Identifier
Created
Classification
Origin
09GENEVA290
2009-04-07 14:58:00
UNCLASSIFIED//FOR OFFICIAL USE ONLY
US Mission Geneva
Cable title:  

REPORTING OF INDONESIA HUMAN AVIAN INFLUENZA

Tags:  KFLU AMGT EAGR PGOV TBIO 
pdf how-to read a cable
VZCZCXYZ0000
PP RUEHWEB

DE RUEHGV #0290/01 0971458
ZNR UUUUU ZZH
P 071458Z APR 09 ZDK
FM USMISSION GENEVA
TO RUEHC/SECSTATE WASHDC PRIORITY 8276
INFO RUEHBY/AMEMBASSY CANBERRA PRIORITY 6508
RUEHJA/AMEMBASSY JAKARTA PRIORITY 2246
RUEHLO/AMEMBASSY LONDON PRIORITY 2855
RUEHOT/AMEMBASSY OTTAWA PRIORITY 5685
RUEHFR/AMEMBASSY PARIS PRIORITY 3377
RUEHKO/AMEMBASSY TOKYO PRIORITY 6863
RUEHPH/CDC ATLANTA GA USA PRIORITY
RUEAUSA/DEPT OF HHS WASHINGTON DC PRIORITY
RUCNDT/USMISSION USUN NEW YORK PRIORITY 3006
RUEHBS/USEU BRUSSELS PRIORITY
UNCLAS GENEVA 000290 

SENSITIVE
SIPDIS

DEPARTMENT FOR OES/IHB - PATTERSON AND SHAPIRO

E.O. 12958: N/A
TAGS: KFLU AMGT EAGR PGOV TBIO
SUBJECT: REPORTING OF INDONESIA HUMAN AVIAN INFLUENZA
(H5N1) CASES - REQUEST FOR CLARIFICATION

REF: A. A. SECSTATE 28521

B. B. JAKARTA 477

C. C. JAKARTA 398

UNCLAS GENEVA 000290

SENSITIVE
SIPDIS

DEPARTMENT FOR OES/IHB - PATTERSON AND SHAPIRO

E.O. 12958: N/A
TAGS: KFLU AMGT EAGR PGOV TBIO
SUBJECT: REPORTING OF INDONESIA HUMAN AVIAN INFLUENZA
(H5N1) CASES - REQUEST FOR CLARIFICATION

REF: A. A. SECSTATE 28521

B. B. JAKARTA 477

C. C. JAKARTA 398


1. (SBU) Summary. WHO confirms Indonesia is reporting human
avian influenza (H5N1) cases to WHO, but WHO has agreed with
the Indonesian Ministry of Health not to publicize that
information before Indonesia does. WHO asserts this
agreement is the only way WHO can conduct risk assessment on
the cases. To date those assessments have not revealed
sustained human-to-human transmission of the virus, which
would trigger dissemination of the information under the
International Health Regulations (2005). WHO believes
bilateral pressure on Indonesia by countries concerned by
Indonesia's restrictions on public reporting will be the most
effective way to turn this situation around. End summary.


2. (U) Mission Health Attache discussed Indonesia reporting
of H5N1 cases, as requested ref A, with WHO officials Dr.
David Heymann, then-Assistant Director-General for Health
Security and Environment (HSE); Dr. Keiji Fukuda, Director,
Global Influenza Program (now ADG ad interim for HSE); and
Dr. Max Hardiman, International Health Regulations (IHRs)
team.


3. (U) WHO confirmed all H5N1 cases are to be reported to
WHO in accordance with Annex 2 of the IHRs, which identifies
cases of human influenza caused by a new subtype as an event
that may cause a public health emergency of international
concern (PHEIC). Provision of such information to WHO is
also covered by Articles 6 to 10 of the IHRs. The IHRs may
be found at www.who.int/csr/ihr/IHR 2005 en.pdf. WHO stressed
that each H5N1 case is in and of itself not/not considered a
PHEIC unless it is associated with sustained person-to-person
transmission, which has not been the case (see para 4 of ref
A).


