Bird Flu Threat Grows In Indonesia

by Fabio Scarpello

(IPS) JAKARTA -- While Indonesia has lowered its bird flu toll from six to three deaths since an outbreak in June, authorities warn that conditions exist for a sudden, devastating flare-up.

Around fifty people are currently under observation in the archipelago for suspected bird flu and the lowering of the death toll was only to conform to World Health Organization (WHO) certifications made by the Geneva-based body's laboratory in Hong Kong.

Health Minister Siti Fadilah Supari explained to reporters, on Thursday, that there had been three recent fatalities from bird flu while four cases, including that of a dead man, awaited WHO confirmation.

Confusion had arisen over the death toll because samples that tested positive for bird flu in Indonesia had not been put through confirmatory tests at the Hong Kong laboratory.

After Indonesia's first human case of bird flu infection was discovered in June, 85 people have been admitted to hospital with either suspected or confirmed bird flu infections.

Indonesia has declared that it was facing an "extraordinary" outbreak of the virus and introduced several emergency measures, such as hospitalization of all suspected cases and import of stocks of oseltamivir, (brand named Tamiflu) capable of fighting the virus -- but these are far from adequate, say observers.

"The government has shown some good intentions, but in truth, it is not enough," Thang D. Nguyen, an expert on Indonesia for the Asian Strategic and Leadership Institute, told IPS.

Since 2003, when it was first detected, bird flu has spread to 22 of Indonesia's 33 provinces where it has killed at least six people and an estimated 9.5 million birds.

The WHO fears the H5N1 strain will mutate, acquiring genes from the human influenza virus that would make it highly infectious and lethal to millions in a global pandemic -- though no evidence that the strain was spreading from person to person has yet been seen.

Last week, Indonesia said all of its known fatalities involved poultry raised close to homes -- indicating the virus had not mutated but pointing to dangerously unhygienic farming practices which needed to be urgently attended to.

Being cash-strapped, Indonesia also called for international support for measures such as vaccinating poultry, carrying out mass culling operations and introducing better farm practices in the far-flung areas of the archipelago where the disease has surfaced.

So far, the government has received 50,000 courses of oseltamivir from neighboring Australia beefing up its existing stock of 10,000. Indonesia's classification of the bird flu outbreak as "extraordinary"did not attract much needed cash but was followed by the setting up of a special team to prepare for any bird flu pandemic and coordinate foreign assistance and funding that should soon start trickling in from a regional fund.

Further help is on the way from the United States which has pledged $25 million to fight bird flu in Asia while the European Union and Japan have shown willingness to contribute.

According to an estimate by the Food and Agricultural Organization (FAO) in Rome and the Paris-based World Organization for Animal Health, over $100 million are needed over the next three years to fight the virus worldwide.

The virus, a mutation of type-A avian influenza, known as H5N1, has also killed 43 Vietnamese, 12 Thais and four Cambodians. Besides the human fatalities, the virus has killed millions of birds in China, Japan, Kazakhstan, Korea, Laos, Malaysia, Mongolia, the Philippines, Russia and Taiwan.

The first strain of type-A influenza was identified in Italy at the end of the 19th century. Through the last century, three flu pandemics were recorded, with the first, known as the Spanish Flu, killing some 50 million people worldwide in 1918. The other two started in 1957 and 1968 in China and Hong Kong, and killed an estimated 70 thousand and 34 people respectively.

On Wednesday, scientists at the Centers for Disease Control and Prevention in Atlanta, Georgia in the U.S. announced worrisome findings from the reconstruction of the 1918 Spanish Flu from mummified victims.

According to the Atlanta scientists, bird flu viruses, now prevalent in Asia, share crucial genetic changes that occurred to the viruses responsible for the devastating 1918 Spanish Flu pandemic.

In Indonesia, a country spread over 17 thousand islands and inhabited by 230 million people, most of whom rear hens in their backyards and eat chicken three times a day, the risk of the virus spreading to large swathes of the population is high.

In the narrow window of action left open, Indonesia has become the key frontline trench.

Jakarta has designated 44 hospitals nationwide, to work as the reference point for all patients assumed to be infected by bird flu, and has promized to cull every bird within a three km radius of new outbreaks, as advized by the WHO but ignored so far.

Poultry vaccinations and spraying with disinfectants are now being carried out, but only sporadically and on a small scale. Although the new initiatives show an acknowledgment of the danger, Nguyen said that it is still far too little and, perhaps, too late.

"To start with, Jakarta has to put more money into the pot to compensate farmers. Unless it does so, villagers are not going to report potential cases of infected animals and sick chicken will continue to enter the food chain and contaminate people," he said.

Among other problems, the analyst listed a slow bureaucracy-- which has already delayed imports of Tamiflu-- and a lack of coordination between the central government and various local administrations.

"The newly-elected governors want to show their independence and in some cases do not follow central government directives," he said, referring to the winners of the recently held first direct election throughout the archipelago.

But problems are not just at the government level. As Jakarta-based veterinarian Femke Van den Bos explained to IPS, hygiene -- or lack of it -- is another big setback in the war against the virus.

"Hygiene standards are poor everywhere. Hens wander freely in and out of houses and onto the streets. In markets, cages are kept one on top of the other, which leads to excrement easily spreading from bird to bird," he said, adding that the government is yet to prohibit the transport and consumption of chicken in infected areas.

Femke also highlighted the importance of a good information campaign. Bird flu has been one of the main topics in most Indonesian newspapers, but coverage has mostly given rise to unjustified fears of poultry and eggs, rather than better public understanding of the problem.

"People still do not have a clear idea of what bird flu is and how you can prevent it. Unless you know this, you cannot fight it," he said, urging the government to start a mass education campaign.