VZCZCXRO8667
RR RUEHCHI RUEHCN RUEHDT RUEHHM
DE RUEHJA #0137/01 0230857
ZNR UUUUU ZZH
R 230857Z JAN 08
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC 7729
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 8299
RUEHBY/AMEMBASSY CANBERRA 1908
RUEHFR/AMEMBASSY PARIS 1078
RUEHGV/USMISSION GENEVA 7719

UNCLAS SECTION 01 OF 02 JAKARTA 000137 
 
SIPDIS 
 
SIPDIS 
SENSITIVE 
 
DEPT FOR EAP/MTS, G/AIAG AND OES 
USAID FOR ANE/CLEMENTS AND GH/CARROLL 
DEPT ALSO PASS TO HHS/WSTEIGER/ABHAT/MSTLOUIS AND HHS/NIH 
GENEVA FOR WHO/HOHMAN 
USDA FOR D U/S LAMBERT 
USDA/FAS/OSTA AND USDA/APHIS ANNELLI 
 
E.O. 12958: N/A 
TAGS: TBIO AMED CASC EAGR AMGT PGOV ID
SUBJECT: AVIAN INFLUENZA: REQUEST FOR PROGRAMMATIC REVIEW 
 
 
FROM AMBASSADOR HUME TO AMBASSADOR LANGE 
 
------- 
Summary 
------- 
 
1.(SBU) The avian influenza situation in Indonesia, although not now 
a crisis, remains alarming.  Our multiagency team is working hard on 
avian influenza issues.  We continue to press Indonesia to 
recommence human sample sharing while simultaneously providing 
assistance to improve the capacity to manage AI on both the human 
and animal sides.  We're making some progress on animal 
surveillance, but Indonesia lacks the capacity and commitment to 
aggressively tackle this problem.  The time is right for an external 
review of our more than $30 million in AI program assistance.  Given 
the scope of the AI problem here and the potential for a pandemic, I 
do not believe our program should be cut.  But we should make sure 
that our money is being spent in the best possible way.  End 
Summary. 
 
--------------------------------------------- --------- 
Human AI: Higher Mortality and Less Access to Samples 
--------------------------------------------- --------- 
 
2.(U) Indonesia leads the world in human AI infections with 120 
confirmed cases and 97 deaths.  From a public health standpoint, 
Indonesia has made minimal progress in early detection and clinical 
management of disease. Despite efforts to increase public awareness 
and the triage of suspected patients reporting to reference 
hospitals, the monthly number of cases remains constant. 
Indonesia's case fatality rate - 86 percent in 2007 - is the highest 
in the world.  Indonesia lacks basic procedures to limit public 
health risk.  Despite evidence of limited unsustained human-to-human 
transmission, the Ministry of Health (MOH) has been slow to address 
basic quarantine procedures.  Last week, hospital authorities 
allowed the family of a woman with confirmed AI to take her home to 
die rather than move her to quarantine in another hospital.  Failure 
to address these issues could contribute to epidemic or possible 
pandemic spread of the disease. 
 
3.(SBU) International research on risk assessment, virus mutation 
and vaccine development has been stymied since Minister of Health 
Supari blocked human sample sharing in January 2007.  Since then, 
Indonesia has shipped samples from only four of 39 patients.  Of 
these, only one virus was isolated and characterized. 
 
4.(U)  USAID supports human surveillance and public education. 
USAID is also providing assistance to the national avian influenza 
commission, KOMNAS.  USAID and the Centers for Disease Control CDC 
train scientists at the national laboratory Litbangkes. 
 
--------------------------------------------- ---- 
Poultry: Challenges But Signs of Progress As Well 
--------------------------------------------- ---- 
 
¶5. (SBU) Challenges abound in the agriculture sector as well. AI has 
been rampant in the country since July 2003.  In the nearly five 
years since the first outbreaks, little has been done to restructure 
poultry production, transport, or marketing in an effort to control 
the disease.   International veterinary experts agree that 
controlling the virus in poultry would take five to ten years of 
sustained efforts.  But indifferent senior leadership within the 
Ministry of Agriculture has resulted in limited funding and support 
for its teams of technical officers.  Decentralization of government 
authority and budgets to local governments, and weak regulatory and 
monitoring policies across the board further limit the authority of 
central government to tackle this issue. The GOI has inadequate 
control over commercial poultry producers, poultry markets and 
movement of poultry around the country.  Veterinary capacity is also 
severely limited. 
 
¶6. (U) But there has been progress as well.  With USAID assistance, 
disease surveillance is up and running in 159 districts and 
expanding to 308 districts by June 2008.  With the network in place 
 
JAKARTA 00000137  002 OF 002 
 
 
and teams trained and supported to conduct field activities, 
authorities can better track the virus in poultry.  We now know, for 
example, that the virus has been reported in poultry in 286 of 344 
districts and that it is endemic in Java, Bali and parts of Sumatra 
and Sulawesi, but remains sporadic in Kalimantan and other areas of 
Indonesia. 
 
¶7. (SBU) The Ministry of Agriculture continues to share samples 
despite pressure from the Ministry of Health to stop.  The Ministry 
is aware that animal virus sharing is essential for the development 
of an effective vaccine.  USAID is funding FAO and World 
Organization for Animal Health (OIE) laboratories to develop a new 
vaccine for Indonesia and leading the effort to intensify an 
effective control program. 
 
¶8. (U) USDA/APHIS has supported training and education efforts aimed 
at upgrading biosecurity and biosafety of local markets, improving 
the diagnostic capability of Ministry of Agriculture laboratories 
and private sector quantitative methods, and strengthening 
district-level epidemiological skills.  USDA/APHIS has also worked 
closely with Indonesian scientists on a number of avian vaccine 
challenge trials at the South East Poultry Research Laboratory in 
Athens, Georgia. 
 
------------------------ 
Expert Assessment Needed 
------------------------ 
 
¶9. (SBU) Given Indonesia's position as the epicenter of avian 
influenza, we must combat the spread of the disease here as part of 
the President's forward strategy.  But we must also ensure that our 
resources are being spent in the most effective way.  We need an 
external review of our avian influenza program assistance to 
evaluate whether to adjust current efforts to meet the challenges 
ahead.  I have asked the Embassy's Avian Influenza Working Group in 
Jakarta to work with your office to develop the terms of reference 
and to contract with an independent, external organization to 
conduct such a review over the next four months. 
 
¶10. (SBU) Ambassador's comment: There are now alarming signs that 
the risks are growing: the disease is endemic among poultry; human 
case-load (unlike elsewhere) is constant and surveillance 
inadequate; effectiveness of tamiflu is unknown and mortality rate 
increasing; and, the true epicenter is the township (Tangerang) in 
which Jakarta's international airport is located.  The Indonesian 
government seems oblivious to the risks, and local authorities have 
just sharply decreased funding for AI programs in Tangerang. 
Perhaps we do not yet have a full-blown crisis on our hands, but we 
could soon.  End comment. 
 
HUME