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Cablegate: Indonesian Ministers Discuss Sample Sharing and Health

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

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