6. Emerging Threats: Bio-security and Disease Surveillance

Prof. Sophal Ear, Department of National Security Affairs, NPS Emerging Infectious Disease Surveillance in Cambodia and Indonesia

Prof. Zafar Jaspal, Department of International Relations, QAU, Bio-security: How real is the threat?

Air Commodore Khalid Banuri on National response and future steps.

Emerging Threats: Emerging Infectious Disease Surveillance in Cambodia and Indonesia

Sophal Ear, Ph.D.Assistant Professor

Naval Postgraduate School8 October 2010

Disclaimer: Material contained herein is made available for the purpose of peer review and discussion and does not necessarily reflect the views of the Department of the Navy or the Department of Defense.

From booby-trapped nuclear coffee cups

To we dont want to let the technology drive the politics, but we want to let the politics drive the technology

To Surrender to the tyranny of the technicians

'Infrared Fever Screening System' April 18, 2003 at Singapore's Changi Airport in Singapore

September 2, 2010...10:41 amConcerns over disease raised in Pakistan flood aftermath

Before After

August 24, 2010: Disease Outbreaks Threaten Pakistan Flood VictimsDiarrhea and cholera wreaking havoc in many of Pakistans flooded areas

Contents

1. The Problems

2. Timeline Context

3. Indonesia Case Study

4. Cambodia Case Study

5. H1N1 (hitting closer to home)

6. Conclusion: The End or the Beginning?

Myriad Problems

Poor to non-existent surveillance

Poor diagnostic laboratory capability

Disincentive to report (bad publicity, bad for business)

Viral sovereignty (in Indonesias case)

Page 213:

In 2006, Indonesia claimed viral sovereignty over samples of H5N1 collected within its borders and announced that it would not share them until the WHO and developed countries established an equitable means of sharing thebenefits (e.g., vaccine) that could derive from such viruses.

Page 3:

in the poorest countries per capita expenditure on all aspects of health care [is] 3% expenditure in high-income countries staff in over 90% not familiar with quality assurance principles more than 60% of laboratory equipment is outdated or not functioning

August 2001: the more things change

2010

Director of Laboratory Systems Development at a major American university with whom the GAOs description was shared for insights wrote the following from my own experiences in countries (Southern Caucuses, Central Asia, Southeast Asia, India, Sub-Saharan Africa) I believe the status has not changed much from the date of the report.

TimelineContextHuman Pandemic Flu Timeline

Spanish (H1N1) HK flu H3N2 HPAI H5N1 H7N2 H7N3 H10N7

Downside of Globalization: Global Reach of Diseases

Quality of Health Care, 2002

H5N1: Highly Pathogenic Avian Influenza

Avian influenza situation in China

8 June 2010 -- 22-year-old pregnant woman died on 3 June exposed to sick and dead poultry.

Of the 39 cases confirmed to date in China, 26 have been fatal: mortality rate of 66%!

http://www.youtube.com/watch?v=X6vFaMy0w00

Indonesia Case Study

After FOUR decades, the Naval Area

Medical Research Unit-2 (Namru-2) is kicked-out of

Indonesia

And all because of one woman?

Maybe not.

Issues Raised in Indonesia

0%

10%

20%

30%

40%

50%

60%

Cambodia Case Study

Lucky guy, thanks to Namru-2...

H5N1 Animal Outbreaks 04-08

200820072006

20052004

200720062005

2008

H5N1 Human Victims 05-08

Issues Raised in Cambodia

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Low Staff Compensation

Donor Dependence Pathologies

Poor staff management/HR

Patronage networks detrimental to work

environments

No compensation for culling

Differing host and donor priorities

Goal: reduce pandemic potential that could strike donor countries themselves

But lets end where we started, with Indonesia and Cambodia

Dateline: 11 April 2010

Namru-2 Jakarta is shutting down. I have been very sad. Not only because I am losing my job, but more than that, Indonesia will loss [sic] an established laboratory research coz [sic] of political reasons

--Senior Indonesian scientist

Scientists Technology should be on tap, but not on top.

Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the

end of the beginning.

--Churchill

The end or the beginning?

25 June 2010: Director of Namru-2 Phnom Penh steps down

Former Namru-2 Jakarta Commanding Officer to head Namru-2 Phnom Penh

Lessons learned from Indonesia should be applied to Cambodia

Thank you.

Prof. Zafar Jaspal, Department of International Relations, QAU, Bio-security: How real is the threat?

Air Commodore Khalid Banuri on National response and future steps.

6. Emerging Threats: Bio-security and Disease SurveillanceEmerging Threats: Emerging Infectious Disease Surveillance in Cambodia and IndonesiaSlide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7ContentsMyriad ProblemsPage 213:In 2006, Indonesia claimed viral sovereignty over samples of H5N1 collected within its borders and announced that it would not share them until the WHO and developed countries established an equitable means of sharing thebenefits (e.g., vaccine) that could derive from such viruses.Page 3:in the poorest countries per capita expenditure on all aspects of health care [is] 3% expenditure in high-income countries staff in over 90% not familiar with quality assurance principles more than 60% of laboratory equipment is outdated or not functioningAugust 2001: the more things change2010TimelineContextSlide Number 14Downside of Globalization: Global Reach of DiseasesQuality of Health Care, 2002Slide Number 17Slide Number 18Avian influenza situation in ChinaIndonesia Case StudyAfter FOUR decades, the Naval Area Medical Research Unit-2 (Namru-2) is kicked-out of IndonesiaAnd all because of one woman?Issues Raised in IndonesiaSlide Number 24Cambodia Case StudyLucky guy, thanks to Namru-2...H5N1 Animal Outbreaks 04-08 H5N1 Human Victims 05-08Issues Raised in CambodiaGoal: reduce pandemic potential that could strike donor countries themselves Slide Number 31Slide Number 32Slide Number 33Slide Number 34Slide Number 35Slide Number 36Slide Number 37Slide Number 38Slide Number 39But lets end where we started, with Indonesia and CambodiaDateline: 11 April 2010Scientists Technology should be on tap, but not on top. Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.The end or the beginning?25 June 2010: Director of Namru-2 Phnom Penh steps downFormer Namru-2 Jakarta Commanding Officer to head Namru-2 Phnom PenhLessons learned from Indonesia should be applied to CambodiaSlide Number 44