Indonesia’s next episode in fighting bird flu: a legacy note

by Arie Rukmantara

Exactly on March 13, 2010, the bird flu control agency 's mandate ended. The 2006 presidential regulation on the establishment of coordinating committee on avian influenza control and pandemic preparedness (Komnas FBPI) has expired. Indonesians must say good bye to its first ever ad hoc committee in responding a public health crisis.

We should extend our appreciation to the staff, the ministers and all people involve in supporting the agency’s work in the last four years. Surely, both achievements and shortcomings have been recorded in the Indonesia’s health history.

Admit it or not, the committee has changed the course of Indonesia’s future. Although it failed to save the lives of some 130 people who died of H5N1 from 2005 up to last month, but it has increased the awareness of over 90 percent of Indonesians on the existence of a new infectious disease called avian influenza or bird flu.

According to UNICEF’s survey in 2009, the committee’s campaign, Tanggap Flu Burung (take action against bird flu), has boosted hand washing practices from less than 20 percent in 2005 to 63 percent in 2009. It has also managed to introduce, for the first time, the term “pandemic” to 30 percent of the population. These numbers represent Indonesia’s promising public health’s future.

Understanding bird flu means Indonesians are learning one of the many zoonotic diseases and therefore also learn how to protect themselves. Increasing hand washing practice, especially among children, will save the next generation not only from H5N1 virus but also protect them from 100 other infectious diseases commonly spread via hands. Learning the term “pandemic” means that an outbreak in one country could become a global threat.

The committee has also trained thousands of cadres, poultry farmers, and officials; developed capacities of hundreds of doctors and veterinarians as well as building regional administrations’ capacity in coping with an influenza pandemic. This is a leverage in responding to future health threats.

Furthermore, Komnas FBPI has commissioned the first historical research on pandemic in the 20th century Indonesia, revealing that some 1.5 million of our ancestors died in the most devastated influenza pandemic in human history, in 1918.

Nevertheless, the quest to fight avian influenza should move on. Simply because the virus remains a public health threat. It is still endemic in 30 provinces, posing a potential danger to mix with the present influenza H1N1 strain virus that has triggered a global pandemic since July last year.

For now, we just have to trust the Health and Agriculture ministries to carry on the committee’s work in controlling bird flu and responding to pandemic H1N1, along with the office of the Coordinationg Minister for People’s Welfare to bridge the gap should the two ministries fail to work hand in hand.

However, the public should notice that the ministers of these three ministries are no longer the same people that dealt with bird flu crisis from 2005 to 2009. They are new politicians appointed by President Yudhoyono after his glorious win over the 2009 general election.

For the record, only Health Minister Endang R. Sedyaningsih who is familiar with bird flu’s fight as she was a member of Komnas FBPI’s panel of experts and studied the disease at the Health Ministry’s research and development’s lab herself.

The same situation applies to the parliament. So far, probably only Rieke Dyah Pitaloka, member of the House of Representative’s Health Commission, who can grasp the idea of how lethal H5N1 is. Prior to her election, she features a TV public service advertisement on anti-bird flu campaign and starred a radio drama on pandemic preparedness.

The rest, deserve a briefing note on what happened before they take office.

So here it is, a short note to people who are entrusted to continue Komnas FBPI’s tasks.

Four years of fighting bird flu, Komnas FBPI’s works reflect a series of connecting dots: surveillance on animal health, early detection by community health clinics, rapid reporting by community members, and quick responses from an integrated medical doctor-veterinary-communicators team, each and every time a confirmed case occur.

Therefore, the future fight against animal-derived diseases must have better zoonotic control, early detection, response, and surveillance. Serious attention to promoting quality of doctors and veterinarians, their laboratories and financially sponsor their researches is vital.

Komnas FBPI has also left a historical track in Indonesia’s public health history. For the first time in over 60 years of its existence, Indonesia now has a National Pandemic Preparedness and Response Plan, the country’s first and only documented contingency plan on health disaster.

And therefore, a more reliable pandemic preparation system is extremely needed because to tell you the truth, the plan is not final. Komnas FBPI chief executive Bayu Krisnamurthi said the plan is “a living document and simultaneously need to be revised based on the latest development.”

So, we are not there yet. Indonesia is not fully equipped to face a pandemic. Fortunate for us, the pandemic H1N1 came as “mild or moderate” pandemic, costing 10 Indonesian lives, although it killed more than 16,000 people worldwide.

Indonesia’s anti-bird flu drive 2006-2009 also showed that we must seek ways to integrate health-related issues with other non-health matters, such as, transportation, security and order, economy, and start taking into account environmental issues (climate change).

We also need to think beyond bird flu, and start paying serious attention to the many other animal-borne illnesses, such as rabies, which currently is disrupting Bali’s and North Sumatra’s public health situation. To cope with rabies and control its spread, the exact same resources that have been mobilized to fight bird flu are needed. No body in this world would like to see the world’s most popular tourist destination turned into “The Island of Rabies”, right?

“There is no room for short minded, no space for short-sighted views,” says one senior government official.

Therefore, the next chapter on the fight against avian influenza, post-Komnas FBPI’s period, needs to also maintain and expand effective public health’s armed weapons—communication, communication, and communication.

Komnas FBPI had managed to pull the right strings: it managed to build effective communication among government officials, ministries and institutions; it succeeded to talk to international partners and explain the complexity of doing things here.

Most of all, the committee has been successful in talking to some 200 millions of people that what was fine is now risky, such as backyard farming and home culling. It has also promoted simple hygiene practices, such as hand washing, as a mean to save lives.

There it is, the recipe for a successful drive in controlling bird flu and other zoonosis--strong infrastructure and people's participation…and of course, a strong and lengthy commitment.

With that in mind, I end this note and wishing all the ministers, parliamentarians and other stakeholders in the war against bird flu and other zoonosis, best of luck.

Arie Rukmantara is a health and environment freelance writer and former consultant for Komnas FBPI. He is a co-author of Building A Plane While Building It, a book on bird flu’s journey in Indonesia, published by Komnas FBPI in early March 2010.