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Cablegate: Indonesia - Avian Influenza Sample Sharing Update

VZCZCXRO3911
RR RUEHCHI RUEHDT RUEHHM
DE RUEHJA #1053/01 1030851
ZNR UUUUU ZZH
R 130851Z APR 07
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC 4328
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 7865
RUEHBD/AMEMBASSY BANDAR SERI BEGAWAN 0377
RUEHBY/AMEMBASSY CANBERRA 0656
RUEHFR/AMEMBASSY PARIS 0999
RUEHGV/USMISSION GENEVA 7554

UNCLAS SECTION 01 OF 03 JAKARTA 001053

SIPDIS

SENSITIVE
SIPDIS

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

E.O. 12958: N/A
TAGS: TBIO AMED CASC EAGR AMGT PGOV ID
SUBJECT: INDONESIA - AVIAN INFLUENZA SAMPLE SHARING UPDATE

REF: A) Jakarta 00933 B) Jakarta 00310

C) 4/5/07 Hohman Update e-mail

1. (SBU) Summary: Despite Health Minister Fadilah Supari's March 28
pledge to immediately begin sharing avian influenza (AI) samples,
and similar pledges following World Health Organization (WHO)
Director General Margaret Chan's April 4 Jakarta visit, the
Government of Indonesia (GOI) has not yet resumed sharing AI
samples. GOI statements on the issue have vacillated between
assurances that Indonesia will resume sharing samples immediately to
inflammatory op-ed pieces in newspapers. NIHRD Director Dr. Triono
Soendoro and his deputy, Dr. Endang Sedyani, will lead the GOI
delegations to upcoming meetings on sample sharing and vaccine
policy in Geneva, making any resumption of sample sharing unlikely
until the two return to Jakarta in late April. A WHO Assessment
team from Tokyo will visit the National Institute of Health (NIHRD)
and the Eijkman Institute on April 23 to assess their qualifications
for appointment as a WHO Collaborating Center for H5N1. The
inability of international laboratories to confirm MOH-diagnosed AI
cases has led to a gap between the GOI's confirmed case count (94 AI
cases with 74 deaths), counts at NAMRU-2 (83 AI cases, with 64
deaths) and WHO (81 cases with 63 deaths). End Summary.

Sample Sharing: Gap Between GOI Rhetoric and Action
--------------------------------------------- ------

2. (SBU) Following World Health Organization (WHO) Director General
Margaret Chan's meetings of April 4 with President Susilo Bambang
Yudhoyono, Health Minister Supari and Foreign Minister Hassan
Wirjuda, Supari announced again that the GOI would resume immediate
sending of samples. Various Indonesian press covered the Chan visit
and carried different accounts of when the sharing would take place.
One newspaper quoted Supari as indicating samples will be shared
immediately, while another noted "We will resume the sending of
virus sample for the sake of global interests. The delivery will
take place this year, within two months from now at the latest."
NIHRD Director Dr. Triono Soendoro also told an Embassy employee the
week of April 9 that the MOH would resume sample sharing with
NAMRU-2.

3. (SBU) However, just a week after the Chan visit, Supari authored
a highly nationalistic op-ed in the Indonesian daily KOMPAS entitled
"Bird Flu and Nation's Sovereignty." According to an Embassy
translation, Supari writes "...The debate over the H5N1 virus
between WHO and Indonesia demonstrates that, as long as an
independent nation still depends on other nation(s), that nation is
still subjugated...Indonesia, together with other developing
nations, has just established a front to confront WHO, which always
sides with rich countries in dealing with matters pertaining to
public health, including bird flu... Exploitations carried out by
industrial countries against poor developing countries are nothing
new...Indonesia has had the courage to take a stance, albeit 'only'
in the field of health...One thing worth noting; from the bird flu
virus we realize that a sovereign nation is capable of upholding
human dignity even though there is a long road ahead."

4. (U) The op-ed also implies that NAMRU-2 improperly obtained AI
samples. It reads "Since 2005, Indonesia had been sending samples to
WHO laboratories because laboratories in Indonesia were considered
not yet meeting requirements. Health agencies from other countries
also tried to take Indonesian specimens either by visiting a victim
directly or hospital, e.g. NAMRU2 who later sent the specimens to
CDC Atlanta." (Note: This is false. NAMRU-2 has obtained NIHRD
permission to ship all samples, and has records on file to prove
it.)

