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 School
8 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 am
Concerns over disease raised in Pakistan
flood aftermath
Before After
August 24, 2010: Disease Outbreaks Threaten Pakistan Flood Victims
Diarrhea 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 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equipment is outdated or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: 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.
TimelineContext
Human 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=X6vFaMy0w0
0
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
2008
2007
2006
2005
2004
2007
2006
2005
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.