VZCZCXYZ0000
PP RUEHWEB

DE RUEHGV #0290/01 0971458
ZNR UUUUU ZZH
P 071458Z APR 09 ZDK
FM USMISSION GENEVA
TO RUEHC/SECSTATE WASHDC PRIORITY 8276
INFO RUEHBY/AMEMBASSY CANBERRA PRIORITY 6508
RUEHJA/AMEMBASSY JAKARTA PRIORITY 2246
RUEHLO/AMEMBASSY LONDON PRIORITY 2855
RUEHOT/AMEMBASSY OTTAWA PRIORITY 5685
RUEHFR/AMEMBASSY PARIS PRIORITY 3377
RUEHKO/AMEMBASSY TOKYO PRIORITY 6863
RUEHPH/CDC ATLANTA GA USA PRIORITY
RUEAUSA/DEPT OF HHS WASHINGTON DC PRIORITY
RUCNDT/USMISSION USUN NEW YORK PRIORITY 3006
RUEHBS/USEU BRUSSELS PRIORITY

UNCLAS GENEVA 000290 
 
SENSITIVE 
SIPDIS 
 
DEPARTMENT FOR OES/IHB - PATTERSON AND SHAPIRO 
 
E.O. 12958: N/A 
TAGS: KFLU AMGT EAGR PGOV TBIO
SUBJECT: REPORTING OF INDONESIA HUMAN AVIAN INFLUENZA 
(H5N1) CASES - REQUEST FOR CLARIFICATION 
 
REF: A. A. SECSTATE 28521 
     ¶B. B. JAKARTA 477 
     ¶C. C. JAKARTA 398 
 
¶1.  (SBU) Summary.  WHO confirms Indonesia is reporting human 
avian influenza (H5N1) cases to WHO, but WHO  has agreed with 
the Indonesian Ministry of Health not to publicize that 
information before Indonesia does.  WHO asserts this 
agreement is the only way WHO can conduct risk assessment on 
the cases.  To date those assessments have not revealed 
sustained human-to-human transmission of the virus, which 
would trigger dissemination of the information under the 
International Health Regulations (2005).  WHO believes 
bilateral pressure on Indonesia by countries concerned by 
Indonesia's restrictions on public reporting will be the most 
effective way to turn this situation around.  End summary. 
 
¶2.  (U) Mission Health Attache discussed Indonesia reporting 
of H5N1 cases, as requested ref A, with WHO officials Dr. 
David Heymann, then-Assistant Director-General for Health 
Security and Environment (HSE); Dr. Keiji Fukuda, Director, 
Global Influenza Program (now ADG ad interim for HSE); and 
Dr. Max Hardiman, International Health Regulations (IHRs) 
team. 
 
¶3.  (U) WHO confirmed all H5N1 cases are to be reported to 
WHO in accordance with Annex 2 of the IHRs, which identifies 
cases of human influenza caused by a new subtype as an event 
that may cause a public health emergency of international 
concern (PHEIC).  Provision of such information to WHO is 
also covered by Articles 6 to 10 of the IHRs.  The IHRs may 
be found at www.who.int/csr/ihr/IHR 2005 en.pdf. WHO stressed 
that each H5N1 case is in and of itself not/not considered a 
PHEIC unless it is associated with sustained person-to-person 
transmission, which has not been the case (see para 4 of ref 
A). 
 
¶4.  (U) Article 11 of the IHRs addresses WHO's obligations to 
provide to WHO Member States public health information it has 
received under Articles 5 to 10, and by reference Annex 2, of 
the IHRs.  Article 11.2 specifies that WHO shall not make 
such information available until such time as: 
 
a.  the event is determined by the WHO Director-General to be 
a PHEIC, or 
 
b.  information evidencing the international spread of the 
infection or contamination has been confirmed by WHO in 
accordance with established epidemiological principles, or 
 
c.  there is evidence that (1) control measures against the 
international spread are unlikely to succeed because of the 
nature of the contamination, disease agent, vector or 
reservoir, or (2) the State Party reporting the information 
lacks sufficient operational capacity to carry out necessary 
measures to prevent further spread of disease , or 
 
d.  the nature and scope of the international movement of 
travelers, baggage, cargo, containers, conveyances, goods or 
postal parcels that may be affected by the infection or 
contamination requires the immediate application of 
international control measures. 
 
WHO has determined on the basis of the information it has 
received to date from Indonesia about H5N1 cases that none of 
these provisions has been met and thus reporting to the 
international community is not required. 
 
¶5.  (SBU) WHO confirmed that the Indonesian Ministry of 
Health (MOH) has indicated to WHO that it would notify 
information about H5N1 cases to WHO under the IHRs but 
requested WHO not to release information about the cases 
publicly before the MOH had done so.  WHO agreed because it 
allows WHO to conduct risk assessment on the cases.  If WHO 
believes the cases represented a verifiable change in risk, 
it would be bound to notify Member States, but that 
situation, according to WHO, has not arisen to date. 
 
¶6.  (SBU) Health Attache stressed that WHO had an obligation 
 
to its Member States to inform them in a timely manner about 
human cases of H5N1, by country, whether or not they are 
determined to be a PHEIC.  WHO asserts that it generally does 
so on its website except in the case of Indonesia, where its 
agreement with Indonesian health authorities has precluded 
public reporting since the beginning of 2009. 
 
¶7.  (SBU) The Core Group (UK, France, Canada, Australia, 
Japan, EC, US) of the International Partnership on Avian and 
Pandemic Influenza (IPAPI) met in Montreux, Switzerland, on 
the margins of an informal meeting of the WHO 
Intergovernmental Meeting on Pandemic Influenza Preparedness 
(PIP-IGM) March 30-April 2.  In light of its concern about 
the lack of reporting on H5N1 cases in Indonesia, the Group 
met March 31 with WHO ADG a.i. Fukuda to discuss this matter. 
 Members of the Group expressed alarm that WHO's agreement 
with Indonesia to withhold information about H5N1 cases 
distorted public understanding of the situation in Indonesia, 
and is unacceptable.  The Group stressed that WHO's 
reputation as the authoritative source of public health 
information leads national public health authorities to 
believe there are no H5N1 cases in Indonesia, which could 
have serious public health implications.  Finally, the Group 
warned Fukuda that acceding to Indonesia's demand not to 
publicize the cases seriously erodes WHO's credibility, 
because WHO's own website is reporting no cases in Indonesia 
even though there are credible reports to the contrary. 
Other Member States may be put in the position of publicly 
contradicting, or at least questioning, WHO's reporting on 
the number of cases. 
 
¶8.  (SBU) Fukuda, while sympathetic, reiterated the points 
outlined above - that WHO's agreement with Indonesia allows 
risk assessment, that WHO is seeing only sporadic cases in 
Indonesia, and that if there were sustained human-to-human 
transmission WHO would be compelled to disseminate that 
information to the international community. 
 
¶9.  (SBU) Fukuda suggested that bilateral pressure on 
Indonesia, at a level above the Minister of Health, to behave 
more responsibly is a better approach than pressure from WHO. 
 He said, however, that having now heard from the Core Group 
he would be able to stress to Indonesia that its lack of 
reporting is not well received by countries.  (Comment. 
Mission believes USG should raise this issue with WHO 
Director-General Chan, and is prepared to do so.  End 
comment.) 
STORELLA