budget of around Rp 20
billion rupiah (USD 2.1 million). Minister Fadilah thanked
Muhammadiyah for its involvement in addressing socioeconomic
and health problems and its willingness to join the GOI in
its fight against AI. The Minister also thanked USAID and
AUSAID for their AI assistance.

Human AI Case Profile
--------------


8. (U) In the past week, the number of confirmed H5N1 cases
in humans in Indonesia remained the same, at 51, with 39
deaths (76 percent).


9. (SBU) NAMRU-2 data indicates the following AI-related
case profile as of June 15:

-- Number of laboratory confirmed (positive PCR and/or
serology) human AI cases: 51, of which 39 have been fatal
(case fatality rate of 76 percent).

-- Number of probable AI cases: 5, with 3 deaths (fatality
rate of 60 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: 319.


10. (SBU) We offer the following additional data on the
recent trajectory of AI cases in Indonesia:

Number of Confirmed and Probable Cases Reported per Month:

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2005
--------------
June - 1
July - 2
August - 0
September - 5
October - 3
November - 5
December - 4

2006
--------------
January - 7
February - 5
March - 5
April - 2
May - 14
June - 3

Areas Affected in the last 30 days:

District/City Province No. Confirmed Cases
-------------- --------------
Karo North Sumatra 7
Bekasi West Java 1
Surabaya East Java 2
Jakarta 1
Bandung West Java 2
Padang West Sumatra 1
Tasikmalaya West Java 1
Tangerang West Java 2

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