The controversial head of the Indonesian Health Ministry, physician Siti Supari, quarantined sick foreigners at warp speed. Already embroiled in a battle royal with the world’s superpowers over another flu virus—the ultra-lethal bird flu—Supari did not have time to deal with a new enemy. She would do everything possible, she told her fellow citizens, to protect them from the new pathogen spawned by a pig.
The recent frenzy in Bali stood in notable contrast to the research paralysis that has gripped this tropical archipelago since late 2006, when Supari declared that flu viruses circulating in Indonesia belonged to her government alone. It was a bizarre, 21st-century twist on an age-old intellectual property argument. Developing nations had long fought passionately over plant and native human genes, but no one had ever before staked claim to microbes that birds could carry anywhere. Yet the 57-year-old health minister insisted she had cause: Rich Western nations were patenting the viral genomes, then using the information to create vaccines that were sold for profit to other Western powers while benefiting Indonesia not at all.
If Supari had stopped there, she might have garnered real support. But she ramped up the rhetoric, launching a barrage of fear bombs by accusing the United States of genetically engineering H1N1 (the swine flu virus) and H5N1 (the bird flu pathogen) as biological weapons. Wielding those charges, she flouted agreements with the World Health Organization (WHO), refusing to share samples from Indonesians infected with avian influenza—specimens the rest of the world desperately needs to track a virus on the move.
Supari not only has clamped down on viral and epidemiological information but has also cut off cooperation with NAMRU-2, the U.S. Naval Medical Research Unit in Indonesia’s capital city, Jakarta. Since 1970 the lab has helped advance knowledge on a range of infectious diseases, including malaria, dengue, and, more recently, bird flu in Southeast Asia. But Supari wants the Americans and their scientific paraphernalia to get out.
This standoff has escalated into a full-blown geopolitical dispute over influenza viruses. Negotiations are so delicate that talks on the U.S. end have risen to the highest levels of diplomacy. The State Department would neither confirm nor deny that Secretary of State Hillary Clinton’s visit to Indonesia in February had something to do with NAMRU-2. “We have no comment on the secretary’s private conversations,” said a source who requested anonymity. Despite intermittent signs of a thaw, this past May Supari reportedly threatened with severe punishment any Indonesian scientist caught conducting experiments with researchers at the naval laboratory. Once bustling with scientists, that lab now has only a handful of researchers, all on temporary visas.
Supari could be written off as an inconsequential hothead if not for the spread of bird flu in Indonesia and the looming international threat it presents. Global health leaders need her cooperation to trace a virus that is relatively rare in most of the world but that has left few regions in this chain of 17,500 islands unscathed. That virus may still represent one of the world’s greatest public-health threats, some scientists fear.
Their concern is based on several chilling facts. More people—and more birds—have died of avian influenza in Indonesia than anywhere else on earth. Smoldering in rural regions as well as cities, the H5N1 virus has the potential to kindle a pandemic strain. With a new, easily transmissible swine flu already circling the globe, scientists are understandably nervous. Some are talking about the potential of a gene swap between the pig and avian flu strains. Long feared as a breeding ground for novel flu viruses—many variants of H5N1 have been identified in humans and chickens here—Indonesia is considered a likely spot where such a genetic reassortment event might occur.
The creation of a swine-avian hybrid could have nightmarish consequences. H1N1 is comparable in severity to seasonal flu, and it spreads just as easily; H5N1 doesn’t pass easily between humans, but it is more lethal. Were bird flu and swine flu to combine, the result might be a killer strain comparable to the 1918 pandemic virus. The Indonesian strategy for preventing this dread convergence—scanning for fevers and disinfecting foreigners at the airport—will not keep the different flu strains apart. But Supari’s information blackout might prevent us from recognizing a deadly H5N1/H1N1 hybrid until it is too late.
BIRD FLU TAKES FLIGHT
Avian flu in Indonesia first caught the world’s attention in 2004, when it wiped out 16.2 million birds in a bit over a year. The first human cases appeared in 2005, and since then the virus has coursed through the country with the stealth of a serial killer. In fact, most of what we know about the human version of the disease comes from Indonesia, where avian flu goes by the nickname AI.
Many hospitals in the country now have AI units to stanch the tide, and with good reason: Of the 141 human bird flu cases in Indonesia reported to the WHO, 115 people have died, a death rate of more than 80 percent. Put another way, bird flu in Indonesia is about 8,000 times as deadly as the swine flu virus now making the rounds, according to global health expert Laurie Garrett of the Council on Foreign Relations in New York City.
As frightening as these statistics seem, the figures are based on spotty reporting from Indonesia’s Health Ministry, which means the actual number of infections and deaths might be substantially higher. Through the first three quarters of 2009, Indonesia failed to report any flu cases at all, even though the Food and Agriculture Organization (a body of the United Nations that monitors avian influenza in birds) has found the infection to be deeply entrenched among fowl in 31 of the country’s 33 provinces and endemic in Java, Sumatra, and Bali.
