Crof, over at H5N1, has an important piece on Indonesia that is worth thinking about. He observes something that lots of us haven't paid attention to: Indonesia hasn't been notifying the UN agency on animal health, the OIE, about bird flu outbreaks in poultry for almost two years:
Here is the very last post from Indonesia: OIE DAILY UPDATE ON AVIAN INFLUENZA SITUATION IN BIRDS. As you will see, the date is September 26, 2006. Since then, Indonesia has told the world nothing about its poultry panzootic.Look at this map of B2B H5N1 outbreaks. Indonesia looks as clean as Argentina.
Look at this report on Indonesia's incidence reports for 2008: No details have been submitted.
So for close to two years, while B2B avian flu has raged from Vladivostok to Nigeria to Britain, from Burma to Pakistan to Egypt, the Indonesians have kept quiet. Millions of ordinary people in Ghana and Russia and Bangladesh and China and South Korea have seen their livings destroyed by culls.
Through all this suffering, which they shared, the Indonesians have kept quiet.
Only when some poor teenager caught the disease and died would they even admit that chickens had died in the kid's neighbourhood. We all took it for granted that H5N1 was endemic in 31 of the country's 33 provinces, so it didn't matter if they didn't report every last die-off. (crof's blog [H5N1])
Crof's theory is that the silence of all concerned (including flublogia which, as far as I know, didn't notice this until crof posted on it) encouraged the Indonesian's to shut off the information spigot for human cases as well. I am generally sympathetic to UN agencies who by charter are creatures of their member states, but I am less inclined to give OIE a pass. WHO has expressed its concern over reporting and virus sharing on numerous occasions and OIE could certainly have done so as well. Why they haven't I'm not sure.
How much difference will this make? Not clear at the moment. As crof points out, we all assume that Indonesia is infested everywhere with infected poultry and who knows what else (they certainly don't). The human cases? The result is more likely to be lots of unconfirmed rumors of clusters and outbreaks. False positives more often than false negatives. If the balloon goes up, we'll hear about it soon enough. The Indonesians have lost the opportunity to manage information. Ironically, cover-up may now be more difficult. No one trusts them. Credibility is zero.
On the other hand, this kind of irresponsible behavior deserves sanction, whether it's Indonesia or China or anyone else. A commenter here, who is highly expert in these matters and with a great deal of international experience, suggested that going after Indonesia on the tourist front might be a useful tactic:
It might be a useful service to travelers -- via travel blogs and sites like tripadvisor -- to post a short note about Indonesia's official announcement that they are no longer reporting human bird flu deaths in a timely manner. I would recommend using direct quotes from the Indonesian health minister, accompanied by a sentence about what the International Health Regulations require, plus a citation (link) to a media source of the information (Path Forward, EM comment thread, June 6, 2008)
It is a perfectly reasonable point to say this is the world's hot spot for death from a very nasty and virulent disease but the government has declined to inform the traveling public of conditions there for fear of harming their reputation. This isn't speculation. It is the explicit reason Indonesia is no longer releasing data on human cases.
Meanwhile, the OIE should also speak up. Maybe there's a good reason they haven't, but I can't see what it is.
Addendum: See Jon's welcome additional info in the comments (second in line), below. I still think crof's observation has some merit, although technically there may be an explanation. None of this goes to their failure to report human cases.
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I saw crof's post and it immediately reminded me of the tragic state of OIE's media reporting mechanisms and website. The WAHID data always appeared patchy at best and it was never clear that what was on the website was actually what OIE knew.
On the other hand...the Indonesians have form.
I've done a bit of digging. It seems that the Indonesian's (or maybe OIE) classified HPAI as 'endemic' at the end of 1996. As it states in the final report crof links to:
"Note by the OIE's Animal Health Information Department:
This event is continuing. Because of the large number of outbreaks, notification by the country will be made using the six-monthly reports."
This is why you aren't getting any more individual outbreak reports, because they are supposed to be for 'Exceptional Epidemiological Events' which can't be endemic diseases. According to the (much improved!! :) ) WAHID interface the Indonesians are behind by a year on their six-monthly reports but so are a whole host of countries, including a number of HPAI hotspots (Egypt and China on first glance).
A bit of a hurry up on the six monthly reports is in order (especially given the gravity of what they are reporting) but perhaps to jump to massive conspiracy is premature.
When you look at the OIE website, not reporting seems to be the normal procedure for diseases which are stated "endemic" .
After a disease is stated "endemic" reporting stops. Look for instance at "bluetongue" in Belgium, same thing.
It says: "final report" . In this final report something is said about 6-monthly reports, but these reports do not follow, same
thing in Belgium.
There are more diseases which are stated "endemic" , same procedure is followed: reporting stops after the "final report".
See for yourself.
So: regarding Indonesia nothing extraordinary. That is: from a burocratic point of view ........
Dutch: See my Addendum to the post. Jon H. pointed this out, too. Hat tip you both.
Conspiracy I don't see here, Concern yes.
I'm glad to see that both Croft and you have made this discovery, but it is incorrect to suggest that this has gone unnoticed by Flublogia.
Please see my blog entitled "Outbreak in Aceh, Indonesia" dated December 16, 2006.
[snip]
"Indonesian authorities have not reported the large numbers of poultry deaths to the OIE (as of December 21, 2006). The last report from Indonesia to the OIE is dated September 25, 2006."
From the Indonesia page at PFI_Main (which has been up for months):
"Indonesia has not reported any infections of animals to the World Organisation for Animal Health (OIE) since September 26, 2006. However, there have been numerous reports of H5N1 infections in animals in the Indonesian press up to an including March 2008.
See this machine translation of an Indonesian news source at PFI_Forum by Commonground for an example:
Poultry die off in Cileunyi, West Java
H5N1 is believed to be endemic in Indonesian birds and has also been reported in pigs and cats."
I don't provide this quotes to claim priority but to provide you with an additional source of information which I hope will prove useful.
Just another little quibble - the OIE isn't actually a UN agency. The UN agency responsible for animal health is the FAO (food and agriculture organisation).
The OIE is separate and mostly independent.
I can vouch that not reporting is normal for endemic diseases. E.G. Bovine paratuberculosis (Johne's disease, Mycobacterium avium paratuberculosis) - is a listed disease. Can you really see a country where this is endemic (i.e. most of them) reporting every single case? Most don't even do surveillance for it, even though it's a serious production limiting disease, and may be linked to Crohn's disease in humans.
Q-fever - not only does it cause disease in people, it is a potential bioterrorism agent. However, as this disease is endemic in livestock (and some wildlife species) nearly worldwide, there is no obligation to regularly report cases (just as well, because reliable tests for animals are few and far between).
Whether or not this is a good thing is debatable. Sometimes there is such a thing as too much information. Is it better to get skewed, incomplete and misleading partial reporting (as is likely to be the case for avian influenza in birds in Indonesia), or just to report it as "present and endemic"?
Oh, and a note to Jon - the new WAHID interface is NOT easy to use - it's a pain in the butt. However, it is a marginal improvement on Handistatus (the old database) in some areas.
monotreme, attackrate: You are both right. We stand corrected on both scores. Hat tip to you both.
revere,
Thanks for your gracious reply.