Blogs

Indonesia  (8 comments)

Posted by: Michael Leavitt
Thursday, April 17th, 2008

Written April 14, 2008

I’m in the Jakarta Airport, having just finished a day of meetings with Indonesian Government officials. I met with President Susilo Bambang Yudhoyono, Coordinating Minister for Family Welfare Aburizal Bakrie, Foreign Minister Noer Hassan Wirajuda, Agriculture Minister Anton Apriyantono, and Health Minister Siti Fadilah Supari. The meetings involved discussions on a group of issues, among them the control of H5N1 avian influenza, the U.S. Naval Advanced Research Laboratory (NAMRU-2) in Jakarta, and Indonesia’s departure from international expectations on sharing samples of influenza viruses.

I was here in October 2005 as we were scaling up our own pandemic preparedness in the United States. Being here is an important reminder of how different the problem looks from different perspectives. Indonesia has 245 million people, who live in a space about the size of New York State. About 60 percent of the country’s area is water, since the nation is really thousands of islands. It appears to me that most of those people must have highly localized lives, and developing a national strategy on anything would be difficult.

The next presidential election in Indonesia will take place in 2009. Just like in the United States, the upcoming election has begun to affect the formulation of policy. The night before I arrived, local elections took place in the largest Province, West Java, and, in what appears to have been a surprise, an Islamist party took power. It would be similar to having a populist movement win a statewide election in California. The election in West Java is an event that will clearly begin to factor into everyone’s political calculus in Indonesia.

I didn’t have any political discussions about this with Indonesian officials. These are observations I am picking up from reading the local papers, and from talking with people at the U.S. Embassy. I’ve always found it important to understand the political context in which foreign government officials are operating- it helps you understand the filter through which they are seeing the world.

My first meeting was with Foreign Minister Noer Hasson Wirajuda. He is a sophisticated and well-educated man who spent five years doing legal studies in the United States. We talked at length about a group of themes related to the challenges of governing an undeveloped country. Later in the afternoon, our discussion continued. I think rather than discuss those in this entry, I will do a separate piece tomorrow.

Next, I visited the office of the Coordinating Minister for People’s Welfare, Aburizal Bakrie. A Coordinating Minister oversees several Ministries or areas of the Indonesian Government, and has the responsibility to coordinate their work. The meeting included the Ministers of Agriculture and Health.

Minister Bakrie is a noted businessperson. His family holdings are extensive, and their reputation looms large within the region. He speaks excellent English, and deals confidently with people. His business background is evident in his willingness to engage directly on problems.

Minister of Agriculture Apriyontono was invited because of the animal-health connection in avian Influenza. I met him in 2005 as well. Likewise, I have met multiple times with Health Minister Supari. She has become a controversial figure within the health world, because she has stopped sharing with the World Health Organization (WHO) any samples of influenza viruses that are circulating in Indonesia. She asserts that if a nation provides a virus from which a manufacturer makes a vaccine, that country is entitled to monetary compensation of some form. This is a dangerous course that threatens to undermine a worldwide agreement honored by nations for nearly 60 years. I wrote previously about this subject.

The Indonesian Health Minister has used the sample-sharing debate and the negotiations over the status of NAMRU-2 in Indonesia to set herself up as an antagonist of the United States, a position I suspect helps her politically among the constituency of her party.

NAMRU-2 is an important public-health asset in Indonesia. The lab is a WHO reference lab, which means the level of expertise there is high enough that the world accepts its work. If a communicable disease breaks out in South East Asia, any country can send samples of the virus there to have them identified. The laboratory has been in Indonesia for decades, and exists under a Memorandum of Understanding (MOU) between our Governments, which is up for renewal.

The MOU that governs the status of NAMRU-2 expired two years ago, and both sides have been trying to renew it. When I was in Indonesia in 2005, the lab was a major topic of conversation in my discussions with various Ministers, and with the President. At that time, I received absolute assurances the Indonesian Government would approve the MOU shortly.

Minister Supari recently issued orders to prohibit Indonesian institutions from providing tissue samples to NAMRU-2, under the justification that such sharing is not legal in the absence of an active MOU and a Material-Transfer Agreement. Her action is obviously linked to her global initiative to seek specific benefits for sharing samples.

To add more drama to this picture, Minister Supari, recently published a book in which she asserts the U.S. military is using influenza samples to create biological weapons. Secretary of Defense Gates was asked about the Minister’s accusation when he was in Indonesia this past February; he replied, “That’s the nuttiest thing I’ve ever heard.”

