Indonesia’s strategies to fight bird flu run afoul of reality

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If Indonesia is able to execute a comprehensive bird flu plan written by the government, it will take great strides toward controlling the outbreak in the sprawling island nation, a visiting professor who has studied the region said Friday (March 9).

Unfortunately, there’s little chance of that happening.

“There’s a level of rhetoric and a level of reality and an increasing gap between rhetoric and reality,” said James Fox, visiting professor of Australian studies in Harvard’s Anthropology Department.

Fox, visiting Harvard from Australian National University, delivered a grim assessment of the spread of bird flu throughout Indonesia, “The Course of Avian Flu in Indonesia: Implications and Possibilities,” as part of the Asia Center’s ongoing Modern Asia Series.

Bird flu, Fox said, has been present in Indonesia birds since 2003, but for much of that year, the government denied its presence, saying birds were dying from Newcastle Disease, a similarly fatal disease of poultry.

By the end of 2003, however, bird flu was reported in birds in nine of the nation’s 30 provinces. It continued to spread until today, when it is present virtually nationwide, Fox said.

“Bird flu is everywhere in the archipelago and that is one of the major problems,” Fox said.

The first human cases were reported in July 2005 and since then the number of bird flu cases in humans has steadily increased. To date, there have been 84 confirmed cases, 64 of which were fatal. That gives a mortality rate of about 76 percent, though Fox said that’s at least partly due to the fact that people tend not to go to the hospital until late in the disease. Death rates have been much lower among those who have sought hospitalization earlier, he said.

The disease has caused the deaths of an estimated 11 million birds, mainly chickens and ducks, both from the illness directly and from culling of captive flocks in an effort to stem the bird flu’s spread.

Fox outlined a complex mix of factors that have worked to aid the disease’s persistence in Indonesia and to thwart the government’s efforts at controlling it. One major factor, he said, is a series of recent government reforms that distributed power from the central government to local governments. The change, he said, is weakening the central government’s ability to require certain unpopular measures, such as culling large numbers of chickens and other domestic birds.

In addition, he said, recent natural disasters, such as earthquakes and floods, have sapped attention and resources, forcing the government to distribute funds that might have been available for bird flu to respond to other catastrophes.

“It is a problem that every time you make progress, a disaster hits,” Fox said.

Smuggling of birds from outlying islands where they can be raised cheaply, to more populous central regions, where they can be sold for more, is keeping the disease distributed throughout the islands despite official quarantines. Further, Fox said, efforts to vaccinate birds have proven ineffective.

The global health community is watching Indonesia cautiously, Fox said, because there have been several cases of suspected human-to-human transmission, though they are thought to have occurred between close family members. Still, the conditions exist, with the disease widespread among Indonesian birds, and some human-to-human transmission occurring, under which the feared mutation making it easily communicable between humans might arise.

“The danger is that the virus mutates. … That’s the motive behind everyone’s concern, looking at Indonesia right now,” Fox said.

The effect on the nation’s chicken industry has been devastating, Fox said, with many mid-level breeders going out of business. In addition to the culling, people have begun to eat less chicken, even though it makes up a large portion of the meat in people’s diets.

Things began to change for the better in Indonesia in August 2006, Fox said. The nation’s vice president issued a public appeal that people take spread of the disease seriously. In September, the central government significantly raised the funding it dedicated to fight the disease, which drew the interest of international donors who began to think Indonesia was getting serious about fighting bird flu. Both the United States and China offered assistance — treatments for people and vaccines for birds.

In January, the government banned keeping chickens in people’s backyards, beginning in Jakarta, and developed a national plan that Fox said is “beautiful” — if it can be implemented.

The government has also designated specific hospitals to handle cases and has seen mortality drop to 38 percent when patients are given tamiflu, antibiotics, and respiratory support, Fox said.

Despite these positive steps, Fox remains pessimistic about efforts to control the disease, saying he thinks that a year from now, rather than stabilizing or improving, the situation is likely to worsen.