VZCZCXRO5182
RR RUEHCHI RUEHDT RUEHHM
DE RUEHJA #5701/01 1251022
ZNR UUUUU ZZH
R 051022Z MAY 06
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC 3764
RUEHPH/CDC ATLANTA GA
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RUENMED/BUMED WASHINGTON DC
RHEFDIA/DIA WASHINGTON DC
RUEKJCS/SECDEF WASHDC
RHHMUNA/CDR USPACOM HONOLULU HI
RUEKJCS/CJCS WASHDC
RUEHBY/AMEMBASSY CANBERRA 9391
RUEHFR/AMEMBASSY PARIS 0841
RUEHRO/AMEMBASSY ROME 1866
RUEHIN/AIT TAIPEI 1788
RUEHHK/AMCONSUL HONG KONG 2127
RUEHBJ/AMEMBASSY BEIJING 3396
RUEHHM/AMCONSUL HO CHI MINH CITY 0061
RUEHGZ/AMCONSUL GUANGZHOU 0219

UNCLAS SECTION 01 OF 06 JAKARTA 005701 
 
SIPDIS 
 
SIPDIS 
SENSITIVE 
 
DEPT FOR EAP/IET, A/MED AND S/ES-O 
DEPT FOR OES/FO, OES/EID, OES/PCI, OES/STC AND OES/IHA 
DEPT PASS TO USDA/FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG 
DEPT ALSO PASS TO USDA/FAS/FAA/DYOUNG AND USDA/APHIS 
DEPT ALSO PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL 
DEPT ALSO PASS TO HHS/BILL STEIGER AND AMAR BHAT 
PARIS FOR FAS/AG MINISTER COUNSELOR 
CANBERRA FOR APHIS/DHANNAPEL 
ROME FOR FAO 
NSC FOR JMELINE 
BANGKOK FOR RMO, CDC, USAID/RDM/A 
USPACOM ALSO PASS TO J07 
 
E.O. 12958: N/A 
TAGS: TBIO AMED CASC EAGR AMGT PGOV ID KFLU
SUBJECT: May 4 AVIAN INFLUENZA UPDATE (AI): VISIT OF AI 
SPECIAL REPRESENTATIVE AMBASSADOR LANGE 
 
REF: Jakarta 5308 and previous 
 
JAKARTA 00005701  001.2 OF 006 
 
 
¶1. (SBU) Summary: The Department of State's Special 
Representative for Avian and Pandemic Influenza Ambassador 
John Lange met with senior Indonesian officials, including 
Coordinating Minister for Peoples' Welfare Aburizal Bakrie, 
on May 1 to discuss U.S. efforts to address the AI pandemic 
threat and support the GOI's efforts to combat the virus. 
Bakrie told Ambassador Lange that although the Government of 
Indonesia (GOI) has AI "under control" with its limited 
resources, Indonesia still needs USD 900 million over the 
next three years to overcome the disease.  Ambassador Pascoe 
highlighted NAMRU-2's contributions to Indonesia, and 
contrasted the Ministry of Health's (MOH) improving AI 
response to apparent inaction at the Ministry of Agriculture 
(MOA).  At a luncheon with donor representatives, 
participants said bilateral funding channels remain 
preferable to a multi-donor trust fund for AI.  A 
representative from the United Nation's Food and 
Agricultural Organization (FAO) worried about inadequate 
compensation for culled chickens and a World Health 
Organization (WHO) representative expressed concern about 
the implications of the continuing flow of human AI cases in 
Indonesia.  Senior MOA and MOH officials admitted to 
Ambassador Lange that coordination at the national level is 
wanting, but said it is quite good at the local level. 
During a local TV interview, Ambassador Lange stressed the 
importance of coordination at all levels, praised the 
President's creation of the National AI Committee, and 
highlighted NAMRU-2's role in helping the GOI fight AI. 
NAMRU-2 reports no new human H5N1 cases in the past week. 
End summary. 
 
