Examining International and Indonesian Responses to H5N1 Influenza – Cindy Lin

Examining International and Indonesian Responses to H5N1 Influenza

Cindy Lin

Introduction

In this paper, I will discuss two protracted responses towards the H5N1 influenza outbreak in Indonesia – the Participatory Disease Surveillance and Response (PDSR) designed and imple- mented from 2005 to 2010 and the aftermath of Indonesia’s refusal to share viral samples with WHO from 2007 to 2011. From Indonesian governmental and international responses, I attempt to demonstrate how discussions on biosecurity, risk control and development differ and in turn, emphasize how borders of modern-state Indonesia were shaped differently by these two events. This article addresses the less conspicuous relationships between biological materials and sovereignty in Indonesia and how these associations are operationalised and instrumentalised by different levels of governance. In the first case study, we will observe how PDSR serves as form of surveillance to monitor and regulate backyard poultry farmers on how to be clean, healthy and non-contagious, implying that the modern citizen is an individual capable of self-managing his or her own health. In the second case study, we will examine how and why the Indonesian government suspended sample sharing with World Health Organization (WHO). This refusal to share and cooperate with international developmental agencies was later, perceived as a threat to global health security.

I argue that while interventionist international responses to contain influenza projected poverty unto marginal villagers largely unattended by the central government, the government’s refusal to share viral samples reemphasizes nation-state sovereignty and highlights the disparities between Global North and South. The H5N1 pandemic which was increasingly viewed in terms of secu- rity led to differing receptions from both Indonesia and the international sphere. One protracted event highlighted the implications of threatened sovereignty and the other refuted its permea- bility to reassert Indonesia as a country capable of consenting to participation in global health surveillance and security.

Background Information

The country’s first confirmed human case is a 38 year‐old government auditor living in a Jakarta suburb on July 2005 [1]. By mid-2005, the virus had reached 31 out of 33 provinces [2]. Econom- ic losses surmounted to over $500 million with more than “2.5 million workers in the poultry industry affected” by August 2005 [3]. Indonesia suffered the highest number of human H5N1 cases and deaths in the world. Indonesians’ huge reliance on poultry also indicated large changes in consumption and daily living with the extensive surveillance, checks and controls conducted by contracted trained teams of vets who trawled neighbourhoods practising backyard poultry farming.

The H5N1 influenza pandemic received unprecedented international mobilization and fund rais- ing among the wealthier nations in the global North, especially the USA. In just four months

from “President Bush’s speech to the UN on 14 September 2005 to the close of the Beijing confer- ence on 18 January 2006” [4], over 100 countries were engaged, a new UN office was established, and US$1.8 billion was raised [5]. At the same time, in 2007, the Indonesian government pulled out of the Global Influenza Surveillance Network (GISN) and justified its action by emphasizing on the origins of the H5N1 (avian influenza) virus and thus, Indonesia’s inherent entitlement to determine the usage and spread of these viral samples. Indonesian state authorities’ proclamation of sovereignty over biological materials drew negative critiques from the international communi- ty as a lack of international cooperation in assuring global health security.

Biosecurity and Sovereignty

To understand biosecurity, I will employ the definition adopted by Aihwa Ong. She defines biosecurity as an “emerging set of thinking and practices through which the state protects and leverages bioresources by placing constraints on the free market forces.” [6] Biosecurity engages “new practices and knowledge formations” designed to understand and manage both “disease and security” in innovative ways [7]. Biosecurity is also a response to challenges within weak- ened public health systems, the “return of the microbe” in the form of new frightening diseases like SARS and West Nile virus and the ongoing battle against the AIDS epidemic [8]. Biosecuri- ty also extends to political events such as the post-September 11 World Trade Center bombing where biological threats in the form of posted letters contained deadly anthrax bacteria [9]. There emerges, in these aforementioned events, a sense of being threatened, endangered and in dire times, requiring of preventive interventions [10]. Where the dangerous non-human is concerned, it is also depicted as protectable, manageable and controllable. Along the same vein, intervention measures employed to control the spread of H5N1 influenza in Indonesia allow me to analyse how national sovereignty, biosecurity and science interact.

