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Headache for US as side-effect of foreign policy hits medical research lab in Jakarta
Shawn Donnan and Amy Kazmin

          WHEN US health secretary Michael Leavitt visited Jakarta last month on a tour of the bird flu front lines, he found time to pop into a tired-looking building facing one of the Indonesian capital's most notorious prisons.
The visit to a laboratory inside that Indonesian health ministry building was, on the face of it, an innocuous gesture. But the tour was designed to send a clear diplomatic message.
Mr Leavitt was visiting a publicity-shy US military-run research facility that for years has been embroiled in a diplomatic dispute between Washington and Jakarta. And the signal he was sending -- and would repeat in a meeting with Indonesia's president, Susilo Bambang Yudhoyono -- was that Washington was fed up.
For more than 30 years the US Naval Medical Research Unit Number 2, or NAMRU-2, has researched emerging tropical diseases in Indonesia and, via satellite offices in Cambodia and Vietnam, elsewhere in south-east Asia.
For the past six, though, its future has been in doubt as Indonesia's military has sought to have it shut in retaliation for Washington's 1999 suspension of military-to-military relations following the debacle in East Timor. This year Indonesian officials sent a letter to the lab asking it to cease operating when the bilateral agreement governing it expires on December 31.
But as Mr Leavitt's visit signalled, NAMRU-2's fate has added significance these days. In recent years it has been intimately involved in the fight against the virulent H5N1 bird flu in south-east Asia, where it has killed more than 60 people. In countries such as Indonesia it is among the first to conduct tests on suspected human H5N1 cases, giving the US what could be a front row seat at the unfolding of a possible pandemic.
Most of a $7.1bn (euro5.9bn; 4.0bn) Bush administration pandemic preparedness plan unveiled recently is focused on the domestic front and the stockpiling of antiviral drugs and vaccines. Also included, however, is $251m to help other countries improve their capacity to detect bird flu outbreaks.
"Early detection is our first line of defence," President George W. Bush said in his recent speech.
Labs such as NAMRU-2 will play a key role in that early detection, experts say, and their presence in southeast Asia gives the US an unparalleled disease surveillance network.
During Mr Leavitt's visit officials in Jakarta were told NAMRU-2 and a similar facility in Bangkok would receive an additional $10m in funding between them, a considerable sum when NAMRU-2's current annual budget is just $8.0m.
But as Washington turns to those labs it is also facing what some see as the post-Iraq-war limits of its influence.
Western health experts and local officials say the Indonesian military have long seen NAMRU-2's researchers as spies. But at a time when many in the world's largest Muslim nation express anger about US policy in Iraq and beyond, diplomats and health officials say there is, rightly or wrongly, an added element of suspicion of NAMRU-2's military status among Indonesian officials.
Its own website, they point out, lists NAMRU-2's primary mission as to "enhance the health, safety and readiness of [US] Navy and Marine Corps personnel" so they can conduct "missions in south-east Asia".
That mission is often overtaken by work with very real civilian applications.
NAMRU-2 and the Armed Forces Research Institute of Medical Sciences (AFRIMS) in Bangkok each year send data back to the US identifying emerging influenza strains, and so help determine the composition of flu shots.
Colonel Bonnie Smoak, AFRIMS' American commander, said the lab's flu surveillance has always been done with a flu pandemic partly in mind. "Among scientists, the threat of the epidemic has always been there," she says. "Even before avian influenza, there were little voices yelling in the woods, 'It's coming'."
AFRIMS is expanding its H5NI-related work, Col Smoak says. It wants to extend its surveillance to US diplomats to monitor strains circulating in a highly mobile expatriate population. It also wants to conduct house-to-house studies in Thailand modelled on those it has done for dengue fever.
Similar work is under way at NAMRU-2, albeit more quietly. Researchers there test specimens from 500 Indonesian patients a month, people familiar with the situation say. Because of that and because the World Health Organisation does not have its own dedicated lab in the country
NAMRU-2 amounts to what is now the only "active" surveillance system searching out H5N1 cases in Indonesia, health experts say.
Officials insist that, faced with a possible pandemic, the diplomatic tension is easing. Following Mr Leavitt's visit, President Yudhoyono ordered his health ministry to work more closely with the lab. Its charter is likely to be extended, aides say.
"We want to keep our working relationship with NAMRU[-2] and strengthen it because it is in the interest of both [the US and Indonesia] to fight this pandemic threat," says Dino Djalal, a presidential spokesman.
Officials in Jakarta also admit, however, that presidential orders do not always filter through Indonesia's bloated civil service, something that could undermine Washington's best efforts to prepare for a pandemic. "You can give NAMRU $50m and, if they don't have any Indonesian partners to work with, it really won't get anybody anywhere," says a western health expert.
Under syndication arrangement with FE


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