Viewing cable 07JAKARTA1053
Title: INDONESIA - AVIAN INFLUENZA SAMPLE SHARING UPDATE

IdentifierCreatedReleasedClassificationOrigin
07JAKARTA10532007-04-13 08:51:00 2011-08-30 01:44:00 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Jakarta
VZCZCXRO3911
RR RUEHCHI RUEHDT RUEHHM
DE RUEHJA #1053/01 1030851
ZNR UUUUU ZZH
R 130851Z APR 07
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC 4328
RUEHPH/CDC ATLANTA GA
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RHHMUNA/HQ USPACOM HONOLULU HI
RHHMUNA/CDR USPACOM HONOLULU HI//J07/CATMED/CAT//
RUEHBK/AMEMBASSY BANGKOK 7865
RUEHBD/AMEMBASSY BANDAR SERI BEGAWAN 0377
RUEHBY/AMEMBASSY CANBERRA 0656
RUEHFR/AMEMBASSY PARIS 0999
RUEHGV/USMISSION GENEVA 7554
UNCLAS SECTION 01 OF 03 JAKARTA 001053 
 
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DEPT ALSO PASS TO HHS/WSTEIGER/ABHAT/MSTLOUIS AND HHS/NIH 
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E.O. 12958: N/A 
TAGS: TBIO AMED CASC EAGR AMGT PGOV ID
SUBJECT: INDONESIA - AVIAN INFLUENZA SAMPLE SHARING UPDATE 
 
REF: A) Jakarta 00933    B) Jakarta 00310 
 
     C) 4/5/07 Hohman Update e-mail 
 
¶1. (SBU) Summary: Despite Health Minister Fadilah Supari's March 28 
pledge to immediately begin sharing avian influenza (AI) samples, 
and similar pledges following World Health Organization (WHO) 
Director General Margaret Chan's April 4 Jakarta visit, the 
Government of Indonesia (GOI) has not yet resumed sharing AI 
samples.  GOI statements on the issue have vacillated between 
assurances that Indonesia will resume sharing samples immediately to 
inflammatory op-ed pieces in newspapers.  NIHRD Director Dr. Triono 
Soendoro and his deputy, Dr. Endang Sedyani, will lead the GOI 
delegations to upcoming meetings on sample sharing and vaccine 
policy in Geneva, making any resumption of sample sharing unlikely 
until the two return to Jakarta in late April.  A WHO Assessment 
team from Tokyo will visit the National Institute of Health (NIHRD) 
and the Eijkman Institute on April 23 to assess their qualifications 
for appointment as a WHO Collaborating Center for H5N1.  The 
inability of international laboratories to confirm MOH-diagnosed AI 
cases has led to a gap between the GOI's confirmed case count (94 AI 
cases with 74 deaths), counts at NAMRU-2 (83 AI cases, with 64 
deaths) and WHO (81 cases with 63 deaths).  End Summary. 
 
Sample Sharing: Gap Between GOI Rhetoric and Action 
--------------------------------------------- ------ 
 
¶2. (SBU) Following World Health Organization (WHO) Director General 
Margaret Chan's meetings of April 4 with President Susilo Bambang 
Yudhoyono, Health Minister Supari and Foreign Minister Hassan 
Wirjuda, Supari announced again that the GOI would resume immediate 
sending of samples.  Various Indonesian press covered the Chan visit 
and carried different accounts of when the sharing would take place. 
 One newspaper quoted Supari as indicating samples will be shared 
immediately, while another noted  "We will resume the sending of 
virus sample for the sake of global interests. The delivery will 
take place this year, within two months from now at the latest." 
NIHRD Director Dr. Triono Soendoro also told an Embassy employee the 
week of April 9 that the MOH would resume sample sharing with 
NAMRU-2. 
 
¶3. (SBU) However, just a week after the Chan visit, Supari authored 
a highly nationalistic op-ed in the Indonesian daily KOMPAS entitled 
"Bird Flu and Nation's Sovereignty." According to an Embassy 
translation, Supari writes "...The debate over the H5N1 virus 
between WHO and Indonesia demonstrates that, as long as an 
independent nation still depends on other nation(s), that nation is 
still subjugated...Indonesia, together with other developing 
nations, has just established a front to confront WHO, which always 
sides with rich countries in dealing with matters pertaining to 
public health, including bird flu... Exploitations carried out by 
industrial countries against poor developing countries are nothing 
new...Indonesia has had the courage to take a stance, albeit 'only' 
in the field of health...One thing worth noting; from the bird flu 
virus we realize that a sovereign nation is capable of upholding 
human dignity even though there is a long road ahead." 
 
¶4. (U) The op-ed also implies that NAMRU-2 improperly obtained AI 
samples. It reads "Since 2005, Indonesia had been sending samples to 
WHO laboratories because laboratories in Indonesia were considered 
not yet meeting requirements. Health agencies from other countries 
also tried to take Indonesian specimens either by visiting a victim 
directly or hospital, e.g. NAMRU2 who later sent the specimens to 
CDC Atlanta."  (Note: This is false.  NAMRU-2 has obtained NIHRD 
permission to ship all samples, and has records on file to prove 
it.) 
 
