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Last Updated: Thursday, 6 October 2005, 02:47 GMT 03:47 UK
Indonesians face up to bird flu threat
By Kate McGeown
BBC News

Mutiara Gayatri, six, a victim of bird flu, lies on a bed at a hospital in Jakarta, Friday, Sept. 30, 2005.
Reports of bird flu victims have panicked many Indonesians
As the number of Indonesians infected with bird flu rises, the nation is becoming increasingly worried.

"The virus of bird flu is like a monster which can claim a human life any time," one local newspaper reported in late September.

"Hysteria has emerged and spread everywhere," wrote another.

According to the World Health Organization (WHO), many people are turning up at their local hospitals with coughs and colds, terrified they could have contracted the dreaded H5N1 virus.

"We need some calm here," cautioned the WHO's regional spokesman Peter Cordingley. "We have only confirmed four cases. There are almost certainly more, but nothing like the hundreds reported in some local media."

That said, there is little doubt that the potential fallout of a huge bird flu epidemic in the country would be catastrophic.

Before the first Indonesian case was reported in July, the deadly disease had killed dozens of people in other Asian countries, and millions of birds had already been culled.

A UN official recently estimated that if the bird flu virus combined with the human influenza virus, it could lead to a devastating global pandemic that could kill between five million and 150 million people.

Vaccination programmes

So far there is no evidence of human-to-human transmission, and Indonesian experts are doing all they can to ensure the situation stays that way.

The government has already imposed "extraordinary" measures, including forcing those infected to go to hospital.

We can't fight this disease in the hospitals and clinics. We need to concentrate on the backyards where the chickens and ducks are
Peter Cordingley, WHO
It has issued guidelines, launched awareness campaigns and restricted access to certain areas - even closing a popular zoo in Jakara after birds there tested positive for the virus.

But there has been criticism of its continued reluctance to sanction widespread culling of birds to stem the spread of infection.

Indonesia prefers, where possible, to use vaccination as a method of control, due to the expense and huge logistical hurdles involved in killing huge numbers of birds.

While mass culling is possible in some nations - especially in the West, where most poultry are confined to large farms - an equivalent cull in Indonesia would be extremely difficult, explained Bungaran Saragih, professor of agricultural economics at Bogor Agricultural University.

"We have 220 million people, 14,000 islands and almost everyone has their own chickens," he said. "It's almost unthinkable to do a widespread cull here."

Officials from the department of agriculture draw samples from a chicken in Bandung, Indonesia.
Indonesia prefers to vaccinate rather than cull, if possible
The WHO's Peter Cordingley has sympathy with this position - and says that during the outbreak in Vietnam and Thailand earlier in the year there was also a reluctance to cull birds.

But both the WHO and the Food and Agriculture Organization (FAO) maintain that culling is the only effective way to stem the virus.

"Vaccination can stop the spread of the virus, yes, but to get rid of the virus altogether is another matter," said FAO spokesman Joseph Domenech.

"Vaccination is a back-up policy," added Mr Cordingley, "but it is not an elimination policy".

No precedent

Another problem facing Indonesia is that its bird flu outbreak is not typical of those which have gone before.

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In other parts of Asia, the majority of victims were people who had worked in large chicken farms, or at least been exposed to such an environment.

This is not the case in Indonesia, where many victims appear to be urban dwellers.

This puts the spotlight on the billions of yards and small enclosures across the country that are full of chickens and ducks reared and eaten by individual families.

"We can't fight this disease in the hospitals and clinics," said Mr Cordingley. "We need to concentrate on the backyards where the chickens and ducks are."

"Until these are cleaned up, this disease will always be around," he said.

A child in Jakarta playing with caged pigeons
Asians eat a lot of chicken, and also have birds as pets
In fact, Mr Cordingley believes that the close living relationship people in Asia have with their animals is a major reason why bird flu epidemics repeatedly start in the region - and he said such living arrangements were "not appropriate anymore".

But he conceded that such a lifestyle change would take years of re-education and a major political commitment.

Even that might not be enough. Mr Domenech said that whatever Asians did to try to combat bird flu, they were still likely be the first to succumb to the disease, as the viruses would almost certainly remain circulating in the region - with the main reservoir most likely to be in southern China.

Foreign aid

In the meantime there is little small-scale Indonesian farmers can do to safeguard themselves and their flocks against the disease.

According to Professor John Oxford, a UK virology expert, the one thing they can do is increase basic cleanliness - although he conceded that even this may be beyond the means of some.

The responsibility lies largely with the Indonesian government - which has already allocated $15bn to tackle the spread of the virus.

But even government ministers acknowledge that this figure is unlikely to be sufficient, and there are increasing calls for more international help.

"Recently, we have had a tsunami, bombs, an increase in fuel prices and we have still not solved the financial crisis of 1997-98, so this country is in a difficult sitation right now," said Prof Bungaran Saragih.

"We need foreign help and expertise quickly, in order that Indonesia is not the starting point of a pandemic."




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