Government responses to infectious disease outbreaks
While the central government's moves in dealing with the first human deaths from avian influenza (bird flu) wins appreciation from many, including the World Health Organization (WHO), many have expressed concern over the way that local governments are dealing with the matter. The Jakarta Post's Sri Wahyuni talked to public health observer Mubasysyir Hasanbasri, who is also director of Gadjah Mada University's Health Policy and Service Management Program about the issue. The following is an excerpt from the interview.
Question: How do you see the bird flu issue?
Answer: The government's response is okay, especially the Minister of Health's quick move in placing herself as the spokesperson in the case. In fact, in the era of decentralization like the present, it's not necessary for her to do so. The local health office should have done so. It's seems that she considers the case as a kind of national crisis, which is good.
What is concerning is the way the respective local governments are responding. However, it is understandable because when dealing with such cases it is indeed the central government that have the resources. Local governments mostly lack such resources. Even in the U.S. it is usually the federal communicable disease control body in Atlanta that takes over whenever an infectious disease outbreak occurs.
Another concerning thing is our dependence on the international community, especially in dealing with virology tests. It would be much better if (the government's) good response was also supported with good laboratory infrastructure. But again, this is also understandable especially because it deals with a new disease.
What is the implication of such a situation?
It slows down the policymaking process. Just to clarify whether the deaths were due to bird flu, for example, we have to await the results of tests from abroad.
In the case of bird flu, a veterinary laboratory is essential. Unfortunately, as far as I can see, most veterinarians here are not paying strong attention to the matter. There seems to be no cooperation between the health office and the veterinary office.
I get the impression here that everything is directly taken to the WHO for consultation. It seems that there is no institution here that is prepared for such a situation. Our scientists, too, do not seem to have the eagerness to do such examination (for the virus) here. It is as if they want to let other people take care of it. The centers of excellence here are week. Even tertiary education institutions do not seem to be organized to have a center of excellence in this particular field.
What do you think is the reason behind the problem?
Among others, is the limited budgets for the development of relatively expensive infrastructure as well as the slow pace in the development of advanced research and technology in this particular field. These are mostly due to the fact that the development of infrastructure so far has been more project- oriented. We never plan seriously.
I think it needs an extraordinary political commitment to speed up our health sector, especially in the field of infectious diseases investigation. Indonesia is very weak in terms of emergency preparedness. We need to improve the management of it. The last two years have been promising to me, in which the government has placed doctors in particular hospitals to specially deal with emergency situations. Yet, not all hospitals enjoy such a program.
Other concerning problem is the fact that the role of related government institutions is also often confusing, even for me. When anthrax broke out several months ago in Yogyakarta, for example, the local veterinary office, which was supposed to be in charge of the outbreak, did not have the data but the health office did. The lack of policymakers who really care about such cases also accounts for the slow response from the bureaucrats.
That's why it was a surprise for me to learn how the present government was very quick in deciding to disburse funds to finance the bird flu case that some, including the respective local government, might consider as an overreaction.
What about the culling of the animals suspected to have been infected by the virus?
Ideally, such culling has to be done to all animals without exception. However, in a country like Indonesia, where we deal with poor farmers, it's impossible to do so. The government does not have the funds to pay compensation. So, I think it's the trade-off between public health and economic interests. We just cannot require all farmers to kill their animals.
This is I think what makes us different from developed countries that have huge amounts of emergency funds, meaning that a total cull of animals can be done without difficulty.
What can we do with all the limitations we have in dealing with possible outbreaks of infectious diseases in the future?
What we have to develop is the management aspects, the way we make decisions. To realize this, however, good gatekeepers are needed. In this case, the press has been acting as a very good gatekeeper. It is the press that has caught the information in the first place and conveyed it to the public, so that the government can also act properly.