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Indonesia under fire for its limited steps to contain avian flu

BOGOR, Indonesia—Despite worldwide pressure for Indonesia to contain avian flu, it's taking little action, increasing the odds that a global pandemic could ignite here.

Indonesia resists killing large numbers of chickens to stamp out the disease and has yet to pay farmers for the small number of foul culled earlier this year.

The inaction has frustrated some global health experts, who say that a more deadly strain of the avian flu virus may be mutating in Indonesia and preparing to spark a global catastrophe.

The virus hasn't yet mutated into a form able to leap easily among humans, but scientists fear that it could do so at any time. That could start a global pandemic as the disease spreads in Indonesia and infects world travelers, who could spread it to the United States and the rest of the world.

Even now, the virus relentlessly evolves every day. And although it hasn't taken a form that passes easily among people, it nevertheless continues to infect and kill.

So far, four Indonesians have caught avian flu, and three have died. A suspected new case was reported in Sumatra last week.

Indonesia is only one front in a worldwide campaign to defend against the lethal H5N1 strain of the virus, which first surfaced in Hong Kong in 1997. Since it re-emerged in December 2003 it has sickened people in 11 countries (Cambodia, China, Indonesia, Japan, Kazakhstan, Laos, Malaysia, Russia, South Korea, Thailand and Vietnam) and at least 60 people have died (in Cambodia, Vietnam, Thailand and Indonesia), nearly all after contact with birds.

Indonesian authorities are battling the perception that they care less about setting off a global health calamity than they do about protecting a huge poultry industry.

"We care about a pandemic. We do care. But so far, there is no scientific evidence of human-to-human transmission," said Mathur Riady, the director general of livestock services at the Agriculture Department.

Indonesian health officials say other fatal or crippling diseases present more immediate threats to the nation than bird flu, including polio, malaria, tuberculosis and dengue fever—which alone has killed 650 people here this year. They say that Western nations don't care much about those constant killers as long as they're confined to the tropics.

The potential for an avian flu pandemic, though, has focused attention on Indonesia and its limited steps to contain bird flu. The World Health Organization says an avian flu pandemic could kill from 2 million to more than 7 million people worldwide.

"Avian influenza has not been a priority for Indonesians," said Juan Lubroth, an animal health expert with the Food and Agricultural Organization in Rome.

Unlike nearby Thailand, Indonesia hasn't deployed an army of veterinarians and public health volunteers to crisscross the country with poultry vaccines and a mandate to cull sick birds. Avian flu virus is present in 22 of the 33 provinces of Indonesia, a country of 242 million people who live on an archipelago that's slightly less than three times the size of Texas.

Public awareness of the disease in Indonesia is dim. Many people don't believe the outbreak is a real threat to humans.

"The bird flu story is just a smokescreen to get people's attention away from the gasoline price increases," said Budi Setiawan, an exotic bird vendor at Jakarta's Pramuka bird market, referring to recent fuel price increases of more than 80 percent.

Teams of foreign agriculture experts and offers of foreign aid are pouring into Indonesia, but Jakarta flatly resists demands by the WHO that it kill all fowl in a radius of slightly less than two miles from where a bird flu infection is detected, as other nations have done.

"Some donors suggest that we have a stamping-out strategy. That's a problem. If we did that for two months, all the chickens would be gone. What happens to the farmers then?" Riady said.

The government is short on vaccines for poultry, has a dismal surveillance system and allots almost no money to pay farmers when their chickens are destroyed. It has yet to pay farmers for 800,000 chickens culled this year, creating a disincentive for farmers to report new outbreaks.

"Why should somebody report when they have a (bird flu) problem when they will have their entire livelihood lost?" asked Lubroth, the expert from the Food and Agricultural Organization. "If you do not have a compensation strategy, people will hide it."

Indonesian President Susilo Bambang Yudhoyono faces numerous other problems, including street protests over gas price increases and the Oct. 1 terrorist bombings on the resort island of Bali. Still, some analysts say his government hasn't addressed the avian flu crisis decisively.

"The government gives the impression that this is not a serious matter," said Soedjati Djiwandono, a prominent political analyst and newspaper columnist.

Commercial poultry farms house 1 billion chickens, supplying the 9.7 pounds of chicken meat the average Indonesian eats per year. Backyard flocks of egg-laying chickens account for another 394 million birds. Millions of Indonesians live in close proximity to chickens.

Public health experts say Indonesia must get more teams out to find sick chickens harboring the virus.

"They have to look for sick birds and unusual deaths," said Subash Salunke, an epidemiologist and regional WHO adviser based in New Delhi.

Curiously, none of the four confirmed cases of Indonesians with avian flu has involved a poultry farm or slaughterhouse worker, raising questions about how viral transmission occurs. Experts say eggshells, duck meat and poultry feces have all been shown to hold high quantities of the H5N1 virus.

Also a mystery is why the strain of H5N1 in Indonesia is unlike the ones found in Thailand, Vietnam and Cambodia, yet similar to one found in wild foul in China.

Indonesia has the fourth richest bird habitat in the world, with some 1,585 species. More than 100 of the species, including small warblers, aquatic birds and eagles, migrate each year from as far away as Siberia.

Health authorities shut Jakarta's Ragunan Zoo on Sept. 19 for three weeks of disinfecting when experts determined that birds there were carriers of the virus.

Persuading bird-loving Indonesians to treat birds cautiously, however, is no easy feat.

"One in five households in Java have birds, like songbirds," said Ria Saryanthi of Bird Life Indonesia, a nonprofit environmental group in this city, two hours drive south of Jakarta. Bird hobbyists, she added, "love their birds more than their wives."

Even free-range chickens are considered symbols of success and fortune.

"Watching chickens walk around makes me happy," said Gianto, a plant vendor, who like many Indonesians uses only one name. As he coddled one of his backyard birds, Gianto dismissed concern about avian flu, saying the disease "is carried by the wind."

While many Indonesians remain unaware of a possible global calamity, physicians at Jakarta's main infectious diseases hospital are concerned.

"Some say the pandemic is knocking at our door," said Dr. Sardikin Giriputro, who manages the hospital's logistics. Giriputro said the hospital isn't prepared.

It has enough of the anti-viral medicine Tamiflu, which may increase the likelihood of survival, for only 20 patients, and it's short on gowns, gloves and surgical masks, he said. Any epidemic would swamp the hospital.

"Many things will collapse, even the hospital and the health services," Giriputro said. "Most of the doctors and nurses would take care of their families first."

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(c) 2005, Knight Ridder/Tribune Information Services.

PHOTOS (from KRT Photo Service, 202-383-6099): AVIANFLU-INDONESIA

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