New Avian Flu Committee Shows Indonesia's Maturing Approach to Epidemics
For many national and international health experts the news that the Indonesian National Committee for Avian Influenza and Pandemic Influenza Control will be dissolved in the next few weeks was disturbing. Fresh outbreaks of bird flu have recently been recorded in a number of provinces and several patients have tested positive for the disease. It just doesn’t make sense why the bird flu battle has to end now.
But then a senior Agriculture Ministry official announced a new group would be formed to replace the aforementioned committee, known as Komnas FBPI.
The announcement of the future committee, to be called the National Committee on Zoonosis, or Komnas Zoonosis, is a welcome sign of commitment from the central government. It also shows a shift in the government’s paradigm and a decision to treat bird flu as one of the many animal-sourced diseases that needs to be tackled.
The year 2006 was the worst year in Indonesia’s bird flu history. More than 50 people contracted the disease and 80 percent of them died. It was the year that the country surpassed Vietnam as the world’s leader in numbers of confirmed bird flu cases as well as fatalities. And it was the year the world was shocked by the discovery of two bird flu clusters in Indonesia: the Karo and the Garut clusters. The earlier cluster appeared in a family, while the latter broke out in a community. The cause and mode of infection remains unknown. Scores of scientific papers published in world renowned scientific journals have not conclusively solved the mystery. The one thing that is certain is that the H5N1 virus, rampant in backyard poultry, was the cause of the infection and deaths in both clusters.
The birth of Komnas FBPI intensified the war against bird flu. The committee launched the first massive nationwide health program since the 1998 reformation: the Tanggap Flu Burung (Take Action Against Bird Flu) campaign. Although disliked by some ministry officials, who argued that Komnas usurped their authority, the committee helped increase communication and coordination between government institutions and international donor agencies.
But the question remains, after tens of millions of dollars spent, thousands of civil servants mobilized and millions of people taking preventive measures, why is H5N1 still around?
There is no easy answer. One of Komnas FBPI’s executives says, “We probably have to face the fact that we have to live side by side with this virus.”
In short, bird flu will remain a public health threat, but Komnas and its campaigns have made people aware of how to protect themselves.
So, why Komnas Zoonosis? The antibird flu campaign has taught the government a very important lesson: a public health threat requires multi-sector cooperation.
Although bird flu is still with us, the number of cases has been diminishing annually since the campaign was launched. This decline has been influenced by many factors.
First, the success of the campaign in teaching people to wash their hands, cook their meat until well done, cage their chickens and go to a doctor when symptoms of influenza appear. This campaign has reached over 90 percent of Indonesians, according to a UNICEF survey.
Second, community training carried out by numerous organizations. This training has facilitated community members discussing and resolving their own problems. It has resurrected the old practice of neighborhood meetings.
Third, the press has played a vital role. Media loves bird flu news. It involves a pandemic: deaths, outbreaks and economic impacts. Noted risk communication expert Peter Sandman says “public attention correlates with media attention.” The more bird flu makes headlines, the more people care about the risk it carries. Bird flu headlines have kept the public informed about the deadly virus. Some media have almost gone overboard in making bird flu news a priority and continuously promoting prevention.
Fourth, the development of a pandemic preparedness plan. The war against bird flu has forced the government and many businesses to organize and draft pandemic preparedness and response plans, as well as business contingency and continuity plans. These plans have been tested on many scales, from table top exercises such as mock up disaster response forums, to full scale simulations that include field exercises with mobilization of equipment and personnel.
The government cannot afford to lose the momentum and resources it has built in the war against H5N1. It wants to and it must keep this momentum alive.
Experts have said that some 70 percent of newly emerging and re-emerging diseases are zoonotic (capable of being transmitted from animals to humans). Dengue, AIDS and rabies are all ongoing challenges.
Historical archives show that in the17th and 18th centuries, millions of people in our sprawling archipelago died of cholera, smallpox, and other epidemics. University of Indonesia historians recently revealed that up to 1.5 million Indonesians died of pandemic influenza in 1918.
The justifications for the creation of Komnas Zoonosis are solid. We need the committee. But what is next?
Aside from maintaining and expanding the successful communication programs on avian influenza and pandemic preparedness, the new committee should focus on two key factors: environmental issues and support from the social sciences.
The committee should highlight the potential link between disease and environmental issues, such as climate change. The fact that most new infectious diseases come from animals may have some connection with the changing climate, threats to biodiversity and wildlife protection. The decline in habitats has forced animals to move, sometimes into residential areas where risky contacts may occur.
Linking zoonoses with climate change might also link the committee with abundant funding. One top official opines that the success of zoonotic disease control and pandemic preparedness will depend on the flexibility of funding. Relying on the state budget would be both ridiculous and problematic. As we all know, the state budget is usually disbursed mid-year; but outbreaks of disease do not recognize dates. They can occur anytime, anywhere.
Finally, the national committee on zoonoses should be inclusive. Medical doctors and veterinarians are not prophets. They cannot solve all the problems in the world. They do not have a panacea for every public health crisis. The members of the committee should consider working with social science experts. They should cooperate with historians to learn what has happened in the past; with anthropologists to learn key human behaviors; with sociologists to understand the present social structures; and with communication specialists to learn to speak in more familiar language and create more people-friendly messages.
Whatever agency takes over Komnas FBPI’s role, it should set higher goals, it should do more than just its best.
Arie Rukmantara is a freelance health and environment journalist and risk communication consultant.