VZCZCXRO1203
PP RUEHCHI RUEHDT RUEHHM
DE RUEHJA #1344/01 2560228
ZNR UUUUU ZZH
P 130228Z SEP 06
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC PRIORITY 9939
RUEHPH/CDC ATLANTA GA PRIORITY
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC PRIORITY
RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RHMFIUU/BUMED WASHINGTON DC
RHEFDIA/DIA WASHINGTON DC
RUEKJCS/SECDEF WASHDC
RHHMUNA/CDR USPACOM HONOLULU HI
RUEKJCS/CJCS WASHDC
RUEHBY/AMEMBASSY CANBERRA 9913
RUEHFR/AMEMBASSY PARIS 0951
RUEHRO/AMEMBASSY ROME 1933
RUEHIN/AIT TAIPEI 1861
RUEHHK/AMCONSUL HONG KONG 2197
RUEHBJ/AMEMBASSY BEIJING 3635
RUEHHM/AMCONSUL HO CHI MINH CITY 0131
RUEHGZ/AMCONSUL GUANGZHOU 0280

UNCLAS SECTION 01 OF 03 JAKARTA 011344 
 
SIPDIS 
 
SIPDIS 
SENSITIVE 
 
DEPT FOR EAP/MLS, EAP/IET, A/MED AND S/ES-O 
DEPT FOR G/AIAG/JLANGE AND RFENDRICK 
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/WSTEIGER/ABHAT/MSTLOUIS AND HHS/NIH 
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: MINISTRY OF HEALTH CHANGES AI SAMPLE SHARING 
PROCEDURES 
 
REF: A) Jakarta 09914 
 
JAKARTA 00011344  001.2 OF 003 
 
 
1.(SBU) Summary.  The Mission's Naval Medical Research Unit 
(NAMRU-2) has continued to be able to send samples to the 
Centers for Disease Control and Prevention (CDC) since 
Minister of Health Dr. Siti Fadilah Supari's August 3 
announcement that only three in-country laboratories would 
conduct tests on suspected H5N1 samples and confirm H5N1 
cases for Indonesia.  In the August 3 announcement, Supari 
also stated that the Ministry of Health (MOH) will no longer 
send samples to the World Health Organization (WHO) 
Reference Laboratory at the University of Hong Kong and 
would only send samples outside of Indonesia if 
collaborating institutes agree to a Materials Transfer 
Agreement (MTA).  While the reasons behind the announcement 
are not completely clear, the Government of Indonesia's 
(GOI) relationships with both the University of Hong Kong 
and WHO Indonesia have grown increasingly strained in recent 
months.  While samples continue to flow to CDC via NAMRU-2, 
the MTA issue remains unresolved and could impede future 
shipments.  End Summary. 
 
Announcements on Sample Sharing 
------------------------------- 
 
¶2. (U) At a press conference on August 3, Minister of Health 
Supari made three important announcements concerning testing 
samples for avian influenza and sharing data 
internationally.  At the conference, the Minister also 
expressed her satisfaction in the ability of local 
laboratories to accurately confirm newly emerging AI cases 
in humans. The three announcements are: 
 
--Effective immediately, three in-country laboratories 
exclusively will conduct tests and confirm H5N1 cases for 
Indonesia.  These laboratories are NAMRU-2, the Eijkman 
Institute and National Institute of Health Research and 
Development (NIHRD). 
 
--The GOI will not send samples to the WHO-Reference 
Laboratory at the University of Hong Kong and will only send 
samples outside of Indonesia if collaborating institutes 
agree to a Materials Transfer Agreement (MTA). 
 
--The GOI wishes to be more open and transparent and will 
seek to release information soon related to the sequencing 
of H5N1 viruses. 
 
¶3. (SBU) Upon hearing the announcement, NAMRU-2 immediately 
contacted MOH and received permission to continue to send 
samples to CDC.  Since August 3, NAMRU-2 has sent samples 
from five patients, including three recent cases from Garut. 
 
Motivations behind MOH Announcement 
------------------------------------ 
 
¶4. (SBU) While the reasons behind Supari's decisions are not 
completely clear, the MOH has been unhappy with delays in 
 
JAKARTA 00011344  002.2 OF 003 
 
 
receiving information from Hong Kong.  At the same time, the 
MOH has been generally satisfied with reports from NAMRU-2 
and US CDC.  Various contacts have told us that the MOH has 
become increasingly uncomfortable with Dr. Malik Peiris, 
senior investigator at the University of Hong Kong WHO 
reference laboratory.  According to our contacts, Malik has 
made public comments about H5N1 in Indonesia while in Hong 
Kong without clearing them with the MOH, and failed to 
inform MOH officials in advance that the Hong Kong 
laboratory was conducting research with H5N1 virus from 
Indonesia.  In addition, MOH officials have complained that 
the Hong Kong laboratory has not forwarded data on sequences 
in a timely and complete fashion. 
 
¶5. (SBU) At the same time, relations between the MOH and the 
WHO Indonesia office have deteriorated since the Karo 
District family cluster in May 2006 and the Expert 
Consultation sponsored by the WHO in June 2006.  Some MOH 
officials told us that they felt publicly criticized during 
the Expert Consultation, and several senior MOH officials 
made announcements denying firm evidence of human to human 
transmission in North Sumatra.  Jakarta-based WHO officials 
have also advocated that the MOH send specimens from human 
cases to the WHO-Reference Laboratory at Hong Kong 
University, while generally discounting results from the 
CDC. 
 
¶6. (U) Another MOH motivation for the revised sample sharing 
procedures may be that, under the leadership of Director 
General Dr. Triono Soendoro, the NIHRD is moving to develop 
the full capacity to diagnose and characterize influenza 
samples in-country in collaboration with the Eijkman 
Institute. 
 
Implications for NAMRU-2 
------------------------ 
 
¶7. (SBU) Dr. Triono has told us that he views the 
announcement as an endorsement of NAMRU-2, and in general, 
the MOH has been pleased with the responsiveness and 
completeness of reports from CDC and NAMRU-2.  The MOH has 
granted NAMRU-2 permission to continue to send samples to 
the CDC, and since Supari's announcement, NAMRU-2 has sent 
samples from eight patients including three recent cases 
from Garut. 
 
¶8. (SBU) However, the efficiency of sample transfers in the 
future will depend on any final MTA with the MOH.  The draft 
MTA the Ministry of Health has given NAMRU-2 is very 
restrictive, with provisions that would assert full control 
on sample flow, sample information and their usage for the 
production of vaccines.  It also raises complicated 
intellectual property rights issues, as well as topics that 
are to be covered in the upcoming GOI-NAMRU-2 Memorandum of 
Understanding.  NAMRU-2 is in the process of reviewing the 
draft MTA and meeting with various MOH officials to better 
understand the implications of the August 3 announcements. 
 
 
JAKARTA 00011344  003.2 OF 003 
 
 
¶9. (SBU) Comment: We believe that much of the driving force 
behind the Minister's announcement is a nationalistic appeal 
for Indonesia to develop full capacity to diagnose and 
characterize influenza samples in country.  However, no in- 
country laboratory currently has the capacity to perform 
necessary testing at the level performed by CDC.  Until the 
MOH and collaborating laboratories sort through the MTA and 
associated issues, the prospects of a more restrictive 
sample sharing regime could dampen NAMRU-2 and other 
researchers' abilities to conduct studies related to H5N1. 
End comment. 
 
PASCOE