RI Health Minister in the spotlight

Dono Widiatmoko ,  Salford, UK   |  Mon, 05/05/2008 11:24 AM  |  Opinion

Whatever her reason, Indonesian Health Minister Siti Fadilah Supari's refusal to send Bird Flu samples to the World Health Organization (WHO) seems to have backfired.

A lot of international media has given negative coverage of her refusal to be a threat to world health. For example, the editorial column of the Wall Street Journal recently condemned her decision and suggests Indonesia's refusal to send H5N1 virus samples to the WHO could lead to a pandemic in the region, if not the rest of the world.

As Indonesia has had the most reported cases of H5N1 bird flu, its refusal to send bird flu samples for vaccine development is being monitored closely by other countries.

As of mid-April 2008, there were 132 confirmed cases of human H5N1 virus infection with 107 deaths in Indonesia. This represents 35 percent of known cases of this deadly virus worldwide. Without Indonesia's bird flu samples, the development of a vaccine would be difficult if not impossible.

Many international commentators have speculated that Siti made a stand to gain domestic political support, in particular by bringing anti-U.S. sentiments to her personal gain. Some went further to suggest she was attempting to gain support from Muslims opposed to the U.S.

Most international media quoted the minister as suggesting the samples would be eventually be used by the U.S. government as a potential biological weapon. But Siti has denied this, saying a misatranslation occurred between her original Indonesian book and its English copy.

Instead, Siti says, the main reason for the rejection was samples would be used by Western Pharmaceutical companies to produce vaccines which would later be sold to developing countries at high prices.

It must also be recognized that the development of a bird flu vaccine is potentially big business. Developing such vaccines is very difficult, mainly because virus strains mutate rapidly, but a successfully developed vaccine could bring huge financial rewards as it would be required in large amounts both for people in developed and developing countries.

What is also interesting is that the refusal was contested largely by the U.S. government, and not the WHO itself. The latest salvo against her decision came from the U.S. Secretary of Health and Human Service, who on a recent visit to Jakarta pressed for Indonesia's acceptance to send the samples to the U.S. laboratory.

The most recent development in this saga comes with the banning of the U.S. Navy's Naval Medical Research Unit No. 2 (NAMRU-2) from operating in Indonesia. Reports from the Indonesian media say collaboration with this institution (which has long been operating in Indonesia conducting virology, microbiology, epidemiology, immunology, parasitology, and entomology research) was halted pending further negotiations with the U.S. government.

Whether the Indonesian people (or government) would gain a share in the development of vaccines is the main political concern here. So far, people living in less developed countries like Indonesia are seen more as the target of western products or developments in health.

Many drug trials, for example, are now conducted in developing countries, mainly because of less stringent requirements in accepting drug trials as well as the relatively cheaper costs.

The profits from developing such medicines and vaccines go primarily to major pharmaceutical companies. What remains for the people and governments of the host countries is the price tag for the developments which were created right under their noses. This is certainly a world of unfair play.

Siti's efforts may seem somewhat justified.

The World Health Organization had commissioned a study on the 'ownership' and patent issues surrounding the Influenza viruses. Further negotiations on the issue of handing over the samples to international bodies, and possibly commercial companies, are continuing.

However, the most important issue facing the Indonesian Health Minister is a potential backlash which would occur if this struggle for a better bargaining position is lost. Indonesia could be accused of putting the world in danger of a global pandemic by not supporting the international effort to find vaccines, and effectively leaving the virus to run wild.

While many prominent figures in the Indonesian health sector backed Siti's stance, losing this battle from an international perspective would be a disaster for Indonesia. There are enough examples of where the Indonesian government's position has been hung out to dry in the international media spotlight.

There is certainly a need to improve the perceptions of the international media toward Indonesia, and in particular the stance of Minister Siti Fadilah, to reach a beneficial outcome for everyone.

The writer is Senior Lecturer in Public Health, University of Salford, Salford, UK. He can be reached at d.widiatmoko@salford.ac.uk 

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