Indonesia's bird flu warrior

by Agence-France Presse AFP, Jan 7, 2009 | Destinations: Indonesia / Jakarta

Sliding with short steps onto the stage in front of a crowd of students, academics and supporters, Indonesia's Health Minister Siti Fadilah Supari is in her element.

Her hair swept up into the voluminous bouffant favoured by Indonesia's wealthy ladies, the bespectacled 57-year-old delivers her scalding critique of global injustice in soft, rounded Javanese vowels that frequently trail into a whisper.

The venue is a university discussion of her memoir-cum-manifesto, "It's Time for the World to Change: Divine Hands Behind Avian Influenza," and the audience bursts into applause as she issues her broadsides.

Supari is in charge of the response to bird flu in the country most heavily hit by the virus. With 112 dead and counting, Indonesia accounts for nearly half of all human deaths from the disease.

If the H5N1 virus mutates into a form easily transmissible between humans, setting off a worldwide pandemic that could kill millions, it will likely happen here.

But while most governments have set about tracking the spread and development of the bug, Supari has turned the fight against avian influenza into a broader struggle over the soul of globalisation.

Since late 2006 Supari has refused to share all but a handful of Indonesia's virus samples with the World Health Organisation (WHO), saying Indonesia will only resume if the system is changed to give poor countries control over where their viruses go, and a share of any profits from vaccines.

Addressing the crowd, Supari accused rich countries and the WHO of a conspiracy to trick poor nations into giving away virus samples, which she says are passed on to drug companies for their own profit.

"Then the virus is turned into vaccines (that are sent to) Indonesia and Indonesia has to buy them and if they don't buy them, they have to go into debt and it turns and turns again, and in the end developed countries make new viruses which are then sent to developing countries," she said.

"The conspiracy between superpower nations and global organisations is a reality. It isn't a theory, isn't rhetoric, but it's something I've experienced myself," she tells the enthralled audience.

The claims are part of a list of accusations -- which include raising the possibility that a US lab could use Indonesian virus strains to create biological weapons -- that have turned Supari into one of the most polarising figures in global health.

While Supari's stand has earned her hero status among many Indonesians for taking on powerful vested interests, critics say keeping virus samples from the world's scientists leaves humanity more exposed to a nightmare pandemic.

Indonesia is saving humankind

A cardiologist before being handpicked in 2004 by President Susilo Bambang Yudhoyono to fill a quota of four women in his cabinet, Supari is not a member of any political party, and is aloof from much of the jockeying of Indonesian politics.

She also says she did not start in her job spoiling for a fight with the West. Rather, she says she was shocked after being offered vaccines containing Southeast Asian H5N1 strains taken without their home countries' permission.

Supari claimed vindication in early 2007 after Australian drug company CSL came forward with a trial vaccine containing Indonesian bird flu strains.

CSL freely admits to using Indonesian strains but says under current WHO rules it is under no obligation to compensate Indonesia or guarantee access, company spokeswoman Rachel David says.

"The concerns that were raised by the Indonesia health minister (in 2007) were legitimate, and of course she was concerned about the access of Indonesia to pandemic vaccines, but it was essentially not something CSL was in a position to help with," she says.

Supari herself appears immune to criticism that she is endangering world health.

The real fear, Supari argues, is that if a pandemic does break out developing countries will be unable to protect their own people.

"(Stopping virus sharing) is important so our voice can be heard by the WHO and we want to change the global virus sharing mechanism to be fair, transparent and equitable," Supari tells AFP at her ministerial offices.

"What we mean by fair is that any virus sharing should be accompanied by benefits derived from the shared virus, and these benefits should be coming from the vaccine producing countries," she says.

"What Indonesia has been doing so far is to save humankind, and Indonesia is of the view that (under) the current system, which is unfair, untransparent and not equitable, the danger is much more than the pandemic itself."

Supari's basic complaint against the world system has received its fair share of support, with developing countries rallying behind Indonesia's efforts to push changes at WHO talks at the end of this year.

