REPORTING OF INDONESIA HUMAN AVIAN INFLUENZA

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