¶2. (U) The State Department's Special Representative for 
Avian and Pandemic influenza (AI) Ambassador John Lange met 
May 1 with senior Indonesian officials, including 
Coordinating Minister for Peoples' Welfare Aburizal Bakrie, 
Dr. Nyoman Kandun, Director General for Disease Control and 
Environmental Health at the MOH, Dr. Triono Soendoro, 
Director General for the National Institute for Health 
Research and Development (LITBANGKES) of the MOH, and Dr. 
Syamsul Bachri, Director of Animal Health at the MOA. 
Ambassador Lange described U.S. efforts to address the AI 
pandemic threat and offered support for the GOI's own 
efforts to combat the deadly virus.  Ambassador Lange also 
toured the facilities of the Naval Medical Research Unit 
(NAMRU-2) and discussed its diagnostic and research 
activities with senior staff. 
 
Meeting with Coordinating Minister Bakrie 
----------------------------------------- 
 
¶3. (SBU) In the meeting with Coordinating Minister for 
Peoples' Welfare Bakrie, the GOI's lead on AI, Ambassador 
Lange noted U.S. concern about AI, as reflected in his 
appointment as Special Representative for Avian and Pandemic 
Influenza and the reorganization of various U.S. agencies to 
face the AI threat.  He also congratulated Minister Bakrie 
on his appointment as the GOI's lead on avian influenza as 
 
JAKARTA 00005701  002.2 OF 006 
 
 
stipulated in the Presidential Decree creating the National 
Committee on Avian Influenza (reftel). 
 
¶4. (SBU) Bakrie acknowledged the importance of his 
ministry's role in combating AI, especially in coordinating 
between the MOH and MOA, which he said could still use 
improvement.  In response to Ambassador Lange's query about 
the effectiveness of coordination between the two ministries 
and problems caused by decentralization, Bakrie said his 
ministry would use its authority under the Presidential 
Decree to resolve the issue.  In response to Ambassador 
Pascoe's comparison of the MOA's apparent inaction with the 
MOH's improving response to AI, Bakrie said a lack of funds 
and information is the root cause, but that both should 
become more available.  He also blamed the MOA's inaction on 
the ministry's lack of authority over local governments, 
which he believed the Presidential Decree would resolve. 
 
¶5. (U) Bakrie outlined the five core functions of the 
National AI Committee: 1) research; 2) animal health; 3) 
human health and preparedness; 4) public relations; and 5) 
medical products such as anti-virals and medicine. He 
provided an update on AI in the human and animal sector, 
claiming that human deaths had ceased at 22 (actually 26 as 
of May 1) and poultry infections were now restricted to 
small enterprises and backyard holdings (sectors 3 and 4), 
which cannot afford vaccines.  Bakrie also claimed the GOI's 
vaccination program enjoyed apparent success despite 
criticism about the danger of rising immunity levels in 
vaccinated chickens.  He admitted, however, that 
restructuring the poultry sector is a top priority and a 
difficult challenge.  World Bank President Wolfowitz's visit 
to the Jakarta suburb of Tangerang (the site of a number of 
human AI cases) confirmed the difficulty of such 
restructuring.  Ambassador Lange concurred, and noted the 
importance of changing culture and behavior.  He warned that 
changing practices in the poultry sector could take a long 
time and would requiring an active communication campaign 
down to the village level. 
 
¶6. (SBU) Touching on his favorite theme, Bakrie told 
Ambassador Lange that although his government has AI "under 
control" with limited resources (an AI budget of USD 50 
million for the next few years), Indonesia actually needs 
USD 900 million for the next three years to overcome the 
disease.  He complained that Indonesia would reportedly 
receive only USD 150 million of the USD 1.9 billion pledged 
at the January 2006 donors' conference in Beijing.  Bakrie 
concurred with Ambassador Lange's assessment of the 
importance of NAMRU-2 and the Indonesia-Singapore-U.S. 
trilateral project.  The Minister said he would recommend 
expanding the project to include the entire district of 
Tangerang since poultry was more plentiful there than in the 
municipality of Tangerang.  Ambassador Lange closed the 
meeting by urging Bakrie to ensure senior GOI representation 
at the second International Partnership on Avian and 
Pandemic Infuenza (IPAPI)meeting June 6-8 in Vienna. 
 
