In real life, a mighty kingdom and its ruler can fall in a single night because its enemies penetrate the border. In 1939, Poland relied on its military defense plan, Plan Zachód. The Allies criticized the plan because it was too weak. Unfortunately, the Polish ignored this and as a result, Nazi Germany defeated Polish forces in just a few days.

The message is clear that when a nation’s borders are weak, it is vulnerable. Every day, goods and people cross Indonesian borders, legally or not.

But the real threat that is often overlooked is disease. Remember how the conquistadores wiped out the entire Maya civilization? The Spanish didn’t even shoot a single rifle. It only took one sick conquistador soldier and the Maya civilization surrendered, forever.

Dealing with communicable diseases transmitted through a border is a very daunting task for several reasons.

First, the carrier usually does not show any obvious symptoms. They look healthy, and the checkpoint officer cannot tell the difference.

Second, the disease is easily transmitted to the new host, because the new host does not (physiologically) recognize the disease and hence has not developed any antibodies against the novel disease. This explains why the avian flu virus is easily transmissible in other countries.

We may have succeeded previously in dealing with the avian flu and swine flu.

But another disease has reemerged: Recently a new case of human monkeypox was reported in Singapore. What should give us cause for concern is that this new case was reported in Asia, far from the disease’s origins in Africa.

The fact prompts two important considerations.

The first relates to the screening system at ports of entry. It could be that a system was not installed, was not up-to-date or did not work properly. Worse, perhaps the symptoms of monkeypox have become more difficult to detect.

Second, the case could potentially cause an outbreak in a new host nation, especially on the Asian continent, as its residents would have not developed a natural immunity against the disease.

The ministry should go beyond the ‘business as usual’ health checks.

Compared to other diseases, monkeypox is a very tricky disease to treat. First, it is highly capable of reemerging after several decades of dormancy. Since the disease has a high prevalence of reemergence, it is also capable of easily infecting new hosts.

In 1970, the first case of human monkeypox were reported in Nigeria. In 1971 and 1978, three cases of human monkeypox were reported in Nigeria again.

After 47 years, an 11-year-old boy was infected and in only one month, the virus allegedly infected 146 people in 22 states across the country.

According to the study “Reemergence of human monkeypox in Nigeria, 2017” by Adesola Yinka-Ogunley, the magnitude of the disease’s ability to spread from one state to another cannot be underestimated.

Furthermore, unlike other viral zoonotic diseases like avian flu and swine flu, monkeypox is difficult to manage because the onset of monkeypox was linked to the African culture of bush meat consumption.

For avian flu and swine flu, the culprit was linked to the poor management of poultry, which can be regulated through strict management practices. But how can a culture be regulated?

In fact, as Lucas Luicelli noted in the study “Bushmeat consumption in large urban centers in West Africa”, the elderly and 13 percent of younger people eat bush meat regularly. In the Singapore case, the suspected carrier was a Nigerian who had consumed bush meat during an event back home.

Indonesia’s Health Ministry has asked the public to remain calm in response to the monkeypox case in neighboring Singapore. At the same time, the government has tightened health checks, especially at ports of entry close to Singapore, like Batam. Others prominent airports like Kualanamu, Soekarno-Hatta and Ngurah Rai have increased health checks as well.

But is this effective?

If monkeypox can be transmitted solely along the Singapore-Indonesia route, the move is certainly appropriate.

But in reality, the porous marine borders between Indonesia and Malaysia are the most vulnerable. According to an official report, 29 illegal routes (for purposes such as human trafficking) link Indonesia and Malaysia through Riau alone.

The Health Ministry cannot work alone in managing cross-border infection. It should involve the immigration office and the Tourism Ministry, for example, to track visitors who may be infected. This is key to preventing human-to-human viral transmissions in the country.

Let’s learn from Singapore’s health authority, which immediately tracked down and quarantined any people who had come into contact with the carrier of the disease.

At this stage, the ministry should go beyond the “business as usual” health checks. It should immediately disseminate information on monkeypox, especially through inflight announcements.

Screenings should be conducted once visitors are seated on a flight. Flight attendants should be trained to recognize any passenger who shows symptoms of the disease

For the long term, the ministry should call for global assistance. Vaccination still remains the best way to protect people from monkeypox.

But, because we have never had this disease, we do not have this type of vaccine yet and therefore are not ready for a possible outbreak.

In the context of regulation, the government has enacted Health Ministerial Regulation No. 82/2014 on Communicable Diseases, but unfortunately, monkeypox is not on the list.

Amending the regulation is a pressing need in the face of the potential spread of the disease. The revision will provide the legal basis for health staff when dealing with infected foreigners or in vaccination programs.

Early preparation will spare us from calamities. Remember that we underestimated avian flu when it arrived in the country, and as a consequence, it claimed 70 lives.

Hopefully, we will not repeat that mistake today.

____________________

The writer is a public health lecturer at the University of Indonesia (UI). The views expressed here are his own.

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