To think about the H5N1 influenza in the global scale does not eliminate the possibilities to talk about nationalism. It is precisely how the epidemic was framed as a “global” threat to biosecurity that I will be able to explicate how the self-acknowledged responsibility espoused by particular groups of people such as intergovernmental and international aid agencies to prepare and elim- inate the epidemic contest certain nation-state boundaries. Furthermore, the fear of “bioinsecu- rity” allows wealthier nations to construct risk around Southeast Asia biosphere so that unsafe bodies can be kept within dangerous borders [11]. These international interventions did not enhance Indonesia’s sovereignty and at times, threatened to disrupt these boundaries by eclipsing what was more important to Indonesia. In Celia Lowe’s words, it might appear to be “an attempt to protect the security of the United States by intervening ‘there’ before the problem came ‘here’— in other words it seemed not unlike the global war on terror.” [12].

Case Study 1: PDSR Biosecurity and Developmental Ideologies

International Development Agencies and Poverty Lens

The Indonesian government was in a difficult position to negotiate with the well-funded and specialized international developmental agencies who designed responses that projected notions of poverty to Indonesia’s rural villages. Since early 2006, FAO’s main activity in Indonesia was the revised Participatory Disease Surveillance (PDS) programme – the Participatory Disease Surveil- lance and Response (PDSR) programme. This programme recommended a “community-based response” to prevent disease spread through the collaboration of Indonesians to provide infor- mation on the location, date and time of outbreaks [13]. However, FAO review of PDSR detected that there was no interrelationship between “reported human case rate” and quantity of backyard family poultry [14]. Moreover, the association between poverty and being “risky” was largely propagated by USAID’s large monetary and logistical investments in PDSR responses to cast poverty and thus, uncivil living as integral to poorer households [15]. In other words, USAID, a pro-poor development agency, was less concerned about funding relevant interventions than to give out funds to targeted populations who exemplified as ideal receivers of the agency’s mission. The developmental ideology only exists insofar as rural backyard poultry became emblems of both risk and uncivility. The huge amount of funding enjoyed by the Indonesian government also meant that other factors which could have caused the spread of avian influenza were not consid- ered. The funding incentivises the Indonesian government for not playing a significant role in the investigation of other viral spread causal factors.

The perception that the government was largely inefficient and unresponsive to global health security was aggravated by how international responses wanted biological hazards to be only con- fined within Indonesia. Indonesia was surveyed by the global health community and was forced, implicitly, to conform to regulations which may not be relevant to Indonesians’ ways of managing crisis. Komnas FBPI [16] funded by the Indonesian government, USAID, UNICEF, CIDA [17], JICA [18] and the World Bank developed Indonesia’s “National Strategic Plan for Avian Influen- za Control and Pandemic Preparedness,” as a response to the international mandate that every country has “a preparedness plan.” [19]. To conform to Global North’s standard for risk manage- ment, Indonesia’s borders were penetrated and predefined by how safe Indonesia was to countries outside of its borders. Even though Indonesian residents living in rural areas refused vaccination despite their prior observations on patterns of infection, their intentions were ignored by In- donesian authorities and international specialists in PDSR survey teams [20]. The PDSR team whose methodology sought to source for “community-based” knowledge in preventing pandemic spread refused to acknowledge the community’s request [21]. It was clear that the developmental ideology persist in Indonesia’s lack of participation in the PDSR programme, further reaffirming international agencies’ poverty lens in controlling and monitoring the epidemic. Indonesia’s bor- ders were permeable to the extensive inputs of international agencies who wanted Indonesia to be biosecure for the sake of wealthier nations’ economies and populations.

“Ibukota” and Modernity

However, this projection of poverty unto rural villages was not exclusive in how the Global North saw the South. The Indonesian government’s focus on capital cities’ development perpetuated
the imagined village as underdeveloped, unhygienic and thus, unmodern. I argue that the design of both the Indonesian state and international responses towards alleviating the ramifications of influenza spread prove erroneous insofar as the Indonesian government maintained the ideology of developmental nationalism only within certain privileged districts in Indonesia.

The ambitions to clean up Jakarta stemmed from the “centralising and self‐serving pembanguan development ideology of the Suharto era”. Developmental nationalism was manifest when both Suharto and Sutiyoso, then Jakarta governor’s (1997 – 2007) ideologies on development focused on the “visible order” of the capital, Ibukota (Mother city) [22]. Prioritizing the trimness of ibu- kota over enacting prevention measures outside of the city [23], developmental nationalism in ibukota was materialized in the form of policies. Both Suharto, the 2nd president of Indone- sia (1967 – 1998) and Sutiyoso sanctioned two decrees to instruct the illegality of unregistered domestic birds and inspections for monitoring the presence of uncertified animals [24]. If found to be infected with the H5N1 virus, these infected birds will be culled and owners will be com- pensated with Rp12,500 per bird [25]. Such policies exemplified the misplaced concerns of Indonesian authorities who were interested in the public image of Indonesia and how it reflected on them. Not only had international developmental agencies sought to permeate and redefine dangerous borders, the Indonesian government had reinforced these borders by propagating developmental ideologies in the making of ibukota.

