VZCZCXRO5492
RR RUEHCHI RUEHCN RUEHDT RUEHHM
DE RUEHJA #0815/01 1140905
ZNR UUUUU ZZH
R 230905Z APR 08
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC 8798
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 8405
RUEHBY/AMEMBASSY CANBERRA 2387
RUEHFR/AMEMBASSY PARIS 1104
RUEHGV/USMISSION GENEVA 7756

UNCLAS SECTION 01 OF 03 JAKARTA 000815 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR EAP/MTS, G/AIAG AND OES 
USAID FOR ANE/CLEMENTS AND GH/CARROLL 
DEPT ALSO PASS TO HHS/MLEAVITT/WSTEIGER AND HHS/NIH 
GENEVA FOR WHO/HOHMAN 
 
E.O. 12958: N/A 
TAGS: TBIO AMED CASC EAGR AMGT PGOV ID
SUBJECT: INDONESIAN MINISTERS DISCUSS SAMPLE SHARING AND HEALTH 
CONCERNS WITH HHS SECRETARY LEAVITT 
 
1.(SBU) Summary.  During a series of meetings on April 14, the 
Indonesian Ministers of Foreign Affairs, Health, Agriculture and the 
Coordinating Minister of People's Welfare discussed highly 
pathogenic avian influenza and other health concerns with Secretary 
of Health and Human Services (HHS) Michael O. Leavitt.  All 
Indonesian interlocutors appreciated the high-level visit and hoped 
that differences of opinion on sample sharing would not hinder 
broader cooperation on other important health issues.  The 
Indonesians stressed the need for greater transparency of the World 
Health Organization (WHO) Global Influenza Surveillance Network 
(GISN), which they proposed renaming; more equitable access to 
vaccines and medicines; use of a standardized Materials-Transfer 
Agreement when sharing samples; and a concrete, "monetary" benefits 
package.  Secretary Leavitt emphasized that although the United 
States supports equitable access to vaccines and medicine, he 
believes the issue should not be directly linked to sample sharing. 
Other issues discussed included the status of the Naval Medical 
Research Unit (NAMRU-2); cooperation on disease surveillance and the 
control of HIV/AIDS, tuberculosis, and malaria; and creating 
increased opportunities for science and technology exchange.  A list 
of participants for each meeting appears in paragraphs 9 and 10. End 
Summary. 
 
Sample Sharing and Highly Pathogenic Avian Influenza 
--------------------------------------------- ------- 
 
¶2. (SBU) Throughout the visit, Secretary Leavitt emphasized that 
Indonesia is an important friend to the United States, and that both 
countries share a commitment to democracy and a desire to be 
partners on a broad range of health issues.  He stressed that in any 
partnership, there are moments of disagreement where face-to-face 
meetings between partners can help better understand and work 
through differences.  Leavitt then clarified the United States is 
fully supportive of Indonesia's efforts to promote greater 
transparency in the WHO GISN and equitable access to 
vaccines/medications.  However, the United States sees access to 
vaccines/medicine as a separate issue that should not have linkages 
to the sharing of individual samples. He emphasized, and noted that 
viruses travel from country to country, which makes the concept of 
virus ownership impractical. Applying monetary value to viruses 
would create serious setbacks for science, the Secretary asserted. 
 
 
¶3. (SBU) The Indonesians continued to stress the need for a 
user-friendly system to track virus samples as they move between 
laboratories; the use of standardized Materials-Transfer Agreements 
(MTAs); an advisory oversight committee for the WHO GISN, which they 
proposed renaming the "WHO Influenza Network"; and a concrete 
"monetary" benefits package linked to the sharing of virus samples. 
Aburizal Bakrie, the Coordinating Minister for People's Welfare, 
told Leavitt that Indonesia does not have a problem with sharing 
viruses, but needs more discussion on the benefits that would accrue 
to countries that share samples, such as low-cost vaccines.  He said 
he was optimistic about resolving the remaining issues within two 
months.  Minister of Health Siti Fadilah Supari reiterated her view 
that the Indonesian virus strain is unique, and belongs to the 
Indonesian people.  She reaffirmed her view that sharing of samples 
should have direct links with monetary benefits such as discounts, 
but not royalties. Minister of Agriculture Anton Apriyanto noted 
that Indonesia is sharing poultry viruses but needs greater 
assistance in helping combat the disease among chickens and ducks. 
He also noted that the entire country only has 1,500 veterinarians. 
(NOTE: Minister Supari sent a letter at the end of the day to 
Secretary Leavitt clarifying that her use of the term "monetary 
 
SIPDIS 
benefit" did not refer to royalty or quid-pro-quo arrangement. END 
NOTE.) 
 
¶4. (SBU) Bill Steiger, Special Assistant for International Affairs 
to Secretary Leavitt, outlined the progress that both countries have 
made to close the gaps in their respective positions including a 
better definition of how samples will pass into the WHO network; a 
shared concern that the WHO Secretariat should accelerate its work 
to define the procedures and prioritization for the international 
influenza vaccine stockpile; and a shared desire to help 
 
JAKARTA 00000815  002 OF 003 
 
 
laboratories in developing countries qualify as WHO collaborating 
centers on influenza.  Steiger raised additional ideas, including 
dialogue with pharmaceutical companies on tiered pricing for 
vaccines and engagement of a neutral third party (like the Bill and 
Melinda Gates Foundation) to convene a panel of experts to think 
through the issues around access to vaccine issues and a pandemic 
stockpile. 
 
