INDONESIA - FEB 23 AVIAN INFLUENZA (AI) UPDATE

UNCLAS JAKARTA 000504

SIPDIS

SENSITIVE
SIPDIS

DEPT FOR EAP/MLS, EAP/IET, MED/DASHO/EMR AND MED
DEPT FOR G/AIAG AND OES
DEPT PASS TO USDA/FAS/HWETZEL
DEPT ALSO PASS TO USDA/FAS/FAA/DEVER AND USDA/APHIS/ANNELLI
DEPT ALSO PASS TO USDA/FAS/OTCB/ROSENBLUM AND USDA/APHIS AUSTGEN
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
BANGKOK FOR APHIS/CARDENAS, RMO, CDC, USAID/RDM/A
CANBERRA FOR APHIS/EDWARDS
ROME FOR FAO
NSC FOR JMELINE

E.O. 12958: N/A
TAGS: TBIO AMED CASC EAGR AMGT PGOV ID
SUBJECT: INDONESIA - FEB 23 AVIAN INFLUENZA (AI) UPDATE

REF: A) Jakarta 00431 B) Jakarta 00310 and previous


1. (SBU) Summary: Despite the February 16 joint media statement by
the Ministry of Health (MOH) and World Health Organization (WHO),
Indonesia has not yet resumed the sharing of AI samples. Various
Indonesian media outlets have quoted Minister of Health Fadillah
Supari as saying Indonesia will not resume shipment of virus
specimens to the WHO until a "new mechanism" for sample sharing is
in place. The inability of international laboratories to confirm
MOH-diagnosed AI cases has led to a gap between the GOI's case count
(85 AI cases with 65 deaths) and the counts of NAMRU-2 and the WHO
(81 cases with 63 deaths). According to an officer from the
Singaporean Embassy in Jakarta, the Government of Indonesia (GOI)
continues to make progress on the Tangerang trilateral project. End
Summary.

Optimistic Joint Statement But Impasse Continues
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2. (U) Following five hours of negotiations on February 16, WHO and
MOH officials released a Joint Media Statement agreeing that
"responsible, free and rapid sharing of influenza viruses with WHO,
including H5N1, is necessary for global public health security" and
that the MOH will "resume sharing viruses for this purpose." The
WHO team included David Heymann, Assistant Director-General of the
WHO for Communicable Diseases; Dr. Keji Fukuda, flu epidemiology
expert; and Georg Peterson, Director of WHO's Jakarta office.
According to journalists present at the media event, Heymann
commented that he trusted that the shipment of specimens would
resume soon. But according to the English-language version of the
weekly magazine Tempo, Supari replied "Without the new regulations,
until our last drop of blood, the answer is still no, no, no!"
Director General for Infectious Diseases Nyoman Kandun echoed this
sentiment in a February 22 meeting that was unrelated to sample
sharing. The MOH and WHO have agreed to convene a meeting of Asian
Health Ministers in March to discuss mechanisms for jointly using AI
virus samples.


3. (U) Indonesian press continues to run stories on the sample
sharing issue, including an interview in the Jakarta Post with Dr.
Triono Soendoro, Director of Litbangkes and a two-page article in
Tempo. Most press stories have focused primarily on the need for
developing countries to benefit from sharing virus samples,
including access to quality pandemic vaccines at affordable prices.
A variety of sources have indicated that the MOH has appointed a
prominent local defense attorney and anti-corruption advocate,
Todung Mulya Lubis, to handle the legal aspects of the issue.

Conflicting AI Counts
--------------


4. (SBU) As a result of the sample impasse, NAMRU-2 and WHO now
classify AI cases differently than the Ministry of Health. NAMRU-2
and WHO show the same numbers for Indonesia with 81 Human H5N1 cases
and 63 deaths for a CFR of 78%. The MOH counts four additional
cases:

(1) a 15 year-old surviving female from Jakarta. NAMRU-2 data from
separate samples suggest she had an H3 (normal flu) virus.

(2) a 30 year-old surviving male from Bandung;
NAMRU-2 data on separate samples suggest he was not infected.

(3) a 20 year-old deceased female from Garut; NAMRU-2 does not have
samples

(4) a 9 year-old deceased male from Garut; NAMRU-2 does not have
samples.


5. (SBU) NAMRU-2 has encouraged NIHRD researchers to both share
samples with NAMRU-2 and seek additional laboratory results from a
WHO-reference laboratory. In the cases of the surviving patients,
virus isolation, full genome sequencing and microneutralization
could resolve the case discrepancy.

Tangerang Trilateral Project Update
--------------


6. (SBU) According to a Singaporean Embassy contact, Singapore has
agreed to provide $600,000 worth of in-kind contributions (including
vehicles, computers, other equipment) for use in the Tangerang
trilateral project. The Singaporean Government has also engaged
Sembawang Logistics Company, a third party contractor to begin
implementing the in-kind contributions. Additionally, Singapore is
prepared to transfer $900,000 before the end of March to the GOI to
fulfill the remaining portion of their Tangerang funding commitment.
Although specific activities have not yet been identified nor the
MOU finalized between Singapore and Indonesia, the MOH has agreed to
begin using the funds and providing quarterly activity reports.

HEFFERN