Analysis: No relief in sight as Indonesia tops bird flu death toll

By Joe Cochrane Aug 8, 2006, 12:42 GMT

Jakarta - Marthen Malelo is self-admittedly a lonely man these days.

The prominent veterinarian made national headlines three years ago by being the first Indonesian researcher to discover bird flu within the country's poultry population.

But with the H5N1 avian influenza virus now infecting and killing humans, including a 43rd death on Monday that made Indonesia the world's worst-affected country, Malelo's phone does not ring much.

'No one has ever asked me to give suggestions to prevent outbreaks,' he told Deutsche Presse-Agentur dpa in an exclusive interview. 'I just stay at home at night.'

That might be because the Indonesian government, already stung by criticism of its less-than-stellar efforts at combating bird flu, does not want to hear any more, although Malelo readily gives his two cents worth.

'They don't have enough money and the coordination does not work - who does what where - in the control of bird flu in the field,' said Malelo, who works at the state-owned Bogor Institute of Agriculture.

'There must be good coordination among the health department, agriculture department and local health offices,' he said, adding that presently 'there's not enough.'

Indonesia prides itself on being the world's largest Muslim-majority nation, but it has nothing to celebrate in passing Vietnam with the most deaths from H5N1.

A 16-year-old boy who had tested positive for bird flu died Monday night in a Jakarta hospital, making him the country's 43rd victim. Vietnam is second with 42, but has had no deaths this year while Indonesia has had 32.

The continuation of almost weekly victims may lessen the psychological impact of Indonesia's record-breaking death toll, but health experts concede that it will undoubtedly go higher.

'Indonesia is the world's fourth largest country and four times larger than Vietnam, so it's hard to say it represents anything,' said Dr Georg Petersen, Indonesia country representative of the World Health Organization (WHO).

'As we have said and the Ministry of Health has said, there's still the outbreak among birds in Indonesia,' Petersen said, 'and as long as there's an outbreak in birds, there may be infections in humans.'

More infections, not to mention deaths, are inevitable. Bird flu is endemic in 27 of Indonesia's 33 provinces with millions of chickens and ducks infected.

The Jakarta Post reported Tuesday that bird flu had also spread to the remote eastern province of Papua with around 174 chickens dead and 414 others culled due to suspected infections.

The controversy over culling was one reason the virus was able to blaze across the vast Indonesian archipelago in the first place. The Jakarta government was reluctant to cull chickens, likely because they did not want to compensate commercial chicken farmers for destroying their own livestock.

But the problem is more complex. There are millions of chickens in the backyards of village homes across the country, and trying to organize them for culls or even a vaccination program is difficult if not impossible.

Despite the continuing cases among both birds and humans, the government's nationwide education, prevention and containment program is making progress, according to the WHO.

But Malelo, the forgotten veterinarian hero, said the Jakarta government has failed to heed advice from experts in Hong Kong who eradicated bird flu through improved hygiene and mandatory segregation of birds in traditional livestock markets that may carry various forms of the virus.

'A major infection source (for humans) is the markets,' he said. 'But the government for some reason cannot apply the concept here.'

Bird flu in Indonesia grabbed the world's attention in May when seven members of a single family died of the virus - the largest recorded cluster to date.

The WHO concluded that limited human-to-human transmission likely occurred, but the virus did not spread beyond blood family members.

Despite Indonesia's woes, there is no evidence suggesting a widely feared - and hyped - human-to-human pandemic that could kill millions of people will originate here.

'No one is saying a pandemic could be in one country over another - no one knows for sure,' Petersen, the WHO chief, said. 'It's a worldwide phenomenon, almost. Where a pandemic will start is anyone's guess.'

That might give Indonesia some comfort as it stands alone atop the current fatality list.