Case Study 2: Viral Sample Sharing

Threatened Global Health Security

In the second case study, the Indonesian government tacitly exemplified the disparity in acces- sibility to healthcare between Global North and Global South by choosing to protect viral sam- ples for vaccine making within Indonesia’s boundaries. It became salient that the interests of the developing and the developed nations do not always meet, particularly with regard to the issue of viral sample sharing for pre-pandemic vaccines.

Indonesia’s sovereignty was threatened when the World Health Organization (WHO) shared
viral samples from the H5N1 outbreak with an affiliated pharmaceutical company without the knowledge of Indonesian authorities. Viral strains were used to make patented vaccines and sold to Indonesians at unaffordable prices. Patents stifled the sharing of virus samples necessary for Indonesia’s development of their own vaccines and did little to reduce Indonesia’s high rate of H5N1 outbreaks. In response, Indonesia state agencies depicted unconsented viral sample shar- ing as a form of biopiracy [26], violating countries’ sovereign control of their biological resources. The Indonesian authorities stopped viral sample sharing with WHO and proposed for sharing to only resume if a revised Material Transfer Agreement is signed among other proposed reforms [27]. Indonesia’s move was perceived as a threat to global health security by other parties involved in this protracted event. This was exemplified in how developed countries framed the issue of health as of particular concern to global ties and security [28].

Anti-West?

Sovereignty is conceived differently in this case study when Indonesian authorities reconfigured the status quo between Global South and Global North through resisting biological and in turn, economic and political power over developing countries. When claiming the WHO’s under- handed ways of obtaining samples as “biopiracy”, Indonesian government’s antagonism towards sharing viral samples was not simply to intimidate the West. It was an unwitting act of resisting power in its very terms by implicitly highlighting how Indonesian borders are constantly pene- trated by international interventions in their mission to stop Influenza spread beyond Indonesia’s “risky” borders. Coupled with international developmental agencies’ immense pressure on trying to obtain effective results in controlling influenza and protecting their borders, I argue that Siti Fadilah Supari, then Indonesian Minister of Health (2004 – 2009) exemplified a figure of Indone- sia’s resistance to ineffective foreign-funded aid.

Nationalistic rhetoric was embedded in Supari’s response towards non-consensual viral sample sharing. She created a new doctrine, which she named as “viral sovereignty” [29]. Viral sov- ereignty, from the health ministry’s perspective, proposes that viruses are a nation’s biological inheritance dependent on their place of origins – nations have exclusive rights to viruses [30]. By employing the concept of sovereignty to prescribe Indonesia’s borders and their rights to bio- logical property, this particular living unit had a sole proprietor – Indonesia. Supari also did not accept WHO’s first concessions – laboratory improvements and free vaccines – in February 2007 and chose to fight for a revised WHO research system and greater accessibility to production of vaccines in Indonesia and other developing countries [31]. Such reforms ensure that the health- care disparity between Global North and Global South can be better mediated. These reforms also reassert how the borders of Indonesia became increasingly distinct and recognizable to other international and Global North powers.

Conclusion

In this paper, I discuss how nation-state borders and sovereignty were emphasized differently in two case studies; both cases concerned the H5N1 outbreak in Indonesia from 2005. In the first case study, we saw how the PDSR programme initiated by FAO and largely encouraged by USAID embroiled poverty in the everyday living of Indonesia’s “rural villagers”. These preventive inter- ventions served the purpose of the Global North in assuring that H5N1 influenza stayed within Indonesia’s dangerous and permeable borders. However, this was not unaccompanied by the Indonesian government’s way of marginalizing non-capital cities and rural areas. In other words, the Global North was not entirely accountable for the pro-poor developmental ideologies which circulated Indonesia during the H5N1 outbreak. Developmental nationalism was opposed in the next case study when viral sample sharing between Indonesia and WHO was halted to decrease the chances of more unaffordable patented vaccines being produced and sold to Indonesians. This fear translated into an emphasis on Indonesia’s sovereignty where it was previously threatened. Supari’s viral sovereignty reaffirmed borders differently from how it was being shaped in the first case study – her borders were firm and sincere to Indonesia and developing countries’ concerns. What is most striking in the study of these two protracted responses is how borders became more influential in times of crisis and how they were differently employed to reinforce or dismantle particular disparities between the North and South. Science and technology elucidates the mak- ing of the nation and nation-state and reemphasizes less prominent ways of understanding the construction of risk, security and development in the Global South.

