Government responses to infectious disease outbreaks

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.