The Political Economy of Emerging Infectious Diseases: Indonesia and Cambodia

Sophal Ear, Ph.D. Assistant Professor

U.S. Naval Postgraduate School 18 March 2012

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.

Contents

1. Questions & Problems

2. Timeline – Context

3. Indonesia Case Study

4. Cambodia Case Study

5. Conclusion

Questions

• What infrastructure is necessary to enable EID surveillance in developing countries?

• What cultural, political, and economic challenges stand in the way of setting up such infrastructure?

• Are there general principles that might guide engagement with developing countries and support EID surveillance infrastructure?

Myriad Problems

• Poor to non-existent surveillance

• Poor diagnostic laboratory capacity

• Disincentives to report

• Viral sovereignty (Indonesia)

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 the benefits (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… staff in over 90% … not familiar with quality assurance principles … more than 60% of laboratory equipment is outdated or not functioning…”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 report

2010

“[F]rom my own experiences in countries (… Central Asia, Southeast Asia, India, Sub-Saharan Africa) I believe the status has not changed much from the date of the … [2001 GAO] report.”

- Director of Laboratory Systems Development at a major American university

Timeline—Context Human Pandemic Flu Timeline

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

Downside of Globalization: Global Reach of Diseases

H5N1: Highly Pathogenic Avian Influenza

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 Minister?

Maybe not.

Issues Raised in Indonesia

0%

10%

20%

30%

40%

50%

60%

Haggling over viruses: the downside risks of securitizing infectious disease

“In the case of H5N1, the securitized international response has also had a range of less salient effects in terms of entangling the long-standing virus-sharing mechanism in a wider set of non-technical and non-medical disputes in international politics. Indeed, the securitized response to H5N1 ended up inadvertently provoking an intense re-politicization of international virus sharing where the latter is no longer seen to be of mutual benefit, but as a bargaining chip used by countries like Indonesia to fundamentally reform the virus-sharing mechanism.” –Stefan Elbe (2010:484)

Cambodia Case Study

Lucky guy, thanks to Namru-2...

H5N1 Animal Outbreaks 2004-2008

2008

2007

2006

2005

2004

2007

2006

2005

2008

H5N1 Human Victims 2005-2008

Issues Raised in Cambodia

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Low StaffCompensation

Donor DependencePathologies

Poor staffmanagement/HR

Patronage networksdetrimental to work

environments

No compensation forculling

Differing host anddonor priorities

Goal: reduce pandemic potential that could strike donor countries themselves

Let’s 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; 7 out of 17 cases of H5N1 discovered in 2011 (no survivors). Former Namru-2 Jakarta Commanding Officer was to head Namru-2 Phnom Penh (but did not end up there) Have lessons been learned?

Thank you.

Sophal Ear, PhD sear@nps.edu