Cindy Lin is a researcher dedicated to the study of shared technological and scientific spaces, vernacular technologies and intergenerational knowledge exchanges in the Global South. Her previous ethnographic work involved extensive fieldwork on the politics of DIY maker and hacker culture in Indonesia and the flows of scientific and technological information across nation-state boundaries. She will be a PhD Student at the School of Information, University of Michigan, Ann Arbor this Fall 2015.


Works Cited

Forster, William Paul. Risk, modernity and the H5N1 virus in action in Indonesia: A multi‐sited study of the threats of avian and human pandemic influenza. Institute of Development Studies. University of Sussex. January 2012

Forster Paul et Charnoz Olivier, Producing knowledge in times of health crises: Insights from the international response to avian influenza in Indonesia. Revue d’anthropologie des connaissances, 2013/1 Vol. 7, n° 1, p. w-az.

Lowe, Celia. VIRAL CLOUDS: Becoming H5N1 in Indonesia. Cultural Anthropology, Vol. 25, Issue 4, pp. 625–649.

Lowe, Celia. Preparing Indonesia: H5N1 Influenza through the Lens of Global Health. Indonesia. No. 90, Trans-Regional Indonesia over One Thousand Years (October 2010): 147-170

Normile, Dennis. Indonesia Taps Village Wisdom to Fight Bird Flu. Science, New Series, Vol. 315, No. 5808 (Jan. 5, 2007): 30-33.

Ong, Aihwa. Introduction. Asian Biotech: Ethics and Communities of Fate. Duke University Press Durham and London (2010): 1-51.

Smallman, Shawn. Biopiracy and vaccines: Indonesia and the World Health Organization’s new Pandemic Influenza Plan. PhD, International Studies. Portland State University. 2012. 21- 36.

Notes 

  1. Celia Lowe, VIRAL CLOUDS: Becoming H5N1 in Indonesia, Cultural Anthropology, Vol. 25, Issue 4, 627.
  2. Forster Paul et Charnoz Olivier, Producing knowledge in times of health crises: Insights from the international response to avian influenza in Indonesia. Revue d’anthropologie des connaissances, 2013/1 Vol. 7, n° 1, p. y.
  3. Priosoeryanto et al., 2005: 146 cited in Forster. “knowledge”, z.
  4. The short span of time required for a significant number of wealthier Global North countries clamouring to raise funds and awareness on the H5N1 virus and containing the risk of outbreak outside Indonesia is remarkable.
  5. William Paul Forster, Risk, modernity and the H5N1 virus in action in Indonesia: A multi‐sited study of the threats of avian and human pandemic influenza, Institute of Development Studies. University of Sussex. January 2012, 61.
  6. Aihwa Ong, Introduction. Asian Biotech: Ethics and Communities of Fate, Duke University Press Durham and London (2010): 40.
  7. Celia Lowe, Preparing Indonesia: H5N1 Influenza through the Lens of Global Health, Indonesia, No. 90, Trans-Regional Indonesia over One Thousand Years (October 2010): 152.
  8. Ibid.
  9. Ibid.
  10. Ibid.
  11. Aihwa Ong, Introduction. Asian Biotech: Ethics and Communities of Fate, Duke University Press Durham and London (2010): 26.
  12. Lowe,“clouds”. 629.
  13. Mariner and Roeder, 2003 cited in Forster, “knowledge”, ad.
  14. Forster. “risk”. 22.
  15. Ibid., 17.
  16. National Committee for AI Control and Pandemic Influenza Preparedness
  17. Canadian International Development Agency
  18. Japan International Cooperation Agency
  19. Lowe. “preparing”. 153.
  20. Dennis Normile, Indonesia Taps Village Wisdom to Fight Bird Flu. Science, New Series, Vol. 315, No. 5808 (Jan. 5, 2007): 32.
  21. IIbid.
  22. Forster. “risk”, 125-126.
  23. Ibid.
  24. Ibid., 130.
  25. Ibid.
  26. Shawn Smallman, Biopiracy and vaccines: Indonesia and the World Health Organization’s new Pandemic Influenza Plan. PhD, International Studies. Portland State University. 2012. 20.
  27. Smallman, 23.
  28. Stefan Elbe 2010 cited in Smallman, 26.
  29. Ibid.,25
  30. Ibid.
  31. Khor 2007 cited in Ibid., 26 & 31.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s