Ministry of Health Meeting 
 
JAKARTA 00005701  003.2 OF 006 
 
 
-------------------------- 
 
¶7. (SBU) In his discussions with Director General (DG) for 
Disease Control and Environmental Health (CDC/EH) Dr. Nyoman 
Kandun and the newly-appointed DG of the National Institute 
of Health Research and Development (Litbankes) Dr. Triono 
Soendoro, Ambassador Lange reiterated the impressive 
contribution of NAMRU-2 to the MOH's mission, the importance 
of good MOA and MOH interaction, the critical role of 
communication in overcoming AI, and the need for changes in 
behavior and animal husbandry practices.  Regarding the 
latter point, Kandun stated frankly that such changes are 
highly unlikely, since they are steeped in tradition. 
 
¶8. (U) Kandun claimed MOH outreach to the village level is 
already improving, but would improve further through 
revitalizing simple technology, biosecurity and risk 
communications.  Dr. Triono concurred, noting that the mass 
successful mass communication efforts for four recent rounds 
of mass polio vaccinations proved this.  Dr. Triono 
emphasized the importance of research in the fight against 
AI given the absence of hard evidence of AI transmission 
between humans.  He pointed out that Indonesia has received 
funding to build several BSL-3 labs, but that bringing BSL-3 
labs online would entail not only construction issues but 
also human capacity and adequate regulations.  Triono 
admitted that the MOH lacked BSL-3 qualified scientists and 
hoped the U.S. could provide required training. 
 
Ministry of Agriculture Meeting 
------------------------------- 
 
¶9. (SBU) Ambassador Lange met Dr. Delima Azahari, Assistant 
to the Minister and the Head of MOA's AI Task Force, Dr. 
Syamsul Bahri, MOA's Chief Veterinary Officer, and Dr. 
Bagoes Poermadjaja, Head of MOA's Animal Disease 
Surveillance Branch.  Ambassador Lange said he fully 
appreciates the complexity of the AI challenge, praised the 
establishment of the National Committee to coordinate 
efforts across departments, and commended MOA for its 
efforts.  He said the U.S. looks forward to continued 
cooperation with MOA.  Dr. Delima described the purpose of 
MOA's AI Task Force, which is to coordinate activities 
across the three MOA Directorates General responsible for 
AI: the Directorate General for Livestock Services (DGLS), 
which implements surveillance, reporting, vaccination, 
culling and compensation programs, and also overseas the 
Regional Disease Investigation Centers that perform testing 
and diagnostics; the Directorate General for Quarantine, 
which controls animal movements and imports; and the 
Directorate General for Research and Development.  She also 
noted that DGLS had created a Campaign Management Unit 
specifically for AI and staffed only by veterinarians.  Dr. 
Delima acknowledged that the lack of compensation funds and 
qualified vets hampers MOA's AI efforts. 
 
¶10. (U) Dr. Delima explained that AI hit Indonesia in two 
waves: the first in 2003/04, which primarily struck large- 
scale chicken farms and resulted in high mortality; and a 
 
JAKARTA 00005701  004.2 OF 006 
 
 
second wave in 2005-06 that has impacted primarily on small- 
scale producers and back-yard flocks and has spread to more 
avian species (more water fowl and quail).  She also said 
that MOA was implementing a nine-point strategy to deal with 
the disease, with vaccination, selective culling, 
biosecurity, and enhanced laboratory capacity as the 
backbones of the strategy.  When asked what the long-term 
goal of the strategy was, MOA officials acknowledged that 
eradication would be very difficult if not impossible to 
obtain in the near future.  Dr. Azahari said they had a 
"vision" for "minimizing" incidence of the disease in three 
years. 
 
¶11. (U) MOA officials noted that the USAID-funded FAO 
project to develop surveillance and rapid response teams has 
been very successful, and is strengthening the Ministry's AI 
reporting and response capacity.  They said the recent 
creation of the National Committee had strengthened their 
hand in dealing with local governments, and in getting them 
to implement the national strategy.  They also observed that 
changing behaviors and basic animal husbandry practices 
remains a huge challenge and vaccination coverage needs to 
be expanded.  In addition, they confirmed that AI continues 
to spread to new provinces, including most recently West 
Irian Jaya (Papua). 
 
Meeting with Donors 
------------------- 
 
¶12. (SBU) At a luncheon discussion with with representatives 
from the FAO, WHO, and Australian and Singaporean Embassies, 
WHO Country Representative Georg Peterson expressed the 
concern that Indonesia remains the only country with 
steadily rising human AI cases and fatalities.  He added 
that as long as the virus remains in endemic in poultry, 
this situation would not change.  He also noted that that 
although evidence suggests some human AI cases have gone 
unreported, NAMRU-2's extensive influenza surveillance 
network would have detected a large outbreak of human AI 
cases if it existed.  Dr. Peterson also highlighted the lack 
of information sharing between the MOH and MOA. 
 