¶5. (U) Indonesian press ran numerous articles on Chan's visit.  The 
Jakarta Post reported that Chan said the global vaccine reserve 
would be of great importance for developing countries in their fight 
against avian influenza, noting "We will look at how to develop 
global stockpiles of vaccines, particularly for developing 
countries."  Chan said the WHO would gather resources from developed 
countries, donors as well as large drug-makers to make the plan 
work.  Press also quoted Chan as having emphasized that the global 
fight against bird flu required the full cooperation of developing 
 
JAKARTA 00001053  002 OF 003 
 
 
countries, an obligation that will be enshrined in a new global 
regulation.  "The sharing of information on the virus is a 
requirement for all countries under an international health 
regulation which will come into effect June 15." 
 
NIHRD Conducts Data Review of Indonesian Samples 
--------------------------------------------- --- 
 
¶6. (SBU) According to Ref C, NIHRD Director Dr. Triono Soendoro has 
requested a review of institutes that have requested viruses from 
Indonesia, and the data generated from analysis of these viruses. 
(Note: On multiple occasions, NAMRU-2 and the CDC have provided 
multiple senior officials at MOH (including Dr. Triono and Director 
General for the Center for Communicable Diseases Nyoman Kandun) 
electronic and hard copies summarizing findings. The CDC has also 
given the MOH disks containing complete sequencing information on at 
least two occasions, including in January 2007.) 
 
GOI Plans for Upcoming WHO Meetings and Visits 
--------------------------------------------- -- 
 
¶7. (SBU) Dr. Endang Sedyani, Deputy Director of National Institute 
of Health Research and Development (NIHRD) told us April 10 that 
both Endang and Triono will participate in sample sharing 
discussions in Geneva from April 18-20. Endang will first accompany 
Minister Supari to bilateral meetings in Madrid before heading to 
Geneva.  Although Triono will return to Jakarta on April 21, Endang 
will stay on to participate in the April 23-25 vaccine policy 
meetings. Endang also stated that NIHRD is preparing for the April 
23 visit of Dr. Masato Tashiro, Director of the WHO Collaborating 
Center in Tokyo.  Dr. Tashiro will evaluate the qualifications of 
the NIHRD and the Eijkman Institute to become a WHO Collaborating 
Center for the diagnosis of H5N1. 
 
NIHRD Claims NAMRU-2 Steals Their Thunder 
---------------------------------------- 
 
¶8. (SBU) Endang explained that NIHRD researchers want peer respect 
in the international research community.  One of the sensitivities 
that NIHRD has felt with NAMRU-2 is the fact that international 
researchers visiting Indonesia contact NAMRU-2 researchers first for 
their views, she said.  In a separate meeting on April 3, Endang 
told us that NIHRD would likely seek to take over NAMRU's flu 
surveillance network and analyze all samples at the NIHRD, confining 
NAMRU-2 to projects specifically directed to "research." (Note: 
"Surveillance" is a charged word in Indonesia because of its 
intelligence gathering connotations.)  When asked how NIHRD will pay 
for the costs of maintaining the network, Endang replied that NIHRD 
would likely use CDC funding.  We explained that research sponsors 
usually direct funds to activities related to ongoing research 
projects, and that unlike development assistance, sponsors generally 
consider research funding as an investment in future joint research. 
 Endang seemed surprised by this point.  (Note:  Despite her 
comments, Endang did not specify a deadline for taking over 
NAMRU-2's surveillance system, which continues to operate.) 
 
Conflicting AI Counts 
--------------------- 
 
¶10. (SBU) As a result of the sample impasse, Ministry of Health 
(MOH), NAMRU-2 and WHO now post different confirmed AI case 
statistics, per Table 1. 
 
--------------------------------------------- --- 
Table 1: Indonesia AI Case Counts (4/13/07) 
--------------------------------------------- --- 
                  No.       No.      Fatality 
Organization    Cases     Deaths       Rate 
--------------------------------------------- --- 
MOH              94        74           78% 
 
NAMRU-2          83        64           77% 
 
WHO (1)          81        63           78% 
 
 
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(1) WHO figures date from when the MOH still sent samples to WHO 
Collaborating Centers for confirmation via NAMRU-2. 
 
¶11. (SBU) NAMRU-2 tests suggest that at least two of the GOI 
positive AI cases were likely not positive for H5N1. Based on 
laboratory findings and epidemiological and clinical review of data, 
NAMRU-2 believes two cases from January 2007 (a 15 year-old female 
from Tangerang and a 30 year-old male from Bandung) did not result 
from AI.  As both patients are alive and well, NAMRU-2 has 
encouraged NIHRD to seek additional molecular and serologic testing. 
 
 
HEFFERN