"She wants to have a transparent mechanism and I think it's not a bad idea. It's good for everybody," says Makarim Wibisono, a senior Indonesian diplomat pushing Indonesia's case at the WHO in Geneva.

"I don't think it's alarming to humanity, I don't think it's alarming for the future of the world."

Supari does appear to be vindicated by a flood of patents being lodged on the samples of H5N1 that have made it out of Indonesia, with companies in developed countries claiming ownership over viral DNA taken from sick Indonesians.

According to US-based influenza blog Immunocompetent, 83 patent applications mentioning H5N1 have been lodged since the start of 2007, the vast majority of them from rich nations.

Supari's fight taps into one of the hot-button issues of globalisation: biopiracy, which refers to the corporate exploitation of indigenous knowledge.

But while countries from Africa to South America fight against attempts by multinationals to patent, for example, chemical compounds in medicinal plants that have been used for generations, Indonesia's claim to virus samples is higher stakes -- and much more emotive.

The nuttiest idea I've ever heard

Even some who sympathise with Supari's charge that corporations rig the global health system think she is playing a dangerous game.

Keeping samples away from international scientists leaves the world dangerously uninformed about the virus and potentially unaware of an emerging pandemic, says Kartono Mohamad, former head of Indonesia's doctor's association.

"If something happens then maybe Indonesia is to blame if we cannot help the world contain the virus," he says.

"She has a point, but she's gambling. She's not only gambling with the virus but the safety and security of the Indonesian people as well."

Supari's confrontational style and bellicose language has also helped turn a bland issue of intellectual property and health bureaucracy into a matter of religious and national pride in Indonesia, and frustration abroad.

The minister's suggestion in her book that a US lab could use bird flu to create biological weapons was denounced by US Defence Secretary Robert Gates on a February visit to Jakarta as "the nuttiest idea I've ever heard".

Aware of her image problem abroad, Supari insists she is not anti-Western. "I love the US government, I love the US, but what I oppose is a mechanism that isn't fair and harms humanity," she says, referring to WHO's virus-sharing system.

Supari also says she has never labelled the current health system a "conspiracy" by developed countries and drug companies, despite using the term in the book and in numerous public statements.

Supari also says she had not argued US labs are using virus samples to make biological weapons, but that the non-transparent system is open to abuse: "I don't know if my virus is going to be used as material for a vaccine or as material for a biological weapon."

"I didn't say that developed countries are making new viruses to be spread in developing countries, but actually I was talking about the dependency of developing countries on developed nations, which is going to get bigger if the current system continues," she says.

The minister has put her Islamic faith at the front and centre of her fight, claiming divine guidance.

She is a member of the moderate Islamic mass movement Muhammadiyah, but has also reportedly cosied up to radicals such as the Islamist Hizbut Tahrir group, which believes in replacing Indonesia's secular government with a Muslim caliphate.

"She has kind of become giddy because many people, especially the Islamic organisations, see her as a hero, a new hero in this country because she is fighting the United States," former top doctor Kartono Mohamad says.

"Her motives I do not know. I think she wants to be a hero fighting against the giants, the David fighting against the Goliath."

Some of those who support her initial stand over virus sharing say Supari's turn into conspiracy theories has taken on a momentum of its own, getting in the way of the bird flu fight.

"I disagree with her approach, with the way she is talking to other parties and actually that approach puts us in a difficult position. For example, I have lost some friends, research fellows," says the head of the expert panel of Indonesia's bird flu committee, Amin Subandrio.

Despite her anti-Western rhetoric, Supari has also frozen most Indonesian scientists out of access to virus samples, Subandrio said.

"Some of the statements in her book are not based on evidence but probably only based on information from some person, I don't know who is giving her information," Subandrio says.

For Subandrio, who shares some of the responsibility for combating the virus, there is not so much fear of a pandemic as exasperation.

Bird flu is endemic in poultry in all but two of Indonesia's 33 provinces and while the number of human cases is dropping, they far outstrip anywhere else in the world, according to health ministry figures.

"I don't think she is gambling but I'm afraid she's looking at the problem not from a scientific point of view but another, probably popularity or something like that," Subandrio says.

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