8 Responses to “Indonesia”

1. Science Teacher says:

   April 17, 2008 at 2:26 pm

   Thank you for the summary, Mr. Secretary. Thank you for again
   pressing this issue with Indonesia.

   Indonesia has dug in its heels on this one. If a pandemic happens, I bet they will be one of the first ones to knock on our door for help just as they had their hands out to receive the Tamiflu we gave them.

   I do understand their worry over being unable to access vaccines for their population. They have chosen the wrong path to address this issue. Blackmail is a very poor choice on their part.

   It would be nice to see some other WHO countries address this stand-off with them, as you have, by meeting in person. It must have been a frustrating experience for you.

   Perhaps NAMRU-2 could provide resources to a different country?
   Surely other ‘incentives’ could be used as well.
   Just a thought.

   Sixty days left to walk softly and carry a very large stick.
2. David Haley says:

   April 18, 2008 at 7:06 am

   Mike,

   You never took me up on my offer to privately fund a two year CMS demonstration project which has the potential of saving Medicare $386 billion over the next 20 years. What does it take to get to this project off the ground? CMS has nothing to lose and everything to gain. Check out my web site.

   David Haley
3. Goju says:

   April 18, 2008 at 7:06 am

   What the Indonesian government is doing should be considered a crime against humanity.
4. Katherine in Michigan says:

   April 18, 2008 at 9:21 am

   Kudos to you, Mr. Secretary! I, personally, was cheering when I read your blog!

   I am relieved to hear that Indonesia’s leaders have been unsucessful in extorting payment for viral samples that may be of vast importance to the world. I hope the U.S. will indeed quickly move on to securing samples elsewhere to begin work on pre-pandemic vaccines that, even if only partially effective, are better than nothing.

   I am particularly glad you have directly addressed the issue of Dr. Supari’s book, in which she apparently claims the U.S. is deliberately using disease and the high cost of vaccines against them to keep third world nations in some sort of impoverished neo-colonial state. As you mentioned in your blog, she has even gone as far to insinuate the U.S. is, or would, use avian flu to this end. This is exactly the kind of inflammatory rhetoric that engenders fury against the U.S., something we surely don’t need in areas that are becoming more and more Islamist. Thank you for mentioning this conflict directly; I hope you will continue this conversation with Dr. Margaret Chan of the U.N. from whom Dr. Supari says she’s derived her information.

   Thank you once again for providing your thoughtful and well-spoken window to the international affairs that affect all Americans. I appreciate this blog!
5. Dwight Gentz says:

   April 23, 2008 at 10:35 am

   Secertary Mike Leavitt, I recently read comments attributed to you about import drug safety in an Associated Press interview by Kevin Freking. I was disappointed to hear you comment that market expediancy needs to be balanced with regulations (inspections)regarding a drug’s fittness for use when bringing it into this country. Specifically the heparin issue. Heparin has been manufactured in the U.S for years and now that someone wants to bring an imported version into the country (at a much lower cost to produce but sold at the same price), we need not look at it in the same light as the U.S. version was looked at????? Please….don’t put our health at risk for corporate profits!!!!!!!!!! If we are going to business with drug makers from overseas then see to it that what comes here is fit for use. It is not in our best interests to rely on the foreign governments to do our inspections for us.
6. Scott McPherson says:

   April 25, 2008 at 7:52 am

   Secretary,
   Please read my blog on your blog. Your words are always welcomed.
   Scott
7. Graybeard says:

   April 29, 2008 at 9:31 am

   Thank you for your informative blog, Mr. Secretary. I agree with your statement, “World health should not be the subject of barter.” but how is that different from having vaccines available only to countries that can pay for them?

   In the case of an influenza pandemic in the U.S., and assuming a vaccine is available, it would be poor public health practice to vaccinate only those who can afford to pay for the vaccine…doesn’t the same hold true on the international scale?
8. Jenny de Montalk says:

   May 5, 2008 at 7:23 am

   You say that the benefits from Indonesia sharing samples are minimal in comparison to the potential detriment of agreeing to their demands. As Indonesia has the highest incidence of death by Avian Influenza in humans, do they have much to lose by not participating in the sharing scheme? What exactly would happen if the Health minister’s demands were met? Has there been any progress since your meeting?