The next President has a problem on his hands, known to public health officials and non-partisan flu bloggers, but all too rarely discussed in the general press. Indonesia, the world's most populous Moslem country, and the epicenter of H5N1 infections in humans (135 confirmed human cases and 110 deaths) has decided that the H5N1 virus should be owned by Indonesia, and sold to whomever they deem worthy. In the meantime, Indonesia has stopped reporting human cases in a day-to-day basis, rebuffed WHO requests for a shared approach, and condemned humanitarian assistance fro the US by demanding NAMRU-2 (a Navy health lab stationed in Jakarta for many years) leave the country and let Indonesia manage its own internal problems.
Richard Holbrooke and Laurie Garrett write up the folly of this approach today in the Washington Post.
Here's a concept you've probably never heard of: "viral sovereignty." This extremely dangerous idea comes to us courtesy of Indonesia's minister of health, Siti Fadilah Supari, who asserts that deadly viruses are the sovereign property of individual nations -- even though they cross borders and could pose a pandemic threat to all the peoples of the world. So far "viral sovereignty" has been noted almost exclusively by health experts. Political leaders around the world should take note -- and take very strong action.
The vast majority of repeated avian flu outbreaks the past four years, in both humans and poultry, have occurred in Indonesia. At least 53 types of H5N1 bird flu viruses have appeared in chickens and people there, the World Health Organization has reported.
Yet, since 2005, Indonesia has shared with the WHO samples from only two of the more than 135 people known to have been infected with H5N1 (110 of whom have died). Worse, Indonesia is no longer providing the WHO with timely notification of bird flu outbreaks or human cases. Since 2007, its government has openly defied International Health Regulations and a host of other WHO agreements to which Indonesia is a signatory.
Moreover, the Indonesian government is threatening to close down U.S. Naval Medical Research Unit Two (NAMRU-2), a public health laboratory staffed by Indonesians and U.S. military scientists. NAMRU-2 is one of the world's best disease surveillance facilities, and it provides health officials worldwide with vital, transparent information. The Indonesian government has accused NAMRU-2 scientists of everything from profiteering off its "sovereign" viruses to manufacturing the H5N1 bird flu in an alleged biological warfare scheme. There is no evidence to support these outlandish claims.
For those of us concerned about tracking emerging infectious diseases, be it by government agency or private citizen networks, Indonesia's approach to intellectual and sovereign property is both dangerous and short-sighted. Viruses know no international boundaries, and as the Toronto experience with SARS shows, an infectious disease problem in Asia can quickly become an infectious disease problem in North America. There are great sensitivities about such things. By international agreement, there'll be no "Hong Kong flu"designation in future. All H5N1 flu viruses will be known by a boring and bland string of letters and numbers:
The initiative, which was encouraged and approved by 3 international agencies (the World Health Organization [WHO]), the World Organisation for Animal Health [OIE], and the Food and Agriculture Organization [FAO]), set out to unify the nomenclature system to simplify interpretation of sequence and surveillance data from different laboratories and to remove stigmatizing labeling of HPAI virus (H5N1) clades by geographic reference.
Many other positive things could be accomplished by international agreement, including tracking and mitigating the next influenza pandemic, which could easily start in a remote village in Indonesia with a story just like this from the IHT on aug 8, 2008:
JAKARTA, Indonesia: Health workers rushed to a village in western Indonesia to test for bird flu Thursday after 13 people were hospitalized with symptoms of the disease and dozens of chickens died, a government official said.
It will take days for test results to come back, said Memed Zulkarnaen, spokesman for the National Bird Flu Commission, adding that the condition of those suffering from high fever and respiratory problems "appears to be improving."
The 13 were admitted to two hospitals in the past week after chickens started dying in Air Batu, their village on Sumatra island, 680 miles (1,000 kilometers) northwest of the capital, Jakarta. The birds tested positive for the H5N1 virus.
This is what Holbrooke and Garrett and public health officials and countless flu preppers are worried about. Preliminary reports are that these suspected cases are negative, but the lack of transparency about reporting, coupled with Indonesia's stated hostility to international cooperation make this an extremely pertinent and timely WaPo column.
The pandemic threat has not gone away just because other stories supercede it in the media. Alas, it sees that it will take a crisis to break through the indifference, and in that, we are no different than we ever were. And that is a public health problem and an international shame.