¶5. (SBU) Secretary Leavitt agreed to pursue discussions on the 
two-month timeframe that Minister Bakrie suggested. In later remarks 
to the associated press, he said, "If Indonesia decides not be a 
part of the world community and the international mainstream on this 
for a time, that would be regrettable. The world will be slightly 
less safe, but at some point we have to move onto finding other ways 
to make the world safe."  The Secretary also posted an entry on his 
blog regarding his conversations with the Indonesian Minister, 
available at www.hhs.gov. 
 
Status of NAMRU-2 
------------------ 
 
¶6. (SBU) Secretary Leavitt and the Indonesian ministers discussed 
the status of NAMRU-2 in all meetings.  The Secretary described 
NAMRU-2 as a valuable shared resource for both Indonesia and the 
United States, but indicated he had not previously understood 
Indonesian sensitivities that NAMRU-2 is a military laboratory.  He 
suggested that NAMRU-2 arrange for Indonesian senior leadership to 
visit other U.S. Department of Defense overseas laboratories to 
understand NAMRUs' role in their respective host countries. 
 
¶7. (SBU) Secretary Leavitt pressed the Indonesians as to why the 
government of Indonesia (GOI) was insisting that NAMRU use MTAs when 
virus samples coming to NAMRU-2 stay within Indonesia.  He said he 
saw this as separate and different from the discussions about the 
international sharing of virus samples, when the packages actually 
leave Indonesian territory.  Minister Supari responded that NAMRU-2 
is a foreign country's laboratory, and because she does not have 
control over its operations, she must insist on MTAs. (NOTE: Later 
in the week, Minister Supari made an unannounced visit to NAMRU-2 
to, in her words, "Say hello."  She continued to voice disquiet over 
the presence of an American military laboratory in Jakarta, even 
though the facility sits on the campus of the Ministry of Health and 
has been a well-known collaborator with the Ministry institution for 
decades.  END NOTE.) 
 
Concerns about HIV/AIDS and Tuberculosis 
---------------------------------------- 
 
¶8. (SBU) Meeting participants also discussed other important 
Indonesian health concerns, including tuberculosis, HIV/AIDS and 
malaria. Minister Bakrie described tuberculosis as Indonesia's 
largest health issue, and tried to put the H5N1 influenza virus into 
a larger context.  He reported that tuberculosis claimed 140,000 
victims in Indonesia last year or about 400 per day, in comparison 
to the cumulative statistics of 132 cases of human H5N1 infection, 
with 107 deaths. 
 
¶9. (SBU) Dr. Nafsiah Mboi, Secretary to the National AIDS/HIV 
Commission described great concern over Indonesia's growing HIV/AIDs 
problem, which she called the fastest growing epidemic disease in 
Asia. She described that different provinces face different epidemic 
threats.  Although experts characterize most of Indonesia (31 of 33 
provinces) as a concentrated epidemic among at-risk populations, 
Papua and Western Papua have generalized epidemics with up to 2.4 
percent of the province's population and 3.5 percent ethnic Papuans 
infected with HIV.  She noted that 22 percent of female sex workers 
in Papua, and up to 52 percent of prisoners in Indonesia, have 
HIV/AIDS.  Dr. Mboi expressed her opinion that the GOI must increase 
the scale of current interventions to keep pace with the growing 
prevalence. She explained that in 2007, the Indonesian government 
made HIV/AIDs a budget priority and increased government spending. 
However, although infections are increasing, foreign assistance is 
dropping, and Dr. Mboi made a pitch that the GOI needs greater 
technical assistance and collaboration. 
 
 
JAKARTA 00000815  003 OF 003 
 
 
Key Participants 
----------------- 
 
¶10. (U) Indonesia: Coordinating Minister for People's Welfare 
Aburizal Bakrie, Minister of Health Siti Fadilah Supari, Minister of 
Agriculture Anton Apriyanto, National Minister for Foreign Affairs 
Hassan Wirajuda, National Committee for Avian Influenza Control 
Secretary Bayu Krisnamurthi, Secretary to the National AIDS/HIV 
 
SIPDIS 
Commission Nafsiah Mboi, Senior Health Policy Advisor to Minister 
Supari Widjaja Lukito, Director General of the Ministry of Health's 
National Institute for Health Research and Development Triono 
Soendoro, Director General of the Ministry of Health's Center of 
Disease Control and Environmental Health Nyoman Kandun. 
 
¶11. (U) United States:  HHS Secretary Michael Leavitt; Ambassador 
Cameron Hume; HHS Assistant Secretary for Budget, Technology and 
Finance Charles Johnson; Special Assistant to Secretary Leavitt for 
International Affairs William Steiger; Deputy Assistant Secretary of 
Public Affairs Holly Babin; Director of the Office of Asia and the 
Pacific Christopher Hickey; and HHS Centers for Disease Control and 
Prevention Country Director Frank Mahoney. 
 
¶12. (U) Secretary Leavitt's party cleared this cable. 
 
HUME