4. (U) Article 11 of the IHRs addresses WHO's obligations to
provide to WHO Member States public health information it has
received under Articles 5 to 10, and by reference Annex 2, of
the IHRs. Article 11.2 specifies that WHO shall not make
such information available until such time as:

a. the event is determined by the WHO Director-General to be

a PHEIC, or

b. information evidencing the international spread of the
infection or contamination has been confirmed by WHO in
accordance with established epidemiological principles, or

c. there is evidence that (1) control measures against the
international spread are unlikely to succeed because of the
nature of the contamination, disease agent, vector or
reservoir, or (2) the State Party reporting the information
lacks sufficient operational capacity to carry out necessary
measures to prevent further spread of disease , or

d. the nature and scope of the international movement of
travelers, baggage, cargo, containers, conveyances, goods or
postal parcels that may be affected by the infection or
contamination requires the immediate application of
international control measures.

WHO has determined on the basis of the information it has
received to date from Indonesia about H5N1 cases that none of
these provisions has been met and thus reporting to the
international community is not required.


5. (SBU) WHO confirmed that the Indonesian Ministry of
Health (MOH) has indicated to WHO that it would notify
information about H5N1 cases to WHO under the IHRs but
requested WHO not to release information about the cases
publicly before the MOH had done so. WHO agreed because it
allows WHO to conduct risk assessment on the cases. If WHO
believes the cases represented a verifiable change in risk,
it would be bound to notify Member States, but that
situation, according to WHO, has not arisen to date.


6. (SBU) Health Attache stressed that WHO had an obligation

to its Member States to inform them in a timely manner about
human cases of H5N1, by country, whether or not they are
determined to be a PHEIC. WHO asserts that it generally does
so on its website except in the case of Indonesia, where its
agreement with Indonesian health authorities has precluded
public reporting since the beginning of 2009.


7. (SBU) The Core Group (UK, France, Canada, Australia,
Japan, EC, US) of the International Partnership on Avian and
Pandemic Influenza (IPAPI) met in Montreux, Switzerland, on
the margins of an informal meeting of the WHO
Intergovernmental Meeting on Pandemic Influenza Preparedness
(PIP-IGM) March 30-April 2. In light of its concern about
the lack of reporting on H5N1 cases in Indonesia, the Group
met March 31 with WHO ADG a.i. Fukuda to discuss this matter.
Members of the Group expressed alarm that WHO's agreement
with Indonesia to withhold information about H5N1 cases
distorted public understanding of the situation in Indonesia,
and is unacceptable. The Group stressed that WHO's
reputation as the authoritative source of public health
information leads national public health authorities to
believe there are no H5N1 cases in Indonesia, which could
have serious public health implications. Finally, the Group
warned Fukuda that acceding to Indonesia's demand not to
publicize the cases seriously erodes WHO's credibility,
because WHO's own website is reporting no cases in Indonesia
even though there are credible reports to the contrary.
Other Member States may be put in the position of publicly
contradicting, or at least questioning, WHO's reporting on
the number of cases.


8. (SBU) Fukuda, while sympathetic, reiterated the points
outlined above - that WHO's agreement with Indonesia allows
risk assessment, that WHO is seeing only sporadic cases in
Indonesia, and that if there were sustained human-to-human
transmission WHO would be compelled to disseminate that
information to the international community.


9. (SBU) Fukuda suggested that bilateral pressure on
Indonesia, at a level above the Minister of Health, to behave
more responsibly is a better approach than pressure from WHO.
He said, however, that having now heard from the Core Group
he would be able to stress to Indonesia that its lack of
reporting is not well received by countries. (Comment.
Mission believes USG should raise this issue with WHO
Director-General Chan, and is prepared to do so. End
comment.)
STORELLA