VZCZCXRO3806
PP RUEHCHI RUEHCN RUEHDT RUEHHM
DE RUEHJA #0877/01 1230829
ZNR UUUUU ZZH
P 020829Z MAY 08
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC PRIORITY 8902
RUEHPH/CDC ATLANTA GA
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEAWJB/DOJ WASHDC
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RUEHGV/USMISSION GENEVA 7766

UNCLAS SECTION 01 OF 02 JAKARTA 000877 
 
SIPDIS 
 
SIPDIS 
SENSITIVE 
 
DEPT FOR EAP/MTS, G/AIAG, L/DL, EAP/EX, AND OES/IHA 
USAID FOR ANE/CLEMENTS AND GH/CARROLL 
DEPT ALSO PASS TO HHS/WSTEIGER/ABHAT/MSTLOUIS AND HHS/NIH 
GENEVA FOR WHO/HOHMAN 
USDA/FAS/OSTA BRANT, ROSENBLUM 
USDA/APHIS ANNELLI 
 
E.O. 12958: N/A 
TAGS: TBIO EAGR KFLU AMGT PGOV ID
SUBJECT: INFLUENZA PANDEMIC SIMULATION EXERCISE 
 
¶1. (SBU) Summary.  The Indonesian Ministry of Health (MOH) hosted a 
three-day pandemic avian influenza simulation exercise in Jembrana 
Regency, Bali during 25-27 April 2008. The exercise focused on early 
detection and rapid containment of an epicenter outbreak of Avian 
Influenza virus with capacity for human-to-human transmission. More 
than 1,000 participants from various Indonesian government agencies, 
district as well as local volunteers participated in the event. 
Simulation activities testing operational plans to contain the 
outbreak occurred at multiple sites including Dangin Tukaday 
village, local health centers, and health care facilities. In 
addition, players simulated activities at Bali's international 
airport to prevent international spread of disease.  End Summary. 
 
 
---------------------- 
MULTISECTORAL EXERCISE 
---------------------- 
 
¶1. (SBU) Led by the Ministry of Health, the simulation activity 
culminated six months of inter-sectoral planning with 
representatives from the Ministries of Transportation, Agriculture, 
People's Welfare, Education, Defense, Police, Port authorities, 
KOMNAS (National AI Committee), UN organizations, CDC, and other 
partners. Working groups developed operational plans to contain an 
outbreak based on Ministry of Health guidelines for epicenter 
containment. CDC and WHO provided technical support and funding 
including $500,000 for operational costs provided by CDC and 
approximately $86,000 for training provided by the government of 
Japan through WHO. 
 
¶3. (U) Planning for the exercise began in October 2007 and included 
formation of working groups to develop operational plans for 
epicenter containment in keys areas including: incident command and 
control, surveillance, risk communication, quarantine, port control, 
non-pharmaceutical interventions, medical treatment, mass 
prophylaxis, and logistics/essential services.  The working groups 
tested these plans in desk-top exercises before the simulation 
activity. Based on these exercises, teams finalized the plans and 
developed training materials to orient provincial and district level 
staff on epicenter containment. 
 
--------------------------------- 
HIGH LEVEL GOVERNMENT INVOLVEMENT 
--------------------------------- 
 
¶4. (SBU) Several key government officials attended the event 
including Bayu Krisnamurthi, Head of KOMNAS; Dr. Nyoman Kandun, DG 
of the Indonesian CDC; Dr. Imansyah, the Surgeon General of the 
Navy; and Dr. I. Gede Winsasa, Jembrana District Governor. (Note: 
Winsana is running for Governor of Bali and is known as an advocate 
for the poor.)  During the welcome ceremony, Dr. Nyoman Kandun, the 
Director General (DG) of Indonesian Centers for Disease Control 
(CDC), read Minister Supari's welcome speech that included reference 
to virus sample sharing and Material Transfer Agreement (MTA). 
 
----------------- 
OUTBREAK SKENARIO 
----------------- 
 
¶5. (U) The outbreak scenario involved human to human transmission of 
avian influenza in Dangin Tukaday village as well as human to human 
transmission in Tabanan hospital. Containment guidelines included 
quarantining of the village; providing hospital staff with mass 
anti-viral prophylaxis; and providing essential services to the 
affected populations. Dr. Winasa, as the local level incident 
commander, played a key role in organizing efforts. There was wide 
scale involvement of local government officials and community-based 
organizations in the simulated response. 
 
¶6. (U) The village at the epicenter (Dangin Tukaday) was the site of 
actual AI fatalities in 2007. Residents of the affected village and 
the outlining community participated with enthusiasm in the 
exercise. Three hospitals also participated in the exercise and 
implemented full measures of epicenter containment. 
 
------------------------- 
OBSERVERS VISIT THE FIELD 
------------------------- 
 
JAKARTA 00000877  002 OF 002 
 
 
 
¶7.  (U) Over 50 international visitors observed the exercise.  Key 
activities included setting up the incident command and control 
centers and management of patients with avian flu. Visitors also 
observed surveillance teams deployed to the epicenter, provision of 
mass antiviral prophylaxis, triage and referral of affected 
patients, infection control procedures, quarantine of the community 
and affected households, implementation of non-pharmaceutical 
interventions such as closing of schools, and culling of poultry. 
 
¶8.  (U) Police used wire barricades to block access to the village 
and implemented decontamination procedures for persons and vehicles 
going in and out of the containment zone.  The government 
communicated with the public using posters, flyers, person to person 
outreach, and a patrolling can equipped with a loudspeaker.  Workers 
used personal protective equipment in the containment zone. 
 
¶9.  (SBU) Health educators and communication experts staffed a media 
center using SMS/call/website lines.  On day two, Minister Supari 
announced an epicenter outbreak in Jembrana in a mock press 
conference. 
 
¶10.  (U) On day three of the exercise, activities moved to Bali's 
international airport.  Passengers entering the terminal completed a 
health questionnaire and passed through a thermal scanner to screen 
for possible AI.  Suspect cases taken to a mobile clinic and 
monitored. 
 
-------------- 
MEDIA COVERAGE 
-------------- 
 
¶11.  (U) More than 30 local and international news organizations, 
representing TV, print, radio reported on the simulation exercise. 
UNICEF will be releasing a video/DVD of the simulation. 
 
--------------- 
LESSONS LEARNED 
--------------- 
 
¶12. (U) International observers provided technical recommendations 
to WHO and MOH to help further refine protocols and operational 
plans.  Lessons learned from the exercise are being summarized in a 
final report that will be shared with the international community. A 
USAID contractor is assisting the MOH to develop revised epicenter 
containment guidelines and operational plans (in Bahasa and English) 
to be shared with the international community. 
 
 
¶13. (SBU) International observer list: 
 
 --WHO (Indonesia, SEARO, WPRO, Geneva) 
 --US, CDC (Jakarta, Atlanta) 
 --USAID (Jakarta) 
 --AusAID 
 --Embassy of Japan/JICA 
 --Embassy of Nigeria 
 --Embassy of New Zealand 
 --Embassy of Canada 
 --Government of Laos 
 --Ministry of Health, Egypt 
 
 
HUME