5. (U) Indonesian press ran numerous articles on Chan's visit. The
Jakarta Post reported that Chan said the global vaccine reserve
would be of great importance for developing countries in their fight
against avian influenza, noting "We will look at how to develop
global stockpiles of vaccines, particularly for developing
countries." Chan said the WHO would gather resources from developed
countries, donors as well as large drug-makers to make the plan
work. Press also quoted Chan as having emphasized that the global
fight against bird flu required the full cooperation of developing

JAKARTA 00001053 002 OF 003


countries, an obligation that will be enshrined in a new global
regulation. "The sharing of information on the virus is a
requirement for all countries under an international health
regulation which will come into effect June 15."

NIHRD Conducts Data Review of Indonesian Samples
--------------------------------------------- ---

6. (SBU) According to Ref C, NIHRD Director Dr. Triono Soendoro has
requested a review of institutes that have requested viruses from
Indonesia, and the data generated from analysis of these viruses.
(Note: On multiple occasions, NAMRU-2 and the CDC have provided
multiple senior officials at MOH (including Dr. Triono and Director
General for the Center for Communicable Diseases Nyoman Kandun)
electronic and hard copies summarizing findings. The CDC has also
given the MOH disks containing complete sequencing information on at
least two occasions, including in January 2007.)

GOI Plans for Upcoming WHO Meetings and Visits
--------------------------------------------- --

7. (SBU) Dr. Endang Sedyani, Deputy Director of National Institute
of Health Research and Development (NIHRD) told us April 10 that
both Endang and Triono will participate in sample sharing
discussions in Geneva from April 18-20. Endang will first accompany
Minister Supari to bilateral meetings in Madrid before heading to
Geneva. Although Triono will return to Jakarta on April 21, Endang
will stay on to participate in the April 23-25 vaccine policy
meetings. Endang also stated that NIHRD is preparing for the April
23 visit of Dr. Masato Tashiro, Director of the WHO Collaborating
Center in Tokyo. Dr. Tashiro will evaluate the qualifications of
the NIHRD and the Eijkman Institute to become a WHO Collaborating
Center for the diagnosis of H5N1.

NIHRD Claims NAMRU-2 Steals Their Thunder
----------------------------------------

8. (SBU) Endang explained that NIHRD researchers want peer respect
in the international research community. One of the sensitivities
that NIHRD has felt with NAMRU-2 is the fact that international
researchers visiting Indonesia contact NAMRU-2 researchers first for
their views, she said. In a separate meeting on April 3, Endang
told us that NIHRD would likely seek to take over NAMRU's flu
surveillance network and analyze all samples at the NIHRD, confining
NAMRU-2 to projects specifically directed to "research." (Note:
"Surveillance" is a charged word in Indonesia because of its
intelligence gathering connotations.) When asked how NIHRD will pay
for the costs of maintaining the network, Endang replied that NIHRD
would likely use CDC funding. We explained that research sponsors
usually direct funds to activities related to ongoing research
projects, and that unlike development assistance, sponsors generally
consider research funding as an investment in future joint research.
Endang seemed surprised by this point. (Note: Despite her
comments, Endang did not specify a deadline for taking over
NAMRU-2's surveillance system, which continues to operate.)

Conflicting AI Counts
---------------------

10. (SBU) As a result of the sample impasse, Ministry of Health
(MOH), NAMRU-2 and WHO now post different confirmed AI case
statistics, per Table 1.

--------------------------------------------- ---
Table 1: Indonesia AI Case Counts (4/13/07)
--------------------------------------------- ---
No. No. Fatality
Organization Cases Deaths Rate
--------------------------------------------- ---
MOH 94 74 78%

NAMRU-2 83 64 77%

WHO (1) 81 63 78%


JAKARTA 00001053 003 OF 003


(1) WHO figures date from when the MOH still sent samples to WHO
Collaborating Centers for confirmation via NAMRU-2.

11. (SBU) NAMRU-2 tests suggest that at least two of the GOI
positive AI cases were likely not positive for H5N1. Based on
laboratory findings and epidemiological and clinical review of data,
NAMRU-2 believes two cases from January 2007 (a 15 year-old female
from Tangerang and a 30 year-old male from Bandung) did not result
from AI. As both patients are alive and well, NAMRU-2 has
encouraged NIHRD to seek additional molecular and serologic testing.


HEFFERN

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