The failure to have sequences from Indonesia made available to the world's scientific community continues to be a scandal. Whose doorstep to lay the blame? There would seem to be three possibilities: WHO, the scientists who do the sequencing, and the Government of Indonesia. An official from the government has already said they would consider a request for release favorably if one were made, but WHO admits they have yet to make one. Meanwhile, sequences often appear in GenBank upon publication of a paper. The available evidence, therefore, suggests WHO is guilty of not pressing the Indonesians and the scientists are guilty of holding sequences until they can publish. Then today, we have an interview with Indonesian Health Minister Siti Fadilah Supari in The Jakarta Post (text sent by a kind reader; link is likely to be up for only limited time). It contains the following (shocking) statements:
Q. The WHO says that there has been limited human-to-human transmission of bird flu in Indonesia, but you consistently deny this. Why?
A. All the data and samples of cases occurring here are kept by us. We haven't shared them with other institutions because we are still conducting our research. After studying samples taken from 56 patients, including those from the Karo cluster, we believe there has been no mutation in the virus. [our emphasis]
Those who say there have been human-to-human transmissions are epidemiologists, because when they see the virus infect a group of people they take that to mean transmission has occurred.
I myself still believe that the virus has not mutated, because all the samples show the virus comes from chickens, not from some other sources. (Jakarta Post)
The Health Minister says the evidence does not show human adaptation, but Indonesia isn't going to let anyone see the evidence.
The only word I can summon up is "deplorable."
[NB: Corrected the Q and A designations. (thanks to ugis)
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That is indeed VERY revealing, Revere!
Indonesia's people need to hear clearly how their own government is trying to deceive them and the international community needs to slam Indonesia's leadership hard for this appalling failure in transparency.
The Indonesian Emperor still has cloths!
I think this calls for a raid on their computer systems. Does anybody know a good hacker who understands gene data basea?
Could it be that the Indonesian government looks at the sequences as a commodity and is waiting for a bidder?
Not to back theie behaviour but maybe they are taking this viewpoint.
Here we are in a deep hole, all the worlds' governments are standing around and telling us to do something about our mess. But all we get is lip-service, limited help and no money. So let's use these sequences; something they want but haven't got, as leverage.
Then I'd guess the next question the health minister wants to here is. "Would you like that in euros or US dollars?"
Perhaps there is a consistency in the attitude towards evidence. The Health Minister also responded to:
What is your office doing to prevent more deaths?
"Because the key is public awareness and prevention ... We will ask them to spray their backyards with disinfectant, have their chickens vaccinated and wash their hands frequently, which has proven to be the most efficient and effective way to stop the virus."
Since the Minister says, in the same article,
"Our vaccination and disinfectant spraying campaigns have not had a significant impact"
then the "proven .... effective" method has got to be hand-washing.
I sure wish that I had some evidence showing clean hands preventing the inhalation of virus shed to the air from its host and/or rendered airborne by disturbance of waste, feathers, etc.
Perhaps, the hands are cupped around the face to filter out the airborne contaminants?
I should think that breath-holding http://mmwr.occhealthnews.net would be more effective.
revere, I think you are misinterpreting the words of the Minister of Health. The human samples are sent to both Hong Kong and CDC who do the sequencing. The data presented in Jakarta had sequences from 37 patients. It is unlikely that there are isolates from the other 19 (other than those sequenced after June 12). Most of the 37 sequences fall on a seperate branch which has not avian isolates. Since there are no avian sequences within the last year, it is possible that the avian sequences exist, but have not been collected / sequenced.
It is unlikely that they have been sequenced and were withheld from the Jakarta data. Samples were being sent to Australia to address the issue of the lack of a match.
As far as "mutations" are concerned. WHO only looks at reassortment and changes at position 226 and 228 as "significant" for H2H, which is what is meant by the statement that there has been no change.
Data will come out next week that will put reassortment between H5N1 and human flu genes in proper perspective.
Henry: I refer to two things, the isolates and the sequences. Indon has released neither as far as I know and they sound like they won't until pressed. Sending them to CDC and Hong Kong is not the same thing, as we know. You know about the sequences not because they were released but because you got the .ppt slides from Jakarta the same place I did. The poultry isolates have just arrived in Australia as I posted today. They were not available until now and have yet to be sequenced as far as I know.
I am not talking about the Jakarta meeting data, which is not public (although you and I both know what was said). I am talking about GenBank and the world scientific community.
Actually, the were phylogeentic trees made prior to Jakarta that didn't have as many patients represented, but had both Hong Kong and CDC isolates. However, only sequence from one isolate by CDC was released, and that sequence was the target for the pandemic vaccine that will be the topic of discussion next week.
Although the minister of health suggested that Indonesia researchers were still studying the data, that is really just another way of saying that the sequences are being held for publication, which will also be coming out soon.
In the past sequencers control the data, and I don't see any indication that anything is different in Indonesia. When the publications come out, so will the sequences.
A good examples of the control was the releae of a 2006 H5N1 sequence from Laos. When teh sequence came out, Laos acknowledge ONE farm (although they did not file the mandatory OIE reporter. Now Thailand (WHO's poster child fro H5N1 control) is admitting H5N1, and guess who isfiling suit.
Of note, the same sequence in Laso is near Kuala Lampur, which is VERY close to Indonesia. Look for the Fujian sequence to begin to appear in areas well beyond the borders of China, where it accounts for all reported H5N1 human cases in 2005 and 2006.
WHO is well aware of these sequences from Laos and Malaysia, which were in its private database prior to release in March on the public side of Los Alamos.
These withheld sequences go on and on. Indonesia is just one example of the games being played.
I am Indonesian, currently living in Bangkok, should there be a law or regulation that force government to share this kind of things? And if there isn't, why?
enda: Since we don't have any governmental authorities above nation states (i.e., no "world government") this isn't possible now except by political or economic pressure.
An Indonesian friend told me (he's doing graduate study in Columbia) that Indonesia currently doesn't have BSL-3 facility (yet) to do the sequencing and has always been sending samples to WHO sequencing center in HK, US or Australia.
Three institutions (UI, IPB Eijkman) is building new BSL-3 facility but is not complete yet.
I am not sure which one is correct, but if my friend information is true then, Indonesia can't be accused of holding the data and sample secret inside the country.
enda: Subsequent to the post this comment thread is attached to Indonesia gave permission to release the sequences. It is true that the sequences were done elsewhere, but the agreement with WHO reference labs is that they cannot be released without the permission of the member state that submitted the samples.
Apparently, we are selling it now: "Indonesia May Sell, Not Give, Bird Flu Virus to Scientists" (nytimes) :(