¶13. (SBU) FAO Country representative Man Ho So agreed, 
pointing out the MOA also needs to be empowered, 
notwithstanding the coordinating role of Bakrie's ministry. 
He said the USAID-funded FAO program will focus on the 
island of Java first, which contains most of the Indonesia's 
human and poultry population, and then scale up to Sumatra 
and finally nationwide.  So said compensation to farmers 
remains an issue, with the GOI opting for Rp 10,000 per bird 
(USD 1.15) while the FAO recommends Rp 15,000 (USD 1.7).  He 
stressed, however, that the timing, not the level of 
compensation is the decisive issue and that speedy 
compensation (3 days) during a recent cull in Indramayu, 
West Java could serve as a model.  The Australian 
representative said the GOI and donors need to address the 
stigma many Indonesians attach to families affected by AI in 
both poultry and humans.  She also pointed out that Bakrie's 
ministry seems to have the authority but not the resources 
 
JAKARTA 00005701  005.2 OF 006 
 
 
to execute its coordinating mandate. 
 
¶14. (SBU) In response to the USAID Director Frej's query 
about funding levels for AI, Peterson suggested that it was 
probably inadequate, given the significantly higher funding 
for tuberculosis and HIV/AIDS.  He said spending on AI 
should be viewed as an investment in health infrastructure 
in preparation for other emerging diseases.  So outlined the 
FAO's cooperative efforts with the U.S., Japan, Holland and 
Australia.  Peterson recommended donors urge the government 
to carefully evaluate its laboratory options, resources and 
priorities, as well as the implications for operating high 
biosecurity level facilities.  When Ambassador Lange sought 
donors' view on an AI Multi Donor Trust Fund coordinated by 
the EU and the World Bank, the consensus was that the donor 
experience in Aceh suggests that creating such a trust fund 
for AI is probably not worth the effort, with bilateral 
funding channels offering quicker and more flexible 
responses. 
 
TV Interview and NAMRU-2 Tour 
----------------------------- 
 
¶15. (U) In an interview with local television station Lativi 
(seen by seven million viewers), Ambassador Lange stressed 
the importance of coordination at all levels of government, 
especially between health and agriculture departments.  He 
praised the President's creation of the National AI 
Committee headed by Minister Bakrie, and NAMRU-2's role in 
helping the GOI fight AI.  He also noted behavior change 
(i.e., the close interaction between humans and poultry) 
constitutes the most difficult challenge for Indonesia and 
other developing countries. 
 
¶16. (U) During his visit to NAMRU-2 facilities, Ambassador 
Lange discussed NAMRU-2's research and diagnostic activities 
related to AI.  NAMRU-2's key point to the Ambassador 
centered on the sustained nature of human AI infections 
since the initial case last July.  Asked to explain its role 
in helping the GOI to fight the virus, NAMRU-2 Commander 
Mark Wooster said his agency's contributions included: a) 
providing Indonesia the only functioning influenza 
surveillance network; b) furnishing information to the GOI 
to inform policy making; c) providing training/capacity 
building for research and diagnostics to Indonesian staff; 
d) offering access to first-rate labs; and e) training 
University students and technicians by providing access to 
its labs.  He also noted that NAMRU-2 also serves as a 
reservoir of viral research to the U.S. Center for Disease 
Control (CDC) by providing it hundreds of virus samples 
every year. 
 
Human AI Case Profile 
--------------------- 
 
¶17. (U) NAMRU-2 reports no new H5N1 cases in humans in the 
past week.  NAMRU-2 data indicates the following AI-related 
case profile as of May 5: 
 
 
JAKARTA 00005701  006.2 OF 006 
 
 
-- Number of laboratory confirmed (positive PCR and/or 
serology) human AI cases: 35, of which 26 have been fatal 
(fatality rate of 74 percent). 
 
-- Number of probable AI cases: 4, with 3 deaths (fatality 
rate of 75 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: 277. 
 
¶18. (U) Ambassador Lange did not have an opportunity to 
review this message. 
 
PASCOE