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Indonesia's new bird flu policy leads to anger

Ali Usman's wife died of bird flu 10 days ago, but the government has yet to notify next-of-kin about the cause. He searches for answers in newspapers, which until last month reported aggressively on deaths linked to the virus, but finds nothing.
/ Source: The Associated Press

Ali Usman's wife died of bird flu 10 days ago, but the government has yet to notify next-of-kin about the cause. He searches for answers in newspapers, which until last month reported aggressively on deaths linked to the virus, but finds nothing.

That's because the health ministry has stopped publicizing bird flu fatalities immediately, part of a campaign to shift focus instead to successes in battling the disease in the hardest hit nation. From now on, deaths will be announced in clusters, perhaps just a few times a year.

The information blackout worries experts and has left health workers and residents confused and frustrated. It took The Associated Press a week to track down and confirm the June 3 death of Usman's wife, Susi Lisnawati, which raised the country's toll to 110.

Though she was suffering from classic symptoms of the disease — breathing difficulties, coughing and high fever — the 34-year-old was not kept in isolation during her two days of hospitalization. Family members said they gave her a traditional Muslim burial, washing and shrouding the body with their bare hands, before placing it in the ground.

"I'm terribly scared, I need to know what the test results were," Usman, a 44-year-old tailor and father of three, said when told that even the government Web site had been stripped of updates on deaths. "How else can I protect my family?"

Indonesia, which has tallied more human deaths than any other country, is seen as a potential hot spot for a pandemic because of its high density of people and large number of backyard chickens. The virus remains hard for people to catch, but scientists fear it could mutate into a form easily transmitted between humans, potentially killing millions across the globe.

The World Health Organization, which has been engaged in a bitter yearlong dispute with Indonesia over the sharing of virus samples, said Health Minister Siti Fadilah Supari promised to keep it informed about new deaths and did not appear to be violating international health regulations with her new policy.

"Indonesia has agreed to continue notifications to WHO .... they have never said they would not do that," said David Heymann, the U.N. agency's top flu expert, adding it does not matter if it takes several weeks to publicize the country's official toll "as long as the virus is known about and handled properly."

Still, the lack of transparency has forced people to rely on word of mouth and rumors. It has also raised fears that deaths could be covered up, especially because the government has been exclusively responsible for carrying out genetic sequencing needed for diagnosis and risk assessment since its standoff with WHO.

Relatives of victims are still shown official bird flu test results almost immediately and Usman's case appeared to be an aberration.

But when asked for an explanation Friday, Health Ministry spokeswoman Lily Sulistyowati said test results had come back negative and would be delivered to the family within days. A senior ministry official, speaking on condition of anonymity because of the sensitivity of the issue, later confirmed the tests were positive.

Four other health workers agreed, some after double-checking with the National Institute for Health Research and Development, the government laboratory responsible for confirmations.

Neighbors, too, were confused after seeing bird flu investigators visit Usman's house, taking blood samples from family members and handing out the anti-flu drug Tamiflu, but only to his youngest son and a child living next door. Residents were asked if they had backyard fowl.

In the past, they too would have turned to the media for information if official notification was slow in coming, as could be expected in a sprawling nation of 235 million people that spans the width of the United States.

Gusti Ngurah Mahardika, a virologist at Udayana University on Bali island, said the new policy on announcements was yet another setback in the fight against the virus, which has killed at least 241 humans worldwide.

If people don't hear regularly about deaths, he said, they "will become complacent about bird flu and its threat."

This is not the first time Indonesia's handling of bird flu has raised eyebrows.

Supari, the health minister, got widespread attention — and some praise — when she bucked the WHO's 60-year-old virus sharing system in January 2007, saying it was unfair to developing nations. She's worried pharmaceutical companies will use her country's virus strain to make pandemic vaccines that are ultimately unaffordable to her own people.

But by refusing to share virus samples, Supari is making it almost impossible for international scientists to make sure the virus isn't morphing into a more dangerous form.

Supari defended her new policy on reporting deaths last week, saying the focus now should be on positive steps taken by the government to combat bird flu. She pointed to a "declining trend" in cases, with at least 18 people infected in the first six months of 2008, down from 27 during the same period in 2